The homoeopathic medicine sulphur as an anti-fungal in the treatment of tinea corporis

January 23, 2025 admin Homeopathic Materia Medica 0

Dr Geoffrey Bhakupar Marbaniang

ABSTRACT:
To display the effectiveness of Homoeopathic medicine Sulphur in the treatment of fungal infection viz. Tinea corporis. Hence, in this article, we can find the usage or applicability of Sulphur in the treatment of Tinea corporis.

KEYWORDS: Sulphur, Tinea corporis, Anti-fungal, Keratinophilic, Dermatophytes.

INTRODUCTION:
Dermatophytosis have been defined as keratinophilic organisms that have the ability to invade hair, nails, and the skin of the living host. Those species that do not invade hair, nails or skin but belong to the already mentioned genera are technically not dermatophytes.[1]

The burden of skin disease is multidimensional that encompasses psychological, social and financial consequences of skin disease on the patients, their families and on society. In modern society more and more people are attacked by variety of diseases in which skin diseases share significant proportion. Cutaneous fungal infections have been reported worldwide as being one of the most common human infectious diseases in clinical practice. In spite of therapeutic advances in the last decades, the prevalence of cutaneous mycoses is still increasing. The skin constitutes the main site of recognizable fungal infections in humans.[2]

According to World Health Organization, the prevalence rate of superficial mycotic infection worldwide has been found to be 20-25%. The prevalence of superficial fungal infections in children was found between 11.3% and 40.57% in different studies.[3], [4] Tinea corporis is one among them which is commonly seen in population.[5]

Its prevalence varies in different countries. It is more prevalent in tropical and subtropical countries like India, where the heat and humidity are high for most part of the year.[6]

Since these infections are often confined with other skin disorders, it is therefore necessary to make early laboratory diagnosis for better management of these conditions. Of all the diagnostic dermatological techniques, the KOH preparation is one of the most helpful in diagnosing the case.[7] Tinea infections are challenging to treat as they get resistant after a certain period of time for the available antifungal treatments. In such situation alternative therapies are found to be effective in controlling the fungal infections. Homoeopathy has always been an alternative therapy preferred by various dermatologists. [8]

According to other systems of medicine, Tinea corporis is a superficial fungal infection which is usually treated by external application which is merely suppressing the disease condition but the disease tends to recur often and becomes a chronic disease. But, in Homoeopathic system of medicine Tinea corporis is an external presentation of an internal disorder due to lowered vitality and immunity. It does not believe in treating any skin diseases by simply applying ointment or creams. As it is a system of medicine which works on inspiration of the humoral or the immune mechanism of the body from its latent or overt reaction, it is thereby the best form of medicine to treat skin diseases and is having a wider and better scope in giving a gentle and permanent result in Tinea corporis.

REVIEW OF LITERATURE:
Dermatology is a branch that deals with the skin & disease of the skin, fat, hair and nails. During the past few decades it has emerged into a speciality with sub-specialities such as dermatopathology, immunodermatology & paediatric dermatology. Skin is not only a barrier, it is also a vehicle for biologic and social communication with the external world. Skin is the vital organ in the body protecting against physical, chemical and immunological trauma. It allows perception of heat, cold, touch & pain. It also portrays expression of various emotions like fear, anger, laughter, anxiety, etc…

As the incidence of skin diseases remains high, the general practitioner must be able to diagnose and treat accordingly. Among the fungal, Tinea corporis infections in the skin presents as one of the commonest form. The dermatophytes itself may sometimes be the immune suppression which results from a serum factor found in widespread dermatophytosis. [9]

Dermatophytosis is a superficial fungal infection of keratinized tissue. the infection is commonly designated as tinea. The literal meaning of tinea is larva as Romans mistakenly thought the infection to be due to insects.

