A Case of Allergic Dermatitis treated with Silicea

Dr HARSHAVARTHINI M 

ABSTRACT: The patient presented with the complaints of itching with eruption since 6 years and increased since 1month and treated with SILICEA 0/3 weekly  one dose followed by improvement as a whole.

INTRODUCTION: Allergic diseases are the most common disease condition among Indians. Approximately 60 million Indians suffer from allergic diseases^. Homoeopathy has a great scope in treating such cases by selecting the suitable remedy on the basis of the symptom similarity. This is a case was effectively treated with Silicea.

KEY WORDS: Silicea, LM potency

PATIENT AS A WHOLE

• Name- Mr. XX
• Age/ Sex -8 / Male
• Religion – Christian
• Occupation- Student
• Address – Kandanvillai
• Date of case taking: 01/09/2018
• Op.no. – YYY

PRESENTING COMPLAINTS

LOCATION	SENSATION	MODALITY	ACCOMPAINMENTS
Extremities upper and lower extremities Since 6 years.	Itching Eruption blackish discolouration and watery discharge Dry skin	<Morning,  <night < intake of fish <scratching

HISTORY OF PRESENTING ILLNESS: 

Patient’s complaints started before 6 years.Itching and eruptions with

Blackish discolouration and watery discharge from eruptions. Initially complaint starts in the upper arm and later spreads to forearm and to lower extremities with itching and it is followed by the watery discharge from the eruption.Skin is very dry in nature.

HISTORY OF PREVIOUS ILLNESS WITH TREATMENT ADOPTED:

 Underwent allopath treatment for presenting complaints but no relief.

FAMILY HISTORY:

        Father: Alive and healthy        Mother: Alive and healthy

PERSONAL HISTORY:

Takes mixed diet.

GENERAL FEATURES:

Appetite: Reduced, Thirst –Normal, Sleep- Good Desire: Egg, sweets, fish

Aversion – Nil. Stool- Regular once daily, Urine- 4-5 times/day; Sweat- Increased on palms.

LIFE SPACE INVESIGATION:

Patient was born and brought up in Kandanvillai. He is the only child to his parent. He is normally delivered baby and full term baby. He is studying in 3^rd standard. He is very silent in nature fear of meeting new people and he is moderate in his studies. Feels worried about his condition. He is not willing to go to school because everyone is mocking at him due to his complaints. He used to cry because of his complaints. Initially the complaint started at age of 6 months. He developed eruptions in the left arm and later spread throughout the hand and he was taken for allopathic treatment it will subside and again it will appear. There is offensive discharge from the eruptions. During childhood there is repeated eruptions and he was taking many treatment for his complaints but no relief, there is recurrence of complaints. 

He is mild in nature, very shy type won’t mingle with other children’s. He used to always cling with his mother and father. He takes time to talk with others.

OBSTERTIC HISTORY:

He is first baby for his parents. He is full term and normal delivery.

MENTAL STATE OF MOTHER DURING PREGNANCY:

His mother is SUPPRESSED during pregnancy. She is suppressed because her husband is not taking care of her. Husband is not willing for the child, he asked to postpone   the pregnancy but she is wants to conceive, so father is not interested in her pregnancy he didn’t came to see her till 7^th month of pregnancy.  He is not staying with her he used to spend time with others but not with her. He won’t listen to her complaints and her wishes. He will go out for his work and won’t even call her. She won’t express her feelings to anyone. She will tell only to her mother and she will weep on thinking of that. She want care and love from her husband but he won’t even mind about her but his social relation is very nice with other people and neighborhood. He used to share his complaints with his colleagues and people who are living around his house. He will only give paisa to manage the home. When she asked about his character towards her he won’t mind it and asked her to leave. She loves to be alone and she will cry when no one is around her. Still now she is longing for love from her husband.

MENTAL GENERALS:.

• Shy
• Nervous and anxiety on meeting new people
• Weeps easily 
• Doesn’t want to meet new people

REACTION TO:

Desire – warm food

 Desire – Fanning, covering. 

PHYSICAL FINDINGS:

Anemia- Not anemic, Jaundice- not icteric, 

Clubbing – Nil, Cyanosis – Nil, Oedema – Nil, Lymphadenopathy – Nil

Conscious and oriented.

