Homoeopathic remedy in the management of contact dermatitis – a case series

Dr S Girish Reddy

ABSTRACT:
Contact dermatitis is a skin condition that causes inflammation. Contact dermatitis is caused by chemical or metal ions that produce toxic effects (contact irritants), or small reactive chemicals (contact allergens) that modify proteins and cause an innate and adaptive immune response. Contact dermatitis types are irritant and allergic dermatitis. Irritant dermatitis is the skin’s nonspecific response to direct chemical damage. This release mediators of inflammation mainly occur in epidermal cells. Allergic dermatitis (type 4) is a delayed (hypersensitivity) reaction to exogenous (contact) antigens. The immunological response is mediated by cytokines interacting with T cells.

KEYWORDS:
Homoeopathy, Holistic approach, Individualization, Constitutional Remedy, Dermatitis, Modified Naranjo Criteria`                                          .

INTRODUCTION:
Contact dermatitis (CD) is a common inflammatory skin disease caused by exposure to contact allergens and irritants. It is also the most common reason of occupational dermatitis and contributes greatly to hand dermatitis and facial dermatitis. Besides the two major forms of contact dermatitis: allergic contact dermatitis and irritant contact dermatitis, other subtypes of CD have been recognized including immediate skin reactions, photoinduced contact dermatitis, systemic contact dermatitis, and non-eczematous contact dermatitis.¹ Based on the mechanism by which contact allergy develops, several types are recognized, including allergic contact dermatitis, irritant contact dermatitis, contact photo-dermatitis and contact urticaria. The clinical presentation of contact dermatitis, regardless of the mechanism, ranges from localized vesicles and bullae on erythematous skin in acute stages to erythematous lichenified plaques in chronic stages.² The physician needs to understand the patient in a holistic way for a clear prescription of individualized homoeopathic remedy. Homoeopathy treats the individual in disease and not the disease alone.³ The Modified Naranjo Criteria for Homoeopathy was originally adopted by Rutten from the Naranjo Algorithm. It is further developed over several years by the clinical data working group of the Homoeopathic Pharmacopoeia Convention of United States (HPCUS) to assess the likelihood of causal attributions of clinical outcome in homoeopathic cases and case report. According to the final outcome in a case a score is assigned in each domain of the Modified Naranjo Criteria of Homoeopathy.⁴

METHODS:
The case series comprises of 3 cases of Contact Dermatitis were reported in outpatient department (OPD) of GHMC, Bangalore and they were treated with individualized homoeopathic medicines. A thorough case-taking of all the patients was conducted, following strict homoeopathic principles. The presenting totality of symptoms, reportorial and miasmatic analysis, formed the basis of prescription. The repertory used for repertorization was synthesis from RADAR software. Each case was followed up with clinical and photographic evidence and was reported accordingly. The assessment of causal attribution of homoeopathic treatment effect was carried out using the Modified Naranjo Criteria.

DISCUSSION:
Contact dermatitis (CD), or dermatitis attributed to “outside” allergens or irritants, is a skin disorder often attributed to occupational skin exposures making it the most common occupational skin disease. Apart from occupational exposures, the increased and frequent use of cosmetics and personal care products is an additional risk factor for the development of CD, particularly in women.⁵

Also, the possible causal attribution of the changes in this case were assessed by using the Modified Naranjo Criteria (Table 4). The total score for the case (+7), as per these criteria, is relatively close to the maximum of +13 and suggests positive causal attribution of the individualized homoeopathic treatment to the clinical outcome of the case found.

Sl. no	MODIFIED NARANJO CRITERIA	YES	NO	NOT SURE	Case 1	Case 2	Case 3
1.	Was there an improvement in the main symptom or condition for which the homoeopathic medicine was prescribed?	+2	-1	0	+2	+2	+2
2.	Did the clinical improvement occur within a plausible timeframe relative to the drug intake	+1	-1	0	+1	+1	+1
3.	Was there any initial aggravation of symptoms?	0	0	0	0	0	0
4.	Did the effect encompass more than the main symptom or condition (i.e, were other symptoms ultimately improved or changed)?	+1	0	0	+1	+1	+1
5.	Did overall well-being improve? (suggest using validated scale)	+1	0	0	0	0	0
6.	Direction of cure: did some symptoms improve in the opposite order of the development of symptoms of the disease?	0	0	0	0	0	0
	Direction of cure: did at least two of the following aspects apply to the order of improvement of symptoms —from organs of more importance to those of less importance—from deeper to more superficial aspects of the individual—from the top downward.	+1	0	0	+1	+1	+1
7.	Did old symptoms (defined as nonseasonal and non-cyclical that were previously thought to have resolved) reappear temporarily during the course of improvements?	0	0	0	0	0	0
8.	Are there alternate causes (other than the medicine) that—with a high probability—could have caused the improvement? (Consider the known course of the disease, other forms of treatment, and other clinically relevant interventions).	-3	+1	0	+1	+1	+1
9.	Was the health improvement confirmed by any objective evidence? (e.g., lab test, clinical observation, etc.)	+2	0	0	+1	+1	+1
10.	Did repeat dosing, if conducted, create similar clinical improvement?	0	0	0	0	0	0
	Total score (Maximum score= +13; Minimum score = -3)				+7	+7	+7

CONCLUSION:
These case studies highlight the capability of individualized homoeopathic medicines. The positive effects presented in the cases show the efficacy of homoeopathic medicines in the treatment of Contact dermatitis. More research needs to be done that might make this study useful.

DECLARATION OF PATIENT CONSENT: In the form, the patient has given their consent for the images and other clinical information to be reported in the journal. The patient understands that their name and initials will not be published and due efforts will be made to conceal their identity.

CONFLICT OF INTEREST: None declared.

FINANCIAL SUPPORT & SCHOLARSHIP: Nil.

REFERENCES:

1. Li Y, Li L. Contact Dermatitis: Classifications and Management. Clin Rev Allergy Immunol. 2021 Dec;61(3):245-281.  doi: 10.1007/s12016-021-08875-0. Epub 2021 Jul 15. PMID: 34264448
2. Klaus MV, Wieselthier JS. Contact dermatitis. Am Fam Physician. 1993 Sep 15;48(4):629-32. PMID: 8379492.
3. Hahnemann, S., Boericke, W. and Dudgeon, R., 2011. Organon of medicine. New Delhi: B. Jain Publishers
4. Teut et al. (2021) Case reporting in homeopathy—an overview of guidelines and scientific tools. Available at:  https://www.researchgate.net/publication/354589265_Case_Reporting_in_Homeopathy-An_Overview_of_Guidelines_and_Scientific_Tools
5. Brar KK. A review of contact dermatitis. Annals of Allergy, Asthma & Immunology. 2021 Jan 1;126(1):32-9 Available at: https://doi.org/10.1016/j.anai.2020.10.003
6. RADAR Software: Frederick Schroyens Synthesis Repertory, Version 9.1
7. Kent JT. Repertory of the Homoeopathic Materia Medica. Enriched Indian ed. New Delhi. B Jain Publishers(P) Ltd;2017.

Dr S Girish Reddy
MD Part- 2
Department of Organon of Medicine
Govt. Homoeopathic Medical College and Hospital, Bangalore-79
Email: girishreddypatil135@gmail.com

UGO, Dr Vijayalakshmi M Angadi
Associate Professor and PG guide

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