SPECIFIC REGIONAL INFECTIONS:
Traditionally dermatophyte infections of the skin have been considered on the basis of the site of involvement because these are often some features unique to each. These infections are also known as “tinea infections‟ and are named according to the location of the lesions on the body.[7]  The subtypes considered are –

  • Tinea capitis
  • Tinea faciei
  • Tinea barbae
  • Tinea corporis
  • Tinea cruris
  • Tinea pedis
  • Onychomycosis
  • Majocchi’s granuloma

TINEA CORPORIS:
It is defined as dermatophyte infection characterized by either inflammatory or non – inflammatory lesions on the glabrous skin with the exclusion of the scalp, palms, soles

& groin.[10] This infection of glabrous skin may be promoted by Trichophyton, Microsporum and Epidermophyton species. The fungus invades and proliferates in the stratum corneum and it includes lesions of the trunk and limbs excluding specialized sites such as the scalp, feet and groins. It affects the children more than the adult.[11]

AETIOLOGY AND PATHOGENESIS:
All species of dermatophytes belonging to the genera Trichophyton, microsporum and Epidermophyton can cause Tinea corporis. [12]

The three most common organisms are Trichophyton rubrum, Trichophyton mentagrophytes and Microsporum Canis. In India, Trichophyton rubrum accounts for the majority of cases of Tinea corporis.[12]

The organisms responsible for Tinea corporis invades the stratum corneum, possibly aided by warm moist and occlusive conditions, and resides in it. After about 1-3 weeks of incubation, it starts spreading centrifugally. The active advancing border has an increased epidermal turnover rate (presumably an attempt to shed the organisms by exceeding the fungal growth rate). This defense mechanism is successful to a certain extent as there is a relative clearing of infection in the center of annular or polycyclic lesions. A serum inhibitory factor may be responsible for limiting this infection. Temporary resistance to infection occurs in this area for a variable of time, however a second wave due to re-infection is commonly seen later. In addition to the involvement of stratum corneum, the hair follicles may also be affected.

EPIDEMIOLOGY:
The tinea infections are found to be prevalent commonly in tropics and in geographical areas where the higher humidity, overpopulation and poor hygienic living conditions are present. Hot and humid climate of India allows these dermatophytes to invade the superficial fungal infection of skin.[3]

According to the studies which was done by Sneha Gandhi, Suma Patil, the infections were commonly found in patients from a rural background (72%) and from a lower socioeconomic status. [3]

Malnutrition, immunosuppressive conditions, such as, diabetes mellitus, human immunodeficiency virus (HIV) infection, cancer chemotherapy are considered to be factors that influence the prevalence and severity of superficial dermatomycoses. The type and frequency of dermatomycoses may vary with time, due to changes in standards of living and attention to personal hygiene.[5]

PREDISPOSING FACTORS:

  • Factors as overcrowding, lack of personal hygiene and exposure to animals or cases play a role in the frequency of Dermatophytosis in different individuals.[9]
  • Tinea corporis may be transmitted directly from an infected human/animal via fomites or it may occur via auto-inoculation from reservoirs of dermatophyte colonization on the feet.
  • Children are more likely to contact zoophilic pathogens especially Microsporum Canis from dogs/cats.
  • Humid climate is associated with more frequent and severe eruptions.
  • Wearing of occlusive clothing, frequent skin to skin contacts and minor traumas such as mat burns competitive wrestling create an environment in which dermatophytes flourish. [10]
  • Transmission of infection by clothing, furniture or any other sites in the same patient
  • Excessive sweating
  • Participating in contact sports
  • Wearing tight clothing
  • Having a weak immune system
  • Sharing clothing, bedding or towels with others[13]

CLINICAL FEATURES:

  • Classical ringworm: Starts as an erythematous, itchy papules which progress to form a circinate lesion. It is studded at the periphery with papules or papulo- vesicles. The lesions are scaly showing clear or apparently normal looking centers. Such lesions are caused by T. rubrum and M. Canis.
  • Eczematous annular ringworm: It presents as circinate erythematous, scaly, mildly, infiltrated plaques. Central clearing however is lacking. Crusted type scutula and crusted masses develops on the glabrous skin
  • Herpetiform type: It is the inflammatory vesicular type of ringworm caused by zoophilic species. The primary lesion is a plaque of grouped vesicles which rupture to leave a red erosion. This is consequently covered by crust. New vesicles develop at the periphery. Hyphae are abundant in the vesicular fluid.
  • Plaque type: Chronic extension and lack of spontaneous clearing in the center lead to the formation of large erythematous scaly plaques. The enlarged eccentrically producing annular pattern. DM, Leukemia and topical application of corticosteroids predisposed to the formation of plaques. T rubrum is responsible for such lesions.
  • Tinea profunda: lt manifests as inflamed elevated, sharply circumscribed, boggy tumor with bright red granulating surface studded with pustules. It may undergo suppuration and become fluctuant. The lesions may undergo spontaneous healing with scarring. It is caused by zoophilic fungi. T. verrucosum and T. mentagrophytes often responsible for it.
  • Majocchi’s granuloma: It is granulomatous folliculitis associated with peri folliculitis. lt presents as plaque studded with nodules. The nodules are slightly raised and often less than 1cm in diameter. It is encountered in women who shave their legs. T. rubrum is its etiologic agent.[11]