Pulse –82 beats/ min 

BP:  – 

Respiratory rate: 16/minute

Body weight: 25kgs

Height: 123 cm

SYSTEMIC EXAMINATION:

RESPIRATORY SYSTEM:

Inspection: Nose: No DNS, No Hypertrophied turbinate. No Polyp.

Palpation: No warmth, No tenderness.

Auscultation: Normal vesicular breathing heard all over the lung fields.

CARDIOVASCULAR SYSTEM:

First and second heart sounds are heard normally in all 4 auscultatory areas.

EXAMINATION OF SKIN:

• Dry skin
• Rough with eruptions
• Discharge from the eruptions
• Unhealthy
• Watery discharge from eruptions
• No redness
• No warmth
• Scar marks are seen
• No keloid formations
• No skin tag
• No ulcerated wounds.
• No bleeding

LAB INVESTIGATION:

                     NIL

ANALYSIS OF SYMPTOMS

COMMON SYMPTOM	UNCOMMON SYMPTOM
Itching with eruption <night <scratching < intake of fish	Shy Nervous and anxiety on meeting new people Weeps easily  Doesn’t want to meet new people Desire – warm food Desire – Fanning, covering. Sweat- Increased on palms. Eruption blackish discolouration and watery discharge Dryness of skin <Morning,

EVALUATION OF SYMPTOMS

Mental Generals:

• Shy
• Nervous and anxiety on meeting new people
• Weeps easily 
• Doesn’t want to meet new people

Physical generals:

• Desire – warm food
• Desire – Fanning, covering.
• Sweat- Increased on palms.

Particulars:

• Eruption with itching
• Eruptions with blackish discolouration
• Dryness of skin
• Watery discharge from eruptions
• <scratching
• <Morning.

TOTALITY OF SYMPTOMS:

• Shy
• Nervous and anxiety on meeting new people
• Weeps easily 
• Desire – warm food
• Desire – Fanning, covering.
• Sweat- Increased on palms.
• Eruption with itching
• Eruptions with blackish discolouration
• Dryness of skin
• Watery discharge from eruptions
• <scratching
• <Morning

MIASMATIC ANALYSIS¹

PSORA	SYCOSIS	SYPHILIS
Dry skin Scratching eruptions followed by dry skin. Itching in night and evening Watery discharge Unhealthy skin <scratching Desire warm food Weeps easily	Shy Blackish discolouration of skin Agg: night Anxiety on meeting new people Profuse sweat in palms	Agg: night

Miasm: Psora Sycotic

PROVISIONAL DIAGNOSIS:  

Allergic Dermatitis

MEDICINAL SELECTED: RHUSTOX

BASIS OF SELECTION^{1, 2}:

• • • Intense itching
    • Burning eczematous eruptions
    • Urticaria
    • Red, swollen
    • Eruptions with tendency to scale formation
    • Vesicles
    • Exanthema on face in general on chin, face, cheeks, mouth, nose, forehead causing much burning and itching²
    • Itching < after scratching
    • Rashes itches
    • Itching over hairy parts 
    • Burning itching 
    • Eruptions with burning, itching worse after scratching 

METHODS ADAPTED:

FIRST PRESCRIPTION:  01-09-2018

R_X

1. RHUSTOX  200 /1 DOSES ,(no 30  sized globule in 1 grain of sugar of milk – dry dose) (M X 1 DAY)
2. SACLAC /6 doses M X 6Days
3. B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS
4. B.DISK  ( 1 – 0 – 1 ) X 7 DAYS

BASIS OF SELECTION OF POTENCY:

Potency is selected according to the susceptibility of the patient.

