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Irritant contact dermatitis treated with constitutional homoeopathic medicine – A case report
*Corresponding author: Hanuman Ram, Department of Homoeopathic Materia Medica, Madhav Homoeopathic Medical College and Hospital, Sirohi, Rajasthan, India. drhrchoudhary@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Patel A, Ram H. Irritant contact dermatitis treated with constitutional homoeopathic medicine – A case report. J Intgr Stand Homoeopathy 2022;5:24-9.
Abstract
Contact dermatitis (CD) is a skin disorder characterised by papules and vesicles on an erythematous base. It is often precipitated by an exogenous cause and has a global prevalence of 1.7–6.3%. Irritant CD (ICD) is a type of CD caused by repeated exposure to irritants such as acids, alkalis and oxidants (chemical burns) or low-grade irritants such as soaps, detergents and solvents. Cases of ICD have been reported to be treated successfully with homoeopathic medicines. In this case, a male patient aged 55 years presented with the complaints of blackish-brown discolouration and thick lichenified lesion on the dorsal aspect of the left forearm with sticky thick discharge. Case taking and repertorisation done on the basis of totality of symptoms led to prescription of the constitutional homoeopathic medicine Sepia. The dose and the potency were modified per the patient’s requirements. The patient reported relief in all complaints; there was a significant change in the visual analogue scale for the itching and the dermatology life quality index. This case illustrates the utility of homoeopathic constitutional medication in treating chronic allergic dermatological conditions. Further, larger scale studies are required to enable generalisation of the findings.
Keywords
Constitutional homoeopathic medicine
Dermatology life quality index
Irritant contact dermatitis
Sepia
Visual analogue scale
INTRODUCTION
Contact dermatitis (CD) is an inflammatory eczematous skin disorder. It is caused by chemicals or metal ions that exert toxic effects without causing a T-cell response (contact irritants) or by reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens).[1] The prevalence of CD in the Western countries and India is 15–20% and 4.38%, respectively.[2] CD can broadly be divided into irritant CD (ICD) and allergic CD (ACD). The exact pathophysiology of CD is unknown, but it is likely associated with the type 3 hypersensitivity reaction. ICD manifests as a cutaneous reaction due to single or repeated exposure to irritants.[3] It is often characterised by erythematous patches that have demarcated borders with scaling. In acute cases, ICD presents as itching with erythema, bullae and vesicles; chronic cases present with fissures or cracks with lichenification of skin.[4] The chronic nature of ICD can cause significant impairment in the patient’s overall quality of life. As it is a benign skin condition, it is considered a somewhat trivial matter. However, patients report being embarrassed by itching, skin irritation, pain of the affected part and psychosocial and familial consequences. All these factors negatively affect the quality of life.[5] The diagnosis of ICD is often clinical and may only be possible after the exclusion of ACD with patch testing. There is no readily available diagnostic test. Patient history and detection of the causative substance are important for proper management of ICD.[1,5] Unfortunately, there is no specific treatment for ICD in mainstream medicine. Antihistamines and topical or systemic corticosteroids are primarily used to treat patients with ICD, but do not provide lasting relief.[1]
Homoeopathy has good scope in treating cases of CD, including ICD. Dastagiri and Shaji report a case of a 12-year-old boy with ICD with secondary infection who was treated with Calcarea sulphuricum, leading to significant relief within 12 months.[6] Homoeopathic remedies offer gentle and safe treatment for patients with ICD. Homoeopathy treats the person as a whole. Determining the right remedy necessitates a detailed medical history of the patient, along with family and causative factors. We present a case that highlights the effectiveness of homoeopathy for the treatment of ICD.
CASE REPORT
A diagnosed case of ICD, 55-year-old male married patient, farmer by occupation came to OPD of Dr. Madan Pratap Khunteta Homoeopathic Medical College, Hospital and Research Institute, Sindhi camp, Jaipur, Rajasthan, on 20 July 2017.
Chief complaints
The patient presented with the complaints of blackish-brown discolouration on dorsal aspect of the left forearm with thick lichenified lesion, sticky thick discharge and itching worse at night [Figures 1 and 1a].
- (a) Baseline status dorsal aspect of the left forearm (20 July 2017) and (b) post-treatment dorsal aspect of the left forearm (30 January 2018).
History of presenting complaints
The patient was apparently well 2 years back, now he was suffering from itching and papular eruption on dorsal aspect of the left forearm. A small lesion first seen on the left leg, after some time, it spread on dorsal aspect of the left forearm. Itching and discolouration gradually increased from working in farms and heat of bed at night. All complaints appeared after continuous exposure with the use of fertilisers and spraying of insecticides and pesticides during farming. After that, the patient had consulted to dermatologist and diagnosed as ICD; took conventional treatment (including antihistaminic and topical steroids) for 6 months. During the course of treatment, the left leg small lesion was completely better but no change was seen in dorsal aspect of the left forearm lesion, so the patient approached to homoeopathic treatment.
Medical history
Malaria 10 years before, which recovered after allopathic treatment.
Family history
Father had hypertension.
Mental generals
The patient easily gets angered on silly things but suppresses his anger. His wife’s behaviour was not good with him and his family, especially his mother. She always used abusive language. He does not like company; prefers to be alone because he thinks that society is not good. He is very religious and goes to temple regularly for worship. He was anxious about his illness.
Physical generals
The patient had a chilly thermal reaction, as he is not able to tolerate cold. He had the desire for sweets things and aversion to bananas with increased thirst. Sleep was adequate and refreshing.
