Translate this page into:
Atopic dermatitis in a 2-year-old child treated with individualised homoeopathic medicine: A case report
*Corresponding author: Sanjukta Mandal, Department of Materia Medica, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Howrah, West Bengal, India. m.sanjukta@yahoo.com
-
Received: ,
Accepted: ,
How to cite this article: Mandal S, Biswas B, Abbas J. Atopic dermatitis in a 2-year-old child treated with individualised homoeopathic medicine: A case report. J Intgr Stand Homoeopathy 2021;4:86-93.
Abstract
Atopic dermatitis (AD) is a chronic, relapsing pruritic skin condition which is accompanied by inflammation of the affected parts. It usually develops during early childhood and has a predilection for the skin flexures. Approximately 70% of cases start before the age of 5 years: Only 10% begin in adulthood. Asthma and allergic rhinitis are comorbid in most cases. This is a case report of a 2-year-old child who presented with reddish elevated papular eruptions on the skin with severe itching. After thorough case taking and examination, the diagnosis was AD, based on the Hanifin and Rajka criteria. The patient underwent individualised homoeopathic treatment. In subsequent follow-ups, the patient’s improvement was monitored using the PO-SCORAD scale and the subjective symptoms. Marked improvement was noted within a few months. Homoeopathic treatment is effective in these cases to yield rapid improvement without any adverse effects.
Keywords
Atopic dermatitis
PO-SCORAD
Homoeopathy
Individualisation
Repertory
INTRODUCTION
Atopic dermatitis (AD) is an endogenous eczema triggered by an exogenous agent.[1] The word ‘atopy’ was first used for a group of hereditary disorders in people who tended to develop an urticarial response to foods and inhaled substances.[2] AD comprises extremely pruritic, recurrent and often systemic eczematous lesions. Sites of involvement are characteristic but vary depending on patient age. This condition is a strong genetic predisposition; patients may have a personal or family history of atopic diathesis and an increased ability to form immunoglobulin (Ig)E in response to common environmental allergens. AD is often described as ‘runs in the family.’ It is hypothesised that AD is inherited through separate but closely related genetic pathways. HLA typing, however, does not support genetic inheritance. The most characteristic investigation findings are elevated IgE levels (more than 80% of patients with AD have IgE levels ≥200 IU/mL); increased IgE levels after exposure to multiple allergens (foods, aeroallergens, microbes and their toxins) and defective control of IgE production by T lymphocytes, reduced delayed hypersensitivity, decreased T-cell activity and increased proportion of B-lymphocytes with surface-bound IgE. AD is seen in 3% of all infants between 3 and 4 months of age. There is increasing worldwide incidence because of increased exposure to pollutants, increased exposure to indoor allergens and decline in breastfeeding.[1]
Three distinct patterns of AD have been recognised, depending on patients’ age:
Infantile phase – Begins after the age of 3 months, which is characterised by intensely itchy papules and vesicles, which soon become exudative. They usually begin on the face but can involve rest of the body but sparing the diaper area. Secondary infection is common, and it runs a chronic course. In 40% of infants, lesions clear by the age of 18 months and in 60% of cases, it changes into childhood pattern[1]
Childhood phase – Dry leathery and extremely itchy plaques are found mainly on the elbow and knee flexor, often reversed (extensor) pattern is also seen[1]
Adult phase – Intensely itchy, lichenified plaques are found in cubital and popliteal fossae and sometimes in the neck. A low-grade involvement may be seen on the rest of the body for example, lip lick cheilitis, nipple eczema, hand dermatitis and nummular dermatitis.[1]
Approximately 50% of AD patients have allergic rhinitis and approximately 30% have asthma. Atopic also develops food allergies and urticaria more frequently.[1]
The complications of AD are as follows:
Bacterial infections: Impetigo[1]
Viral infections: Herpes simplex, molluscum contagiosum and HPV[1]
Fungal infections[1]
Miscellaneous: Due to poor sleep, growth is poorer than normal, side effects of steroids and social and psychological disturbances.[1]
Hanifin and Rajka criteria for AD[3]
PO-SCORAD for AD
PO-SCORAD is the most widely used disease severity scale in AD. It was developed in 1993 by the European Task Force on AD.[4] The SCORAD index uses [Table 1] the rule of nines to assess disease extent and evaluates five clinical characteristics to determine disease severity: (1) Erythema, (2) oedema/papulation, (3) oozing/crusts, (4) excoriation and (5) lichenification. It also assesses subjective symptoms of pruritus and sleep loss with visual analogue scales. These three aspects – extent of the disease, disease severity and subjective symptoms – combine to give a maximum possible score of 103 [Figures 1-3 score 60.2] [Figures 4-7 score 53.4] [Figures 8-11 score 13.2] [Figures 12-15 score 06.2] [Figures 16-19 score 04.4] [Figures 20-23 improved]. Of all the severity scales used in AD, it is the most widely validated disease severity instrument.[5] It has been found to be valid and reliable, and it has shown excellent agreement with global assessments of disease severity.[6]
Management
Avoid scratching, avoid woollen, synthetic clothes and avoid excessive degreasing of the skin.[1] Avoid milk and eggs.[1] Patients should not be inoculated against influenza, measles and yellow fever.[1] Avoid cosmetics.[1]
Role of Homoeopathy in AD
In a German prospective observational study with 225 children, results revealed strong improvement for the first 3 months that continued for the full observation period after homeopathic treatment.[7]
Another prospective study including 42 patients with AD treated with homoeopathic medicines showed positive results.[8]
A study on Japanese patients with intractable AD showed 50% improvement in overall impression after treatment with homoeopathy.[9]
An RCT held at D.N. De Homoeopathic Medical College and Hospital (Govt. of WB) under the STSH scheme of CCRH showed that improvement after homoeopathic treatment was greater than after placebo, but the between-group differences were mostly non-significant over 3 months of intervention.[10]
CASE REPORT
A 2-year-old male child was brought to the outpatient department (OPD) of Mahesh Bhattacharyya Homoeopathic Medical College and Hospital. He was well nourished and weighed 12 kg.