DIAGNOSIS:
Though superficial fungal infections are usually diagnosed and treated clinically in routine practice, the identification of the fungal species is epidemiologically important since the source of infection can be traced and its transmission halted.[5]

Diagnosis usually is made clinically but can be confirmed by a potassium hydroxide preparation (KOH) performed on scale obtained from the border of lesion or culture.[2]

INVESTIGATIONS:
Since these infections are often confused with other skin disorders, it is therefore necessary to make early laboratory diagnosis for better management of these conditions.[7]

  • Potassium hydroxide preparation (KOH)
  • Culture test
  • Dermatophyte test medium[10]

DIFFERENTIAL DIAGNOSIS: [14]

  • Erythema annular centrifugum
  • Nummular eczema
  • Psoriasis
  • Tinea versicolor
  • Sub-acute cutaneous lupus erythematous
  • Cutaneous candidiasis
  • Contact dermatitis
  • Atopic dermatitis
  • Pityriasis rosea
  • Seborrheic dermatitis
  • Mycosis fungoides
  • Parapsoriasis, secondary syphilis.

COMPLICATIONS: [15]

  1. Dermatophytid reaction: Inflammatory tinea infection may be associated with appearance of vesicles on the palms and soles.
  2. Cicatricial alopecia: Though tinea generally does not cause Cicatrical alopecia, kerion and favus can cause permanent hair loss.
  • Eczematisation
  1. Lichenification

MANAGEMENT

General Management

  • All local causes are to be given careful consideration and removed, if possible, not forgetting the diet and general hygiene of the patient, as well as climate, vocation, habits or anything that might prone a hindrance to the restoration of the patient’s health.[16]
  • Educating the parents in detail about the personal hygiene, particularly the need to avoid overcrowding, washing clothes separately with hot water each day, avoiding dampness, and sharing of clothes and other fomites among children.[3]
  • Keep the affected area clean and dry.
  • To prevent passing on the infection, do not share towels or clothes
  • Wash towels, sheets and clothes frequently
  • Clean the shower or bath well after used
  • Try not to scratch the rash as this may spread the fungus to other areas of the body..[14]

HOMOEOPATHIC ASPECT:
Homoeopathy is a system of medicine which is based on the law of similars. In Homoeopathy we are not treating the disease, but the patient as a whole. One individual is different from other individual likewise in disease, symptoms presented by one patient differs from that of another patient.

No local treatment is to be thought of for any of the skin disease .The homoeopathic physician is supposed to know that the disease lies behind the tricophyton; that the bacilli of any disease is simply a physical microscopic expression of a subversive force ,in which the life force is predisposed weakness(due to psora) has allowed it to enter, not only the organism, but to influence the action of the life force itself, and having such a positive bond with the life force as to prevent it from throwing off the disease.[17]

Homoeopathic potentiation is a mathematico-mechanical process for the reduction, according to scale, of crude, inert or poisonous medical substances to a state of physical solubility, physiological assimilability and therapeutic activity and harmlessnesss, for use as homoeopathic healing remedies.

The primary objective of potentiation is to reduce all substances designed for therapeutic use to “a state of approximately perfect solution or complete ionization, which is accomplished only by infinite dilution.” (Arrhenius.) The greater the dilution, the higher the degree the degree of ionization until, at infinite dilution, ionization is complete and therapeutic activity conditionally greatest.

The facts go to show that the result of the process is not only a division of the matter into particles, but a series of differentiations and progressions by which successive reproduction or propagations of the medical properties of the drug take place. The powers and qualities of the are progressively transferred to the diluting medium. Recognizing this fact, Garth Wilkinson proposed to call them “transmissions.”

Finke explained the action and efficiency of infinitesimal doses by applying the “law of the least quantity,” discovered Maupertuis the great French mathematician and accepted in science as the fundamental principle of the universe. That principle is stated as follows: “the quantity of action necessary to effect any change in nature is the least possible.”