CRITERIA	CRITERIAS	SUSCEPTIBILITY
AGE	7	HIGH
SEX	MALE	HIGH [ MALE]
SEVERITY OF DISEASE	MODERATE	MODERATE
MODERATE/DISTURBED SLEEP	MODERATE	MODERATE

FOLLOW UPS:

DATE	FOLLOW UP	MEDICINE PRESCRIBED
22/9/2018	Patient complaint increased after 3 days. Patient took allopathic ointment for presenting complaint. Itching increased before 3 days. M/G: Shy          Moderate in education.          Sweating over palm and foot. P/G:      App: Normal     Thirst: Increased      Sleep: Normal     Stool: Regular     Perspiration: Profuse on palm     Weight: 20kgs CVS: S1 S2 is heard and no added sound is heard. RS: Normal vesicular breath sound is heard.	RX SILICEA 0/3 1DOSE  poppy sized  globule in 1grain of sugar of milk – Dry dose  (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS BASIS OF SELECTION OF SILICEA: Every little injury suppurates Long lasting suppuration Dry fingers Eruptions itch only in day and night Better by warmth Nervous temperament Inclined to sweat Want of grit both physical and mental Silicea will mature the abscess and also reduce the suppurations Painful sensitive skin Itching over whole body < night Unhealthy skin, every injury tends to heal.
29/09/2018	Patient feels better. Itching is reduced, but persist Eruptions started coming out. Watery discharge from eruptions.   P/G:  App: Reduced Thirst: normal Urine: Normal Stool: Regular	RX SILICEA 0/3 1DOSE (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose)no.30 sized globule in 1gm of sugar of milk – Dry dose  (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS
06/10/2018	Eruption on extensor aspect of forearm and leg is feels better. Itching is reduced but persists. Discharge present but reduced P/G:  App: Reduced          Thirst: normal          Urine: Normal          Stool: Regular	RX SILICEA 0/3 1DOSE  (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose)  (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS
13/10/2018	Patient feels better. Itching is reduced Eruptions are reduced.  P/G:  App: Reduced          Thirst: normal          Urine: Normal          Stool: Regular	RX SILICEA 0/3 1DOSE  (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose) (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS
20/10/2018	Patient feels better Complaints are reduced but still persist. Itching is reduced, but still slightly persist Eruptions are reduced. P/G: App: Reduced Thirst: Normal Other: Good. CVS: S1S2 is heard. No added sound is heard. RS: Normal vesicular breath sound is heard.	RX SILICEA 0/3 1DOSE  (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose) (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS
27/10/2018	Patient feels better Complaints are reduced but still persist. Itching is reduced, but still slightly persist Eruptions are reduced.	RX SILICEA 0/3 1DOSE  (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose) (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS
03/11/2018	Patient feels better Itching is reduced, but occasionally present Eruptions are reduced Discharge is reduced Weakness of memory Difficulty in remembering subjects P/G:  App: Regular Thirst: Normal Stool: Regular	RX SILICEA 0/3 1DOSE  (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose) (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS
10/11/2018	Patient feels better Itching is reduced, but occasionally present Eruptions are reduced Discharge is reduced Weakness of memory Difficulty in remembering subjects P/G:  App: Regular Thirst: Normal Stool: Regular	RX SILICEA 0/3 1DOSE  (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose)  (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS
24.11.2018	Patient feels better Eruptions are reduced Itching is reduced but occasionally present  < playing in sand GENERALS: Good CVS: NAD RS: NAD	RX SILICEA 0/3 1DOSE  (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose) (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS
1.12.2018	Patient  feels better Itching is reduced but persist Eruptions are reduced Concentration in studies is increased – Said by the teacher  GENERALS: Good CVS: NAD RS: NAD	RX SILICEA 0/3 1DOSE  (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose) (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS
08.12.2018	Patient  feels better Itching is reduced but persist occasionally.  Eruptions are reduced Discharges are reduced GENERALS: Good CVS: NAD RS: NAD	RX SILICEA 0/3 1DOSE  (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose) (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS
15.12.2018	Patient  feels better Itching is reduced but persist occasionally.  Eruptions are reduced Discharges are reduced GENERALS: Good CVS: NAD RS: NAD PR: 87/min	RX SILICEA 0/6 1DOSE  (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose) (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS
22.12.2018	Patient feels better but itching after eating fish and chicken Eruption slightly started after eating chicken  No discharge from the eruptions. P/G: Good	RX SILICEA 0/6 1DOSE  (1 Poppy seed sized globule in 1 grain of sugar of milk – dry dose) (M) X 1 DAY SACLAC /6 doses M X 6Days B.PILLS  ( 3 – 0 – 3 ) X 7 DAYS B.DISK  ( 1 – 0 – 1 ) X 7 DAYS

PHILOSOPHY OF PRESCRIPTION:

DISCUSSION:

POTENCY:

According to the susceptibility of the patient during the current state of disease and to avoid the chances of medicinal aggravation.

