Homoeopathic Management in Atopic Dermatitis – A Case Report

Dr Joanna Irwin, Dr Muddassir Mulla

Abstract
Atopic Dermatitis is an immune mediated inflammation of the skin that is chronic and characterized by itching, redness, dryness and recurrent eczema like lesions. It is commonly associated with other atopic conditions such as Asthma and Allergic Rhinitis. A 5 year old male presented with dryness of skin, cracks and generalized eruptions since 2 years. A detailed case taking was done and after analysis Graphites was prescribed.

Keywords: Atopic Dermatitis, Graphites, Homeopathy, Dermatological disorders

Introduction
Atopic dermatitis  is a chronic, inflammatory skin disease characterized by pruritus and a chronic course of exacerbations and remissions. It is ssociated with other atopic conditions, including food allergies, asthma, allergic rhinoconjunctivitis, eosinophilic esophagitis, and eosinophilic gastroenteritis.¹

Atopic dermatitis has the highest disease burden based on disability-adjusted life-years among dermatological disorders and ranks 15th among all non-fatal diseases. In India, the prevalence of Atopic dermatitis has been reported to be increasing owing to changes in environmental factors. Prevalence ranged from 3.1% to 7.21% among the paediatric population, as determined by studies conducted on children aged 0 to 16 years old using surveys or hospital-based data collection.^2,3

Atopic dermatitis has substantial impact on quality of life due to the chronic nature of the condition. Atopic dermatitis patients have also been observed to suffer from mood disorders like anxiety and depression.¹

Homoeopathy offers the possibility of a significant cure by stimulating the body to heal itself and thus curing the symptoms of the patient holistically, as it is a system that looks at the individual and not the disease.⁴

Case report

• Name- Master A
• Age- 5 years
• Sex- Male
• Occupation- Student
• Date-2/11/2024
• Informant- Mother

Presenting complaint
c/o dryness of skin, cracks and generalized reddish eruptions since 2 years increased since 1 week.

History of presenting complaint
The patient presented with skin, cracks and generalized reddish eruptions since 2 years. The eruptions were predominantly in periorificial, eyelids and flexor surfaces of  both upper and lower extremities. Since 1 week there was a sudden aggravation with new reddish eruptions overback, chest and abdomen. His complaints aggravate during winter, upon exposure to cold air, warm bath and with increased perspiration. He has severe itching that causes burning and bleeding upon scratching  followed by pain. The complaints are temporarily better by cold water application. The skin is very dry with cracks that bleed occasionally upon scratching. The patient has used allopathic medications as well as topical applications for the same.

Past history

• Nothing significant
• No allergic history
• Family history
• All are apparently healthy

Birth and Developemental history
Normal full term hospital delivery, Birth weight- 2.8kg. Mother and baby were healthy following birth and breast feeding was inniated immediately following birth and continued upto 1 year. Complementary feeding was initiated at 7 months. All milestones were attained on time.

Personal history

• Diet- mixed
• Appetite- good but unable to eat due to cracks around mouth
• Thirst- thirstless
• Desire- spicy fried food 2+
• Aversion- nothing specific
• Bladder habits- regular, no associated complaints
• Bowel habits- once per day, no difficulties, occasionally hard stools
• Perspiration- profuse, generalized
• Sleep- disturbed due to itching
• Dreams- unremembered
• Habits- nil
• Thermals- chilly patient

General physical examination & vitals

• Well built and nourished
• No oedema, cyanosis, pallor, clubbing, icterus or lymphadenopathy
• Temp- afebrile at the time of examination
• Pulse- 84 beats/min

Systemic examination

• Respiratory system -B/L normal vesicular breathing sounds-heard, No added sounds
• Cardiac system-S1& S2 heard, no murmur heard
• Gastrointestinal system
• Inspection: no scar, no lump, no visible pulsation
• Palpation: no tenderness
• Percussion: tympanic note heard
• Auscultation: 6 to 7 bowel sounds heard per minute

Local examination

• Inspection- Reddish macular eruptions, cracks and dryness of skin
• Excoriations. No bleeding, varices
• Palpation- tenderness over cracks
• No oedema, local rise of temperature

Diagnostic criteria
Hanifin and Rajka Criteria⁵– fulfils the diagnostic criteria

Provisional diagnosis
Atopic dermatitis

Classification of disease: Chrnoic miasmatic disease-Psorosyphilitic

Totality of Symptoms

• Reddish eruptions ²⁺
• < winter, cold air exposure
• < warm water bath
• Itching > cold water application
• Bleeding upon scratching
• Itching < scratching causes burning

Prescription
Sulphur 0/1 water dose TID for 1 week

Basis of prescription
Based on the analysis of the case and the need for a quick prescription to be made due the severity of the complaints the most suitable remedy was found to be Sulphur which would even overcome the bad affects of topical applications priorly used. 0/1 potency was selected due to gentle action that can be repeated frequently without any fear of aggravation.