Particulars (complaints related to dorsal aspect of the left forearm)
Unhealthy skin
Dry, thick skin
Sticky/glutinous discharge.
On examination [Figure 1a]
Location – left dorsal aspect of forearm
Lichenified macule and papule lesion
Colour – tan, brown and black
Discharge – sticky/glutinous.
Analysis of the case
Proper case taking was done as per the directions of the Organon of Medicine and Homoeopathic philosophy. After analysis and evaluation of the symptoms of this case [Table 1], the totality was constructed and the case was repertorised with the help of RADAR 10.0 Synthesis 8.1 V (English) software.[7] The repertorial results are shown in [Figure 2].
| Mental generals | Physical generals | Particular (dorsal aspect of the left forearm) |
|---|---|---|
| Patient suppresses his anger | Craving for sweets | Thick and unhealthy skin |
| Anxiety about his family | Increased thirst | Thick and sticky discharge |
| Patient is religious | Profuse perspiration | Blackish discolouration |
| Patient lives alone always, aversion to company | Lichenified skin |
![Repertorisation chart from synthesis repertory using RADAR software.[7]](/content/112/2022/5/1/img/JISH-5-024-g002.png)
- Repertorisation chart from synthesis repertory using RADAR software.[7]
Evaluation of symptoms and miasmatic analysis
Miasmatic evaluation of all the presenting symptoms was processed with the help of comparison of the chronic miasms,[8] which shows the predominance of psoric and sycotic miasm in combination.
Repertorial totality (Kent’s approach) [Figure 2]
Mind – Ailments from – anger – suppressed
Mind – Company – aversion to – loathing of company
Mind – Anxiety – family; about his
Generals – Food and drinks – sweets – desire
Stomach – Thirst – extreme
Perspiration – Profuse
Skin – eruptions – blackish
Skin – eruptions – discharging – glutinous
Skin – eruptions – discharging – thick
Skin – unhealthy.
Repertorial analysis [Figure 2]
Sepia officinalis – 12/7
Calcarea carbonicum – 14/6
Graphites – 14/6
Lycopodium clavatum – 14/6
Arsenicum album – 12/6.
Clinical diagnosis: ICD.
Selection of remedy
The selection of remedy was based on repertorisation of the case using synthesis repertory, RADAR 10.0 Synthesis 8.1 V (English) software.[7] Sepia was selected because it covers the mental generals and particulars along with the physical make-up of the patient like a lean and thin build, chilly thermal reaction, profuse sweating and predominant psora-sycotic miasm. As we followed the Kentian, prime importance is given to mental generals; therefore, Sepia was selected after Materia Medica differentiation.[9]
Selection of potency
The slow disease progresses and availability of mental, physical and particular characteristic symptoms with structural reversible pathological changes indicate that the state of susceptibility was moderate to high. Thus, 200 potency were selected and repeated infrequently.[10]
First prescription
20 July 2017: Sepia 200C/1 dose stat, placebo TDS × 15 days.
Follow-up sheet
Follow-up sheet [Table 2].
| Date | Response/condition of the patient | Prescription | Justification |
|---|---|---|---|
| 5 August 2017 | >Itching, lichenification gradually decreasing but discharge+and general improvement in mental status (VAS-7) | Placebo TDS for 15 days | Considering improvements in general |
| 22 August 2017 | Status quo (VAS-7) | Sepia 1M 1 dose Placebo TDS for 15 days |
No further improvement and case was stand still |
| 10 September 2017 | >+Itching, blackish colour change seen (VAS-4) | Placebo TDS for 30 days | Considering improvements in general |
| 15 October 2017 | >++Itching, normal skin colour seen (VAS-2) | Placebo TDS for 30 days | Considering improvements in general |
| 20 November 2017 | No itching, healthy skin appearance (VAS-2) | Placebo TDS for 30 days | Considering improvements in general |
| 25 December 2017 | Healthy skin seen (VAS-1) | Placebo TDS for 30 days | Considering improvements in general |
| 30 January 2018 | Healthy skin seen (VAS-1) | No medicine required | Improved |
VAS: Visual analogue scale
DISCUSSION
Homoeopathy is a system of medicine that embraces a holistic approach for treating patients. Detailed case taking is essential to elucidate the constitutional makeup of the patient and a single remedy is selected on the basis of totality of symptoms. This case report shows that the homoeopathic constitutional approach is helpful in the treatment of ICD without requiring medicated external applications. In this case, Sepia 200C and 1M potencies were administered overtime, which not only ameliorated the skin symptoms but also improved his mental state, he was quite hopeful about his recovery.
Improvement status was assessed on the basis of the visual analogue scale (VAS) [Figures 3a and b][11] and the dermatology life quality index (DLQI) scores. The VAS is a simple, reliable and reproducible daily monitoring tool to know the difference in severity of symptoms. In this case, it changed from 08 to 01, which indicates significant improvement.
- (a) Visual analogue scale (VAS) score at baseline and (b) VAS score post-treatment.
The DLQI shows the quality of life; the higher the score, the greater the impairment in the quality of life.[12] The score changed from 20 to 3, which is a marked difference that reflects a promising result of using homoeopathic medicines [Figures 4a and b].
- (a) Dermatology life quality index (DLQI) score at baseline and (b) DLQI score post-treatment.
The individual curative response of homoeopathic medicine was assessed through the Modified Naranjo Criteria for Homoeopathy Inventory.[13] The total score was 7, suggesting a probable association between the medicine and the outcome (definite ≥9; probable 5–8; possible 1–4 and doubtful ≤0). Reporting of the case adhered to the HOMCASECARