A case report of acne vulgaris treated with homoeopathy

Dr Charu Popli
Dr Kushagra Krishan

ABSTRACT
Acne is a worldwide inflammatory skin disorder affecting the pilosebaceous follicles that is persistent and chronic. Over 85% of teenagers suffer from acne, and the condition can last until adulthood. The distinct lesions can be classified as either inflammatory (papules, pustules, nodules, and cysts) or non-inflammatory (open/black and closed/white comedones), which can result in scar formation and skin pigmentation and require long-term, consistent treatment. Lesions are usually found on the chest, upper back, neck, and face. ^[1]

The case study is of 20 years female diagnosed with acne vulgaris was successfully treated with homoeopathic medicine.

INTRODUCTION
A common skin ailment called acne is caused by clogged hair follicles beneath the skin’s surface. Lesions, commonly referred to as pimples or zits, appear when dead skin cells and sebum—an oil that helps prevent skin from drying out—clog pores. The breakouts mostly affect the face, although they can also arise on the shoulders, back, and chest.^[2]

Acne affects people of all races and ages, but it is most prevalent in teenagers and young adults. Males are more likely to get acne during teenage years. When acne does persist into adulthood, it mostly affects women. ^[2]

Acne can be brought on by, made worse by, or exacerbated by a number of factors, including genetics, the environment (temperature, pollution, humidity, sun exposure, mineral oils/halogenated hydrocarbons), nutrition, hormonal status, stress, smoking, and comedogenic medications such androgens, halogens, corticosteroids, bacteria, and cosmetics. ^[1]

The pathogenesis of acne is multifactorial due to the previously mentioned exposome factors. The four main causes of acne are excessive sebum production, hyperproliferation of the bacteria known as cutibacterium acnes (formerly known as propionibacterium acnes), abnormal hyperkeratinization of the pilosebaceous follicles, and inflammatory mechanisms. ^[1]

There are various varieties of acne that can be identified, such as acne conglobate, acne rosacea, acne fulminans, acne cosmetica, acne excoriee (also known as picker’s acne), acne medicamentosa, acne chloracne, and acne mechanica. However, out of all acne cases, acne vulgaris accounts for 99 percent of cases. It is the most common type of acne. It is distinguished by two kinds of lesions: inflammatory papules, pustules, nodules, and cysts; and non-inflammatory, open and closed comedones. There are two different kinds of comedones: an open comedo is called a blackhead type, and a closed comedo is called a whitehead. ^[1]

CASE REPORT-

Name- Ms. XYZ	Marital status-Unmarried
Age- 20 years	Occupation-  Student
Sex- Female	Socioeconomic status- Middle class
Date of Registration- 13/8/2023	Religion– Hinduism

Presenting Complaint:
Reddish, fluid-filled eruptions on face since 3-4 months

History of Presenting Complaint:
Patient was apparently well 2-3 months back when the eruptions started appearing on face. It started as a small fluid-filled eruption(pustule) which increased in size and started discharging fluid.

Character of eruptions- Reddish, fluid-filled eruptions with pain when the eruption discharges

• Aggravation-On scratching the eruptions breaks open causing pain with the discharge
• Amelioration-N/S
• Onset-Insidious
• Took allopathic treatment for the same

Past History: She suffered from typhoid when she was 12 years old and chicken pox when she was 8 years old, for both she took allopathic medicines.

Personal History:

• Diet-Non-vegetarian
• Development landmark -On time
• Habit and addiction – Nothing significant
• Allergy –No

Family History:

Maternal History- Mother- 52 years of age, healthy and alive

Paternal History-Father- 57 years of age, healthy and alive

Sibling– Eldest brother -26 years of age, elder brother- 24 years of age, both are healthy and alive

Menstrual History:

• Menarche: when she was in 6^th standard (around 11 years of age)
• Cycle: 28+ 4 days
• Flow lasts: 5 days
• Character of flow: no clots, average flow, 2-3 pads/day (for initial 2 days), with pain in lower back and lower abdomen before menses.