Date	Symptoms	Prescription
5/11/24	c/o Itching slightly better for 1st 2 days after medicine c/o Eruptions over back and chest – started to dry c/o Dryness of skin increased c/o excoriations around face especially periorificial region – oozing with sticky discharge that bleed upon scratching < scratching- burning followed by pain Sleep- disturbed Other generals good	1.    Graphites 1 M water dose every 2 hourly 2.    Rubrum 4-4-4 for 5 days Basis of Prescription- Complementary to Sulphur and immediate relief was needed due the severity of the complaints. It also covered the current presentation of oozing and bleeding cracks.
15/11/24	No new eruptions Old eruptions that existed 2 years back appeared over Bilateral forearms with mild itching. c/o eruptions over back, chest, flexor aspects and periorificial and face subsided. c/o itching – mild No bleeding, no oozing, no pain or burning Sleep improved Other generals – good	Rubrum TID- 15 days
30/11/24	No new eruptions c/o old eruptions over forearm subsided Other eruptions subsided c/o itching mild occassionally No burning, bleeding or discharge Generals- good	Rubrum TID- 15 days

Discussion
This case report upholds the efficacy of Individualized homoeopathic remedy in managing the intensity and recurrence of symptoms of Atopic dermatitis. In this case the recurrence of Atopic dermatitis after treatment with allopathic medication was completely treated following administration of Individualized homoeopathic remedy. The following case adds to the fact that Homoeopathy has not only contributed as a palliative action in many of the progressive disorders but also has played a vital role as a curative mode of treatment in majority of cases. Also, in the following case the improvement of complaints was assessed with the help of clinical symptoms and findings.

Conclusion
Homoeopathy is a holistic approach which treats the person as a whole. Atopic dermatitis has been one of the most common skin condition affecting majority of people. Allopathic management of Atopic dermatitis includes topical application of corticosteroid creams which do not cure but suppress the eruption with it recurring again. This case is evidence for homoeopathy having greater scope in such cases of Atopic dermatitis since the basis of prescription here has been upholding the importance of holistic and individualistic approach; further verification of the fact with larger sample size has been suggested to evaluate the effectiveness of homoeopathic treatment in Atopic dermatits. Complete symptomatic and pathological relief can be seen within weeks of prescription invalidating the myth of homeopathy being slow in its action. Homeopathy can stop further recurrence in the condition and give relief to the patient.

Consent – Obtained

Conflict of interest-Nil

References

1. James WD, Elston DM, Treat J, Rosenbach MA, Neuhaus I, Andrews GC. Andrews’ diseases of the skin: clinical dermatology. Edinburgh: Elsevier; 2020.
2. De A, Sonali Karekar, Adhav C. Current Burden of Atopic Dermatitis in India: A Systematic Literature Review. PubMed [Internet]. 2023 Oct 12;68(4):487–7.
3. Kumar S, Nayak C, Padhi T, Rao G, Rao A, Sharma V et al. Epidemiological pattern of psoriasis, vitiligo and atopic dermatitis in India: Hospital-based point prevalence. Indian Dermatology Online Journal. 2014;5(5):6.
4. Hahnemann S. Organon of medicine. 6th ed. New Delhi: Mayur Jain Indian books and periodicals publishers; 2010. p183-184.
5. Akan A, Dibek-Mısırlıoğlu E, Civelek E, Vezir E, Kocabaş CN. Diagnosis of atopic dermatitis in children: comparison of the Hanifin-Rajka and the United Kingdom Working Party criteria. Allergologia et Immunopathologia. 2020 Mar 1;48(2):175-81.

Dr Joanna Irwin
MD (Hom) Scholar
Under the guidance of Dr Muddassir Mulla (HOD)
Department of Pediatrics, Government Homeopathic Medical College and Hospital, Bangalore

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