Consequently, the law of the least action must be acknowledged as the posological principal of homoeopathy.[18]

RUBRICS FOR TINEA INFECTION FROM REPERTORY

MURPHY’S REPERTORY

  • Skin ITCHING scratching, agg. –  ANAC. Arg met, ARS. CAPS. Caust. PULS. RHUS-T. Si1. Staph. SULPH.
  • Skin – ITCHING – night – ail. am-c. CARBN-S. Clem. gels. Graph. Led. stram. SULPH. thuj. URT-U.
  • Skin ERUPTIONS red- Agar.AM-C. apis. Ars. Calc. Cocc. Dulc. Graph. Kali-bi. KALI-C. MERC. PHOS. Stram. SUL- SULPH.
  • Skin – DRY, skin — rough – iod. Lith-c. merc. nat-c. [19]

SYNTHESIS REPERTORY

  • SKIN ERUPTIONS dry- Alum. anac. ARS. AUR. AURM. CALC. CALC-S. canth. Graph. Hep. Kali-c. Kreos. Merc. Natm. Petr. PHOS. Psor. rhus-t. SEP. SIL. Staph. Suph. thuj.
  • SKIN – ERUPTIONS – itching – night – ant-c. ant-t. Ars. ars-i. asc-t. Iris, MERC., puls. Rhus-t. staph.
  • SKIN – ERUPTIONS – scaly – white – anac. Ars. graph. KALI-CHL. kali-m. lyc. nat-ar. thuj. tub. zinc.
  • SKIN – ERUPTIONS – scratching, after – AM-C. Ars, bell., canth. Dulc. graph. Kreos. LYC. Merc. nat-c. Petr. phos. Puls. RHUS-T. sep. Sil. staph. SULPH.[20]

KENT’S REPERTORY

  • SKIN ITCHING – night -CARB -S, SULPH., URT-U, Graph, Sil
  • SKIN – ITCHING – burning – ARS, BRY, GRAPH, SULPH, Calc.ph, Bell
  • SKIN – ERUPTION -white – KALI – CHL, Ars, Graph
  • SKIN – ERUPTION – dry – PHOS, SEP, SIL.[21]

 DR S R PHATAK’S CONCISE REPERTORY

  • SKIN-ERUPTIONS – dry: Ars, Ars -iod,
  • SKIN-HERPETIC (RINGWORM): Acon, ARS Calc-s, Clem[22]

BOENNINGHAUSEN’S THERAPEUTIC POCKET BOOK

SKIN -ITCHING IN GENERAL – AGAR., Ant crud., Dulc., Graph., LYC.,MERC., NAT-M., PULS., RHUS., SIL., SULPH[23]

CLARKE’S CLINICAL REPERTORY 

RINGWORM – Ant. t.,  Ars., Bac., Bapt., Mez., Phyt., Pos., Sep., Sulph., Tell [24]

DETAILS OF HOMOEOPATHIC REMEDY SULPHUR
This is great Hahnemannian anti-psoric. Its action is centrifugal-from within outward-having an elective affinity for the skin, where it produces heat and burning, with itching; made worse by heat. Inertia and relaxation of fibre; hence feebleness of tone characterizes its symptoms. Ebullitions of heat, dislike of water, dry and hard hair and skin, red orifices, sinking feeling at stomach about 11 am, and cat-nap sleep; always indicate Sulphur homoeopathically. Standing is the worse position for Sulphur patients, it is always uncomfortable. Dirty, filthy people, prone to skin affections.  Aversion to being washed. When carefully-selected remedies fail to act, especially in acute diseases, it frequently arouses the reactionary powers of the organism. Complaints that relapse. General offensive character of discharge and exhalations. Very red lips and face, flushing easily. Often great use in beginning the treatment of chronic cases and in finishing acute ones.[25]

Its utility in treating Tinea:
Itching, burning; worse scratching and washing.[25] Itching, voluptuous; scratching >; “feels good to scratch”; scratching causes burning; < from heat of bed. Itching; voluptuous; violent, aggravation – at night; in bed; scratching and washing.[26]

