Scope of Homoeopathy in the treatment of drug resistant tinea


Dr Yashasvi Verma

Introduction
Tinea, also known as dermatophytosis or ringworm, is a common superficial fungal infection of skin. Centers for Disease Control and Prevention, USA defines Tinea as “A common infection of skin and nails caused by fungus, which is typically represented as red, itchy, scaly, circular rash.”[1]
Classification of Tinea depends upon the location of the infection on the body. Areas of the body that can be affected by ringworm include:
1. Feet (tinea pedis, commonly called “athlete’s foot”)
2. Groin, inner thighs, or buttocks (tinea cruris, commonly called “jock itch”)
3. Scalp (tinea capitis)
4. Beard (tinea barbae)
4. Hands (tinea manuum)
5. Toenails or fingernails (tinea unguium, also called “onychomycosis”)
6. Other parts of the body such as arms or legs (tinea corporis.)

In today’s time, tinea is emerging as an epidemic. It is an indisputable fact that there is an increase in the prevalence of dermatophytosis over the past 4–5 years across the country.[3] India being a tropical country plays an important role in the increasing prevalence of fungal infections.
In present scenario, not only treatment but diagnosis of dermatophytosis too, is becoming more and more channelling than ever before.

Challenges in the diagnosis of Tinea.
In 2022, diagnosis of tinea based on the clinical presentation and morphological features is not a child’s play.  Abuse of potent topical steroids, anti fungal creams, and FDC Creams (Fixed Drug Combination creams) is one of the most important cause of atypical presentation of Tinea among masses. There is a veritable epidemic of steroid modified tinea in India. It is a common observation that severity of changes in the clinical pattern correlates with the duration of the abuse of topical steroids. [3] According to a review article published by the doctors of Department of Dermatology, Venereology and Leprology, PGMIER, Chandigarh – “Several atypical clinical types such as psoriasis-like, eczematous dermatitis-like, seborrheic dermatitis-like, and rosacea-like have been reported in hospital OPDs in past few years. Hence, dermatophytosis has been suggested to be included in the list of great imitators.”[4].

Challenges in the treatment of Tinea.
Tinea is becoming Durg resistant worldwide. Ignorance among population, low socio-economic status, and non judicial mode of treatments such as excessive use of topical steroids and fixed drug combination creams is making superficial fungal infections more chronic, more relapsing and hence, more difficult to treat. Conventional allopathic treatment can mask off skin lesions for a considerable time by the help of potent steroids but at the same time, is fully ineffectual in the permanent irradication of the disease. Second time when same patient came with same such lesions then more potent topical steroids are prescribed. This cycle keeps on going and tinea is becoming chronic and obstinate in masses. Today, we have attained a level where most of the fungal infections are resistant to the conventional allopathic treatment.

Role of Homoeopathy
Homoeopathy has an immense scope in the treatment of drug resistant tinea. By the help of proper constitutional treatment, we can not only treat the drug resistant Tinea but also irradiate its recurrence completely. Where Allopathic treatment has a dead end, homoeopathy emerge as a ray of hope. Here, I demonstrate my four cases (one acute and three chronic) of drug resistant and/or relapsing tinea, which responded on homoeopathic treatment beautifully. This is the greatest scope of Homoeopathic System of Medicine.

Acute Case

Case – 1
A Case of Tinea Cruris.
A 46 year old female patient, having history of diabetes, came to my clinic with atypical presentation of tinea cruris. She is having patchy eruptions around the hipline and thighs, with apparently no itching but excessive watery discharge from them. She had taken allopathic treatment from 1 general physician and 2 reputed dermatologist of west delhi in last one month, but having no significant relief, except in itching. She is have so much watery discharge that it wets her clothes and she is compelled to change her undergarments in every 3-4 hours. The site and presentation of lesions are in favour of Tinea Cruris but excessive watery discharge from them is suggestive of “weeping eczema”. It was an acute case and based on acute totality (especially intensity of discharge) I prescribed Dulcamara in LM Potency, in three hour repetition.
Basis of Selection of Dulcamara
1. History of suppression of Skin disease (Tinea)
2. Excessive thin, watery discharges from skin (Excessive discharges from all mucus membranes, eyes, nose, skin – Boericke)
3. Chilly patient. Sensitive to cold.
Basis of Selection of Potency – LM Potency
1. Can frequently repeat our selected medicine.
2. Negligible change of aggravation.
After 15 days of treatment, patient was absolutely fine and having no itching, no discharge and no eruptions at all. We reach upto LM3 in our treatment. Here well selected homoeopathic medicine works magically, where patient was not responding on allopathic treatment.

CHRONIC CASES
Case – 2
A case of Tinea Cruris with Tinea Corporis
From last few years we are frequently encountering the case where Tinea cruris and Tinea Corporis presents in association at a same time at different anatomical locations of body. Here, a 42 year old female patient was suffering from T. Cruris and T. Corporis from last 5 years. She had taken her treatment from 7 highly qualified allopathic doctors, 3 pharmacists, 3 quacks and 1 ayurvedic doctor in last 5 years. In her words “I’m perfectly fine as long as I apply these creams and ointments, but whenever I stop then my condition become even more worst then it was previously.” So it was a case of relapsing tinea. She has presented with many intersecting irregular rings around her thighs, genitals, waste line and buttocks and few isolated spots were on neck and behind left ear. There was intense itching and burning in them, especially in thigh region which aggravates with warmth of bed at night and on sweating. Patient was thermally hot, sweats profusely and desire sweets. 
Complete removal of her steroidal creams is the biggest challenge as her lesions will relapse like a storm and difficult to manage. Initially we started our treatment with an integrated approach where both allopathic and homoeopathic treatment was given simultaneously but gradually the potent steroids were tapper off with time in a perfectly scientific manner. Abruptly stooping up the steroids, on which patient is dependent from last 5 years is not an act of maturity! 