Chief complaint
Reddish elevated papular eruption on skin associated with severe itching. The child was in an irritable state due to the intolerable itching. He was scratching the parts continuously, which led to some bleeding points. The itching was greatly aggravated at night and from heat of the bed. During examination, when we asked his mother to undress him, the intensity of itching increased.
Medical history
The child had suffered from measles when he was 2 months old.
Family history
His father, grandmother and one of his paternal uncles suffered from bronchial asthma. His elder sister also suffers from breathing distress when exposed to dust and cold weather.
Physical generals
The child was very chilly and always wanted to be covered. His sweat was offensive especially of palms and soles. The child had ravenous appetite and liked to have sweet things and eggs. His stools were regular but offensive. His sleep was greatly disturbed due to the itching.
Clinical findings
Reddish elevated papular eruptions all over body and face
Intolerable itching
Family history of bronchial asthma.
Evaluation of symptoms for homoeopathic prescription
Extremely irritable child
Child unable to sleep at night
Sleepless; he must be carried
Chilly patient
Ravenous appetite
Offensive perspiration of palms and soles
Intolerable itching aggravated at night and in bed
Aggravation from undressing.
Repertorial Anaysis was done with Kent’s Repertory using Zomeo software by, Hompath.[11]
Timeline
The patient visited the OPD on 28 January 2021. Medicine was prescribed on the same day. The patient was followed up at regular intervals. Medicine was repeated on the 3rd visit – 11 February 2021. Placebo was given at the 2nd, 4th, 5th and 6th visit.
Diagnostic assessment
The diagnosis was made based on the Hanifin and Rajka criteria. PO-SCORAD was calculated during each visit to evaluate the condition of the patient [Table 1]. AD may be confused with psoriasis, seborrheic dermatitis or pityriasis. Therefore, the particular distribution, medical history and family history should be considered for the diagnosis of AD.
| No. of visits | Date of visit | Symptoms | PO-SCORAD | Prescription |
|---|---|---|---|---|
| 1 | 28 January 2021 | Excessive itching with dry, red eruptions on upper part of body aggravated on undressing and at night. Extreme irritability, constant crying and unable to sleep | 60.2 | Psorinum 200C 1 dose followed by placebo for next 6 days |
| 2 | 4 February 2021 | Itching slightly reduced. Eruptions same as before | 53.4 | Placebo for 14 days |
| 3 | 11 February 2021 | Itching better than before. Eruptions reduced. Child is less irritable and can sleep at night | 33.2 | Psorinum 200c 1 dose followed by placebo for next 21 days |
| 4 | 4 March 2021 | Itching occasional. Eruptions very much reduced. Child is no more irritable and sleeps well at night | 13.2 | Placebo for 21 days |
| 5 | 25 March 2021 | Itching and eruptions are negligible. Child is doing well | 06.2 | Placebo for 21 days |
| 6 | 15 April 2021 | Eruptions slightly seen. No itching. Child is doing very well no other symptoms | 04.4 | Placebo for 1 month |
The prognosis of this disease is mostly favourable as it is automatically cured by the time of early adolescence. However, patients with severe disease and concomitant atopic conditions have poor prognosis.[12]
Therapeutic intervention
After thorough case taking, repertorisation [Figure 1][11] using Kent’s method, and Materia Medica differentiation,[13] Psorinum was selected. Single medicine was prescribed as per law of similia and only one dose of medicine was administered to the patient in centesimal potency and advised to be taken in empty stomach on early morning the next day as per law of minimum. The PO-SCORAD on the 1st prescription day was 60.2 [Table 1]. The patient was asked to report after 7 days.
- Repertorial analysis.
During follow-up, every change in the symptoms was noted [Figures 2-4]. Repetition of the same medicine in the same potency was done during the 3rd visit [Figures 9-12] as there was no marked improvement. Medicine was not repeated as long as improvement continued [Figures 13-24].[14]
- 1st visit.
- 1st.
- 1st visit.
- 2nd visit
- 2nd visit
- 2nd visit.
- 2nd visit.
- 3rd visit.
- 3rd visit.
- 3rd visit.
- 3rd visit
- 4th visit.
- 4th visit.
- 4th visit.