Physical Generals:

• Appetite-Adequate (3meals/day- 2 chapatti/meal)
• Thirst-Adequate (3-4 l/day)
• Desire-Spicy
• Aversion- Sweets
• Intolerance-N/S
• Urine- D_5-6 N₁, N/S
• Stool-D₁ N₀
• Taste- N/S
• Tongue- Clean and moist
• Sleep-Refreshing
• Dream- N/S
• Perspiration-Generalised
• Skin-Oily
• Thermals- Hot

Mental Generals:

• If they refuse to fulfill her demands – she stops taking to everyone and sits alone (obstinate)
• Due to acne she is hesitant to go out (if someone will see they will pass comments)
• When contradicted-she gets very angry and shouts

On observation-

She seemed to hide something when questioned about her relationship (otherwise she was answering about her bonds openly) (she visited for treatment alone)

Physical Examination:

Complexion- Light- complexioned	Temperature- Afebrile
Built- Ectomorphic	Tongue– Clean, moist
Weight- 50 kg	Oedema- Absent
Height- 5’4	Pallor– Present (2+)
Pulse- 70 bpm	Cyanosis– Absent
Blood Pressure- 118/74 mm of Hg	Clubbing– Absent
Respiratory rate- 15/minute	Lymph nodes– Not palpable

Clinical Diagnosis:

Acne vulgaris- Pilosebaceous unit inflammation that is persistent. It is very prevalent, usually begins during puberty, and is estimated to impact more than 90% of adolescents. Most prevalent between 12 and 20 years old. Acne can have a detrimental impact on one’s self-esteem at any age. ^[3]

Differential Diagnosis: ^[3]

Acne rosacea-

The central face is affected by a chronic inflammatory illness that manifests as flushing, erythema, papules, pustules, and telangiectasiae. Usually affects middle-aged, fair-skinned women; heat, sunlight, and alcohol can make it worse.

Acne conglobata- Markedly scarred, and characterised by comedons, nodules, abscesses, sinuses, and cysts. It is uncommon, often affects adult males, and is most frequently found on the upper limbs and trunk.

Totality of symptoms:

1.Water filled eruptions on face with pain on discharge from eruption

2. Obstinate
3. Angry on contradiction

4.Hesitant to go out in public

5. Secretive

6.Desire-spices (namkeen)

7. Aversion- sweets

Analysis Of Symptoms:

COMMON	UNCOMMON
Water filled eruptions on face with pain on discharge from erruption	Obstinate
Anger on contradiction	Secretive
Hesitant to go out in public	Desire-Spicy
	Aversion- sweets

Evaluation Of Symptoms:

Symptoms of patient	Intensity	Miasm[4]
1.       Obstinate	+3	Psora
2.       Secretive	+3	Sycosis
3.       Desire- spicy	+2	Psora
4.       Aversion- sweets	+2	Psora

Repertorial Totality ^[5]

1. MIND- OBSTINATE
2. MIND- SECRETIVE
3. GENERALS- FOOD and DRINKS- spices- desire
4. GENERALS- FOOD and DRINKS- sweets-aversion

Repertorial Chart

Repertorization was done using synthesis repertory

Therapeutic intervention: After analysing the reportorial totality, it was observed that Lycopodium clavatum covered maximun  rubrics with the maximum score. Lycopodium clavatum seems to be the nearest similimum of the case, after consulting material medica. It was prescribed in 200C potency, one dose of four globules of size 30 to be taken one day on the baseline visit i.e.13/08/2023 followed by Sac lac 30/TDS/ 1 week.

FOLLOW-UP OF THE CASE
On 20/08/23 the acnes were reduced. The patient was feeling little confident and was calm. Hence Sac lac 3 / TDS/ 1 week was continued.

 RESULT

There was reduction in acne with homoeopathic treatment.

• BEFORE TREATMENT- BASELINE- 13/08/2023
• AFTER TREATMENT- FOLLOW UP- 20/08/2023

DISCUSSION AND CONCLUSION:
In this instance, acne vulgaris and mental health have both improved through a holistic homoeopathic approach. The effectiveness of homoeopathic treatment for acne vulgaris is supported by this case report. It offers an additional evidence of Lycopodium clavatum’s effectiveness in cases of acne vulgaris.

REFERENCES

1. Vasam M, Korutla S, Bohara RA. Acne vulgaris: A review of the pathophysiology, treatment, and recent nanotechnology based advances. Biochem Biophys Rep. 2023 Nov 23;36:101578. doi: 10.1016/j.bbrep.2023.101578. PMID: 38076662; PMCID: PMC10709101.
2. Acne [Internet]. National Institute of Arthritis and Musculoskeletal and Skin Diseases [cited 2024 Feb 3]. Available from : https://www.niams.nih.gov/health-topics/acne
3. Ganong Stanley, Davidson‟s Principle & Practice of Medicine, 21^st
4. Speight P. A Comparisons of the Chronic Miasms : (psora. Pseudo-psora. Syphilis, Sycosis).
5. Schroyens F. Synthesis Repertory: Version 8.1: B. Jain Publishers (P) Limited

Charu Popli
PG Scholar, Bakson Homoeopathic Medical College and Hospital, Greater Noida, UP

Kushagra Krishan
PG Scholar, Bakson Homoeopathic Medical College and Hospital, Greater Noida, UP