Based on the “Conjoint melody” I prescribed Bacillinum 200 three doses, followed by Tellurium Metallicum LM-1 TDS 

Basis of Selection of Bacillinum
1. It’s better to start your treatment with an intercurrent remedy, than to give it in the mid of treatment. It would remove the miasmatic blockage in very first stage only and shorten your time of treatment.
2. Covers Psora + Sycotic taint.
3. Have a high reputation the treatment of Ringworms.
Basis of Selection of Tellurium Metallicum
1. Multiple Ring shaped lesions with intersecting lines.
2. Severe itching and burning of the part.
3. Therapeutically useful in the treatment of Ringworm.
Basis of Selection of Potency – LM Potency
1. Can increase potency easily in the treatment of chronic skin disease without the chance of aggravation.
Steroidal creams were completely removed in next 2 months. From third month onwards we were managing the case purely with homoeopathic medicines. In the course of treatment of 14 months we came upto Tellurium LM-9, with some intercurrent doses of Bacillinum in 200th and 1M potency. To counter the relapsing character of tinea, infrequent doses of Sulphur 6CH, 30CH and 200CH was given. Also, patient was depicting the constitutional sketch of Sulphur afterwards. It took more than a year but now patient is having no lesion of Tinea in her body. She is still taking my treatment for her age-related joint pains.

Case – 3
A case of Tinea Corporis.
A 23 year old male patient, suffering from tinea corporis from last 2 years came to my clinic with big circular patches around the neck and shoulder. He have also taken allopathic treatment for same for last 1.5 years but having no significant improvement. Symptoms present were itching, burning and occasional bleeding. His itching aggravates exponentially during sweating and in heat, in any form. On careful case taking we came to know that as a person he is thermally hot, sweats profusely, thirsty, flabby tongue with imprints of teeth, having dribbling saliva during sleep and a sense of internal heat in the body. On the basis of these  clearcut constitutional symptoms Merc. Sol in LM Potency was prescribed.

Basis of Selection of Merc. Sol
1. Aggravation from sweating.
2. Flabby tongue with imprint of teeth.
3. Dribbling saliva during sleep.
Basis of Selection of Potency
1. For the same reasons as mentioned in Case-1 & Case-2.
Patient was fully recovered in next 6 months from his obstinate drug resistant tinea. 

Case – 4
A case of Onychomycosis (Fungal infection of Nail)
A 54 year old female patient came with the fungal infection of nail from last 4 years. She had visited many allopathic and homoeopathic physicians for her complain in last few years but had little benefit. Now his fungal infection is not responding on any treatment and keep on spreading from one finger nail to another. In allopathic system of medicine the treatment of nail fungal infections is comparatively difficult because it a big challenge to deliver the medicinal salts through blood vessels to the most peripheral part of body such as nails. 
On case taking we came to know that her family had a strong history of seborrheic dermatitis and other scaly skin diseases. As a person she is very soft, mild and emotional. She is a religious person, thermally chilly and loves to have sweets and tea. Based on the above set of constitutional symptoms Thuja 6CH was prescribed.
Basis of Selection of Thuja
1. Has a special affinity for nails (Other remedies – Graph., Ant. Crud., Sil.)
2. Has an anti fungal action.
3. Mentally soft, emotional and religious.
4. Loves sweet and tea.
Basis of Selection of Potency and mode of administration.
1. Considering morphological changes in nail, a lower potency in Centicimal scale was selected.
2. Mode of administration – One poppy sized globule fully moistured with a dilution of Thuja 6CH is dissolved in a bottle containing 100 ml of water. Each time, patient is suggested to give 10 stroked to the bottle and then take one table spoon of that solution as a dose of medicine. Repetition of medicine was TDS.
Infrequent doses of Thuja 6CH was given in a span of 7 months, along with some intercurrent medicines like Myristica 30CH and Silicea 200CH and 1M. It was a challenging task but patient was fully recovered from Onychomycosis in next 7 months. She is still under my observation.

Conclusion
Homoeopathy is effective and has a vital scope in the treatment of drug-resistant and/or relapsing tinea.

References
[1] – Centers for Disease Control and Prevention, “Definition of Ringworm”. CDC. December 6, 2015. Archived from the original on 5 September 2016. Retrieved 5 September 2016.
[2] – Centers for Disease Control and Prevention, “Symptoms of Ringworm Infections”. CDC. December 6, 2015. Archived from the original on 20 January 2016. Retrieved 5 September 2016.
[3] – “The Great Indian Epidemic of Superficial Dermatophytosis: An Appraisal by Dr. Shayam Verma & Dr. R. Madhu” Indian Journal of Dermatology; May-Jun; 62(3): 227–236. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5448256/
[4] – “Emerging atypical and unusual presentations of dermatophytosis in India by Dr. Sunil Dogra & Dr. Tarun Narang” Clinical Dermatology Review; Year 2017, Vol-1, Issue-3, Page 12-18. https://www.cdriadvlkn.org/article.asp?issn=2542-551X;year=2017;volume=1;issue=3;spage=12;epage=18;aulast=Dogra

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