Dr Suyash Dhadiwal
Abstract : Ringworm, or tinea, is the name given to inflammatory rashes caused by dermatophytes of the genera microsporum, epidermophyton and trichophyton. These fungi can infect skin, hair and nails. The important clinical patterns are: tinea capitis, tinea corporis, tinea pedis (athlete’s foot), tinea cruris, tinea unguium (Onychomycosis), and tinea barbae. This article provide information about Tinea corporis along with homoeopathic approach by various repertories with miasmatic background .
Key words : Tinea corporis, homoeopathy,dermatophyte , Rerpertory ,Homeopathic philosophy.
Introduction : Tinea corporis is a superficial dermatophyte infection characterized by either inflammatory or non inflammatory lesions on the glabrous skin (i.e., skin regions other than the scalp, groin, palms, and soles). [1]
EPIDEMIOLOGY: According to W.H.O. the prevalance rate of superficial mycotic infection worldwide has been found to be 20-25%.It is more prevalent in tropical and sub tropical countries like India where heat and humidity is high for most parts of the year [2]
The commonest anamorphic genera causing this disease are:
- Trichophyton
- Microsporum
- Epidermophyton
Dermatophytes may infect humans (anthropophilic) or non human mammals (zoophilic), or they may reside primarily in the soil (geophilic).[1]
It has following varients:
1) Majocchi granuloma : This variant of tinea corporis is a fungal infection of the hair, hair follicles, and, often, surrounding dermis. Typically caused by Trichophyton rubrum, it manifests as perifollicular, granulomatous nodules typically in a distinct location, which is the lower two thirds of the leg in females, with an associated granulomatous reaction. Majocchi granuloma often occurs in females who shave their legs.[1]
2) Tinea corporis gladiatorum: This variant is a dermatophyte infection spread by skin-to-skin contact between wrestlers; it often manifests on the head, neck, and arms, which is a distribution consistent with the areas of contact in wrestling.[1]
3) Tinea imbricate: Another variant of tineacorporis, this form is found mainly in Southeast Asia, the South Pacific, Central America, and South America. Tineaimbricata is caused by T concentricumand is recognized clinically by its distinct, scaly plaques arranged in concentric rings. [1]
4) Tinea incognito: This is tinea corporis with an altered classic presentation due to corticosteroid treatment.[1]
Tinea corporis can manifest as follows:
Typically, the lesion begins as an erythematous, scaly plaque that may rapidly worsen. Following central resolution, the lesion may become annular in shape. The inflammation can cause scale, crust, papules, vesicles, and even bullae to develop, especially in the advancing border. Rarely, tinea corporis can present as purpuric macules [1]
Lesions modified by site and named variously as Tinea capitis (scalp), T. faciei (face), T. corporis(trunk), T. cruris (groin), T. pedis (feet), T. manuum(hand), and T. unguium (nails)[3].
PATHOGENESIS : Dermatophytes grow only on the keratinised layers of the skin and its appendages and do not ordinarily penetrate the living tissues. Fungal products may be responsible for inciting local inflammation. Hypersensitivity to fungus antigens may play a role in pathogenesis and is probably responsible for the sterile vesicular lesions sometimes seen in distant form the ring worm.[4]
Following the incubation period of 1-3 weeks, dermatophytes invade peripherally in a centrifugal pattern. In response to the infection, the active border has an increased epidermal cell proliferation with resultant scaling. This creates a partial defense by way of shedding the infected skin and leaving new, healthy skin central to the advancing lesion. Elimination of dermatophytes is achieved by cell-mediated immunity.
Trichophyton rubrum is a common dermatophyte and, because of its cell wall, is resistant to eradication. This protective barrier contains mannan, which may inhibit cell-mediated immunity, hinder the proliferation of keratinocytes, and enhance the organism’s resistance to the skin’s natural defenses.[1]
SIGNS AND SYPTOMS
- Scaly ring-shaped area, typically on the buttocks, trunk, arms and legs.