SELECTION OF POTENCY

Aphorism 270: During the treatment of chronic diseases, it is best to begin with the lowest degrees of dynamization and when necessary advance to higher, ever more powerful but mildly acting degrees.

So in the treatment of both acute and chronic disease we have to start from lowest degrees of dynamisation, i.e., from LM/1 or LM/2 or LM/3. After finishing that prescribed potency then to be applied next higher degree. 

In any case treatment is to be started from the lowest degrees of dynamization, i.e., with any potency from LM/1 to LM/6. 

In any case, acute or chronic, we generally start the treatment with one of the potencies from LM/1 to LM/6 as per susceptibility of the patient. Then we continue from the next higher potency of the ap

plied medicine gradually (i.e., LM/1, M/2, LM/3, LM/4, LM/5, LM/6, LM/7 and so on). We select one of the lowest possible potencies (i.e. LM/1 or LM/2 or LM/3, etc.) of a judiciously selected medicine in case of the second prescription also.

The 0/3 or 0/6 is a good one to start with. 

THE ACTION OF LM POTENCIES: 

Disease, especially chronic, does not aggravate suddenly but aggravated gradually and slowly. It is to be increased by degrees. Moreover, cures also come gradually and slowly. The action of LM potency is suited for the situation, uses a series of slowly increasing potencies, each dose slightly more potent than the last. The LM potency tends to aggravate at the end of treatment when the pathology is mostly healed.

Aphorism 92 – ACUTE DISEASES FROM OTHER SCHOOL OF MEDICINE 

§ 92

But if it be a disease of a rapid course, and if its serious character admit of no delay, the physician must content himself with observing the morbid condition, altered though it may be by medicines, if he cannot ascertain what symptoms were present before the employment of the medicines, – in order that he may at least form a just apprehension of the complete picture of the disease in its actual condition, that is to say, of the conjoint malady formed by the medicinal and original diseases, which from the use of inappropriate drugs is generally more serious and dangerous than was the original disease, and hence demands prompt and efficient aid; and by thus tracing out the complete picture of the disease he will be enabled to combat it with a suitable homoeopathic remedy, so that the patient shall not fall a sacrifice to the injurious drugs he was swallowed.

MANAGEMENT IN SKIN CASES:

So also the physician should not at once discontinue the woolen underclothing, which is said to prevent the taking of cold and the recommendation of which is carried very far by the ordinary physicians in default of any real assistance.

Though they are a burden to the patient, we should wait until there is a visible improvement effected by the antipsorics which remove the tendency to taking cold, and until the warmer season comes. With patients who are very weakly, he should in the beginning change to cotton shirts which rub and heat the skin less, before requiring patients to put linen underclothing on their skin.

For many easily perceived reasons, but especially in order that his delicate doses of medicine may not be interfered with in their action, the homoeopathic physician can not in  his antipsoric treatment allow the intermediate use of any

hitherto customary domestic remedy, no perfumery of any kind, no fragrant extracts, no smelling-salts, no Baldwin tea, or any other herb teas, no peppermint confection, no spiced confections or anise-sugar or stomach drops, or liqueurs, no Iceland-moss, or spiced chocolate, no spice-drops, toothtinctures or tooth-powders of the ordinary kinds, nor any of the other articles of luxury.

So-called warm and hot baths for the sake of cleanliness, to which spoiled patients are usually very much attached, are not to be allowed, as they never fail to disturb the health; nor are they needed, as a quick washing of a part or of the whole of the body with lukewarm soap-water fully serves the purpose without doing any injury.PRESCRIBING IN PREGNANCY:

Hahnemann has lucidly explained this in THE CHRONIC DISEASES- their peculiar nature and homoeopathic cure” where he states that,Pregnancy in all its stages offers so little obstruction to an ANTI- PSORIC treatment that this treatment is often most necessary and useful in that condition. 