 BIBLIOGRAPHY

  1. Ameet R. V, Siddappa K, Valia R. G. IADVL Textbook of dermatology. Third edition. Bhalani Publishing House Mumbai, India; 2012; 1:252
  2. Hanumanthappa H, Muddapur S, Sarojini K, Shilpashree P. Clinic mycological study of 150 cases of dermatophytosis in a tertiary care hospital in South India. Indian Journal of Dermatology. 2012; 57(4):322.
  3. Badad A, Gandhi S, Patil S. Clinicoepidemiological study of dermatophyte infections in pediatric age group at a tertiary hospital in Karnataka. Indian journal of Paediatric Dermatology. 2019-20(1):52.
  4. Bharathi G, Murthy D. S, Ramesh K. G, Sridevi K, Surekha A, Usha G. Superficial dermatomycoses: a prospective clinico- mycological study. Journal of Clinical and Scientific Research. 2015; 7-15.
  5. Ganesh K. P, Hema M. M, Lakshmanan A, Madhavan R, Mohan S. Epidemiological and clinical pattern of dermatomycoses in rural India. Indian Journal of Medical Microbiology. 2015; 33 (5):134.
  6. Bhatia V, Sharma P. Epidemiological studies on Dermatophytosis in human patients in Himachal Pradesh, India. Springer Plus. 2014; 3(1).
  7. Patil A, Uttamchandani P. Homoeopathy an Alternative Therapy for Dermatophyte Infections. International Journal of Health Sciences & Research (wwwijhsrorg). 2019; 9(1):316-320
  8. Weedon D. Skin Pathology. 2nd ed. London: Churchill Livingstone.2002;660.
  9. Fitzpatrick T, Goldsmith L, Wolff K. Fitzpatrick’s dermatology in general medicine. 8th ed. New York: McGraw-Hill. 2012; 2:2281-2282.
  10. Caputo R, Gelmetti C. Pediatric Dermatology and Dermatopathology. 1st CRC Press. 2002;95.
  11. S. IADVL Textbook of Dermatology. 4th ed. Bhalani Book Depot Publishers. 2016;473-474.
  12. URL: https://www.healthline.com/health/tinea–
  13. Krowchuk D, Mancini A. Pediatric Dermatology. Elk Grove Village: American Academy of Pediatrics; 2006;200.
  14. Douglas M. Skin diseases. Their description, etiology, diagnosis and treatment according to the law of the similar. New Delhi (India): B. Jain Publishers Pvt. ltd. 2000;189.
  15. Valia R.G. Textbook and Atlas of dermatology. Bhalani publishing House. 1994; 1.
  16. URLhttps://patient.info/infections/fungal–infections/ringworm–tinea–corporis
  17. Allen J.H. Disease and Therapeutics of the skin. New Delhi (India): B Jain Publishers PVT. LTD; 2019;182 – 185.
  18. S. The Genius of Homoeopathy lectures and essays on homoeopathic philosophy. New Delhi, Indian books and publishers. 2011;74-75, 130, 107-108.
  19. Murphy R. Homoeopathic. Medical Repertory. A modern Alphabetical and Practical Repertory, 3rd B. Jain Publishers (p) Ltd. 2009;1926, 1935, 1945-1946.
  20. Schroyens F. The Essential Synthesis. 2nd New Delhi; B. Jain Publishers Pvt. Ltd. 2012.
  21. J. T. Repertory of the Homoeopathic Materia Medica and a word index. 6thed. New Delhi: B. Jain Publishers (p) Ltd; 2002;1311, 1319, 1327.
  22. Phatak D. A concise Repertory of homoeopathic Medicines 3rd New Delhi; B. Jain Publishers Pvt. Ltd. 123-124.
  23. Allen T. Boenninghausen’s Therapeutic pocket Book. New Delhi; B. Jain Publishers Pvt. Ltd. 213, 218.
  24. Clark J.A. Clinical Repertory to the Dictionary of Materia Medica. New Delhi; B. Jain Publishers Pvt. Ltd. 2010;122-128.
  25. Boericke W. Pocket manual of homoeopathic material Medica and Repertory – 9th reprint edition, B. Jain publisher Pvt. Ltd, New Delhi. 1993.
  26. Allen H. C. Keynotes And Characteristics With Comparisons of some of the leading Remedies of the Materia Medica – 10th edition, Jain publisher Pvt. Ltd.

Dr. Geoffrey Bhakupar Marbaniang
PG Scholar, Department of Homoeopathic Materia Medica
Father Muller Homoeopathic Medical College Deralakatte, Mangalore – 575018
E-mail ID: geoffmarbaniang@gmail.com
Under the guidance of Dr. Arun Varghese
Assistant Professor, Department of Homoeopathic Materia Medica

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