- Itchiness.
- A clear or scaly area inside the ring, perhaps with a scattering of bumps whose color ranges from red on white skin to reddish, purplish, brown skin.
- Slightly raised, expanding rings.
- A round, flat patch of itchy skin
- Overlapping rings
INVESTIGATION: Potassium hydroxide (KOH) scraping-Simple, inexpensive, quick, and sensitive test. Samples to be taken depend on the site of infection. Specimen to be take in tinea corporis- Scales from edge.[5]
MANAGEMENT:
Auxillary Mangement– General measures includes keeping area dry, avoiding use of synthetic clothes[4]
Homoeopathy Treatment: Conventional treatment is efficacious to draw away the superficial lesions which mostly reappear after sometime. According to homoeopathy, no eruption is local and is manifestation of internally deranged vital force, hence medicine given, should also act on dynamic level and should be given internally to assist vital force to cure. The selection of Homoeopathic similimum is based on totality of symptoms of the case. Totality is outwardly reflected picture of the internal essence of the disease, that is, of the affection of the vital force”. [6]
As Homeopathy is a system of medicine which works on the dynamic level and the person as a whole and hence it is there by the best form of medicine to treat skin diseases, here the cure is obtained by constitutional treatment and or therapeutics .In homeopathy, one can treat the patient as a whole, by using holistic approach. One can collect lots of information during case taking and by evaluating the symptoms of the patients and repertorization done on those characteristic rubrics of the patients and thus we find a narrow range of similar medicines and similimum can be given after confirmation in materia medica.
CASE STUDY:
Patient details: A 29-year old female of fair and flabby constitution belonging to a middle socio- economic status reported with red eruptions in circular pattern with reddish discolouration on fore-arm, inframammary region since 6 months. There was burning and itching present at the site of the lesion which was aggravated in afternoon, evening and cold air while get ameliorated in warmth of bed.
Totality of symptoms:
- Indifference towards family members
- Eruptions with itching and burning
- Eruptions reddish and Circular
- Itching < Evening and cold air
- Itching> warmth of bed
Timeline: The duration of treatment was 5 months. Patient came to the Outpatient Department on 17/1/2024 with evidence of Tinea Corporis and improvement was seen on 13/4/2024 .
Prescription – On the totality of symptoms, MERCURIUS SOLUBILIS 200 / 3 dose was prescribed And the Lesion started disappearing , itching showed amelioration for few days & then aggravation. Placebo was given for a Month. On the 3rd Visit, Mercurius Solubilis 1M / 1 dose was prescribed and the Patient showed no itching, burning or any New eruptions.
FOLLOW UPS:
17/1/2024 Mercurius Solubilis 200 × OD × 3dose
10/03/2024 Mercurius Solubilis 1M OD
Conclusion : Synthesis Repertory is used in daily practise with modified rubrics which is very useful in day to day practice. Synthesis is the enlarged Repertory, linked to the different homeopathic software . New rubrics being added, old rubrics and their corresponding medicines are verified & upgraded where required . Useful to repertories all types of Skin diseases .
REFERENCES:
- Lesher, J. (2017). TineaCorporis. [online] Medscape. Available at: http://emedicine.medscape.com/article/1091473
- Indian journal of medical microbiology . Vol-33 (2015)
- Davidson’s principles and practice of medicine 21st edition
- Panikar textbook of microbiology .7th edition
- Khanna,N.(2017). Illustrated Synopsis of Dermatology and Sexually Transmitted Diseases. 4th ed
- B.K. Sarkar -Hahnemann`s Organon of Medicine
- Synthesis Repertory
Dr Suyash Dhadiwal (MD-Part I)
Dept. of Repertory, D.K.M.M.H.M.C. Chh. Sambhajinagar (Aurangabad)
Guided By – Dr. S. M. Wagh
Email : dhadiwalsuyash@gmail.com
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