• He emphasises upon this fact in footnote of 280 aphorism of 6th edition of ORGANON OF MEDICINE as 
• But the case of mothers in their (first) pregnancy,by means of a mild antipsoric treatment,especially with sulphur dynamizations prepared according to the directions in this edition (270)is indispensable in order to destroy the psora – that producer of most chronic diseases which is given them hereditarily;destroy it both within themselves and in the foetus,thereby protecting posterity in advance. This is true of pregnant women thus treated,they have given birth to children usually more healthy and stronger,to the astonishment of everybody.

ACTION OF SILICEA:

• • A large proportion of earth’s crust is composed of Silicea.²
  • Silicea has a greater allergic actions it is a very good anti-inflammatory remedy³
  • Silicea will set up suppurative action, to the risk of patient’s life.²
  • Silicea both mature abscesses and reduces excessive suppurations.²
  • It will also resolve indurations left after suppurations²
  • The skin is unhealthy and every little injury suppurates²
  • Hands and feet are sweaty²
  • Sensitiveness is one of the keynote and an over susceptibility to nervous stimuli^2.

SKIN AND MIASM:

PSORA	SYCOTIC	SYPHILLITIC
Dryness  Itch and eczema eczema and eruptions Sensation of burning Scratching eruptions are followed by dry scales Psora, itching often occurs late in evening before midnight Skin appear dirty, dry and harsh becomes more dry with washing Unhealthy skin Psoric eruptions are not noticeable by their colour but roughness of skin Crusts, which are thin, light, fine and small are present in psora Scanty, sour smelling sweat, especially on forehead and sleep is psoric AGG: cold, in winter, and from undressing Amel: natural discharge	Itching but in genital, anus and nose with thickening of skin It is subject to warts, moles, skin tags, dermoid cyst. Hyper pigmentation. Keloids,corns with thickening of skin Small, reddish, flat vesicular eruptions, which are slow to heal and recur during the menstrual period are Sycotic Sycotic has a disturbed pigment metabolism producing both hyper and depigmentation, which occurs in patches or is diffused in different parts. Abnormal growths Sweat appears on the forehead during sleep. skin has oily appearance and perspiration is thick and copious Agg: consumption of meat, humid and rainy weather Amel: Dry weather	Syphilitic skin is not itchy but there can be sensations of rawness and soreness  Depigmentation Ulcers and abscesses Ulcerative and degenerative Threating appearance. In syphilis, there are copper coloured eruptions, which do not heal fast, but turn to ulceration. Crusts are always thick and heavy Syphilitic sweat is offensive and aggravates all complaints. Agg: night, warmth of bed, summer Amel: Abnormal discharge

CASE SUMMARY

  The patient named Mst.XX aged 8 years presented with the complaints of itching with eruption since 6 years and increased since 1month.Intially he was treated with Rhustox 200/ 1 Dose. There is improvement in his complaints, but later after 3 days itching is increased. Next week after retaking the case he was treated with SILICEA 0/3 weekly one Dose. There is improvement in his complaints itching with eruptions is reduced, discharges are reduced.Now, there is improvement as a whole.

CONCULSION: Thus from this case we learned about the Silicea’s action over skin and when to repeat the medicine and also we have learned about the importance of obstetric history and how we have to give importance to such symptoms. We also learned about the skin complaints of different miasms.

REFERENCES

1. Boericke William. Pocket manual of Homoeopathic material medica and Repertory. New Delhi : B. Jain Publishers (P) Ltd ;2015.p.514,515
2. Clarke J.H.A Dictionary of practical Materia medica.New Delhi : B. Jain Publishers (P) Ltd.p.458,460.
3. Phatak S.R Materia medica of Homoeopathic medicine,. New Delhi : B. Jain Publishers (P) Ltd.p.658,660.
4. The guiding symptoms of our Materia medica volume 4, New Delhi: B. Jain Publishers (P) Ltd; 2015.p.no 684-686.
5. Banerjea Kumar Subrata. Miasmatic Prescribing. Skin. New Delhi: B. Jain Publishers (P) Ltd; 2015.
6. Hahnemann Samuel. Organon of Medicine. Aphorism. 5^th& 6^th edition. New Delhi: B. Jain Publishers (P) Ltd; 2005. p.236.
7. Hahnemann Samuel. Organon of Medicine. Aphorism. 5^th& 6^th edition. New Delhi: B. Jain Publishers (P) Ltd; 2005. p.250.
8. Miasm and labour