- 4th visit.
- 5th.
- 5th visit.
- 5th visit.
- 5th visit.
- 6th visit.
- 6th visit.
- 6th visit.
- 6th visit.
Follow-ups and outcomes
No. of visit date of visit symptoms PO-SCORAD prescription
28th January, 2021 Excessive itching with dry, red eruptions on upper part of body aggravated on undressing and at night. Extreme irritability, constant crying and unable to sleep. [Figures 2-4] PO-SCORAD -60.2 Psorinum 200C 1 dose followed by placebo for next 6 days.
4th February, 2021 Itching slightly reduced. Eruptions same as before. [Figures 5-8] PO-SCORAD 53.4 Placebo for 14 days.
11th February, 2021 Itching better than before. Eruptions reduced. Child is less irritable and can sleep at night. [Figures 9-12] 33.2 Psorinum 200C 1 dose followed by placebo for next 21 days.
4th March, 2021 Itching occasional. Eruptions very much reduced. Child is no more irritable and sleeps well at night. [Figures 13-16] PO-SCORAD - 13.2 Placebo for 21 days.
25th March, 2021 Itching and eruptions are negligible. Child is doing well. [Figures 17-20] PO-SCORAD - 06.2 Placebo for 21 days.
15th April, 2021 Eruptions slightly seen. No itching. Child is doing very well no other symptoms. [Figures 21-24] PO-SCORAD - 04.4 Placebo for 1 month.
DISCUSSION
AD is mostly an inherited disease. Local treatments provide very short-lasting results, hence, it needs to be managed with internal medication. Homoeopathic medicines are prescribed on the basis of holistic concept. Studies have proved the effectiveness of this mode of treatment.
The above-discussed case has been diagnosed on the basis of the Hanifin and Rajka criteria. We used the PO-SCORAD clinical scoring to evaluate the patient’s condition in each visit. From the etiopathogenesis and clinical picture of AD, we cannot have any idea of predominant miasmatic background. A very careful history of every individual patient, extensive clinical examination, relevant and supportive investigation available and individualisation of the case on the basis of homoeopathic philosophy help us select the similimum remedy. Thus, the above-discussed case was managed successfully with the classically selected homoeopathic medicine.
CONCLUSION
AD is a chronic skin condition that manifest itself physically and psycho-socially in the patients. It demands chronic care. Alongwith medications, attention should be given to personal hygiene and avoidance of any triggering factors. .
Acknowledgments
Department of Surgery (OPD), Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Howrah, West Bengal, India.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent. Since Patient is a Minor, the consent of the parents was taken.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- Illustrated Synopsis of Dermatology and Sexually Transmitted Diseases (4th ed). Netherlands: Elsevier; 2011. p. :91-5.
- [Google Scholar]
- StatPearls. 2021. Treasure Island. FL: StatPearls Publishing; Available from: https://www.ncbi.nlm.nih.gov/books/NBK542187 [Last accessed on 2021 Jul 10]
- [Google Scholar]
- Diagnosis of atopic dermatitis in children: Comparison of the Hanifin-Rajka and the United Kingdom Working Party criteria. Allergol Immunopathol. 2020;48:175-81.
- [CrossRef] [PubMed] [Google Scholar]
- Clinical validation and guidelines for the SCORAD index: Consensus report of the European task force on atopic dermatitis. Dermatology. 1997;195:10-9.
- [CrossRef] [PubMed] [Google Scholar]
- Outcome measures of disease severity in atopic eczema. Arch Dermatol. 2000;136:763-9.
- [CrossRef] [PubMed] [Google Scholar]
- Health outcome measures in atopic dermatitis: A systematic review of trends in disease severity and quality-of-life instruments 1985-2010. PLoS One. 2011;6:e1752.
- [CrossRef] [PubMed] [Google Scholar]
- Homeopathic treatment of children with atopic eczema: A prospective observational study with two years follow-up. Acta Derm Venereol. 2009;89:182-3.
- [Google Scholar]
- Prospective observational study of 42 patients with atopic dermatitis treated with homeopathic medicines. Homeopathy. 2012;101:21-7.
- [CrossRef] [PubMed] [Google Scholar]
- Homeopathic treatment of Japanese patients with intractable atopic dermatitis. Homeopathy. 2003;92:108-14.
- [CrossRef] [Google Scholar]
- Efficacy of Individualized Homeopathic Medicines in Treatment of Atopic Dermatitis in Adults: A Double-blind, Randomized, Placebo-controlled Trial, Project Report STSH180111; CCRH STSH scheme, 2018 New Delhi: CCRH; 2019.
- [Google Scholar]
- Using Kent's Repertory 2019 Version. Maharashtra: Mind Technologies Private Limited; 2019.
- [Google Scholar]
- Mechanisms of disease: Atopic dermatitis. N Engl J Med. 2008;358:1483-94.
- [CrossRef] [PubMed] [Google Scholar]
- Pocket Manual of Homoeopathic Materia Medica Comprising the Characteristic and Guiding Symptoms of all Remedies. (9th ed). Mumbai: Modern Homoeopathic Publication; 2003. p. :533-4.
- [Google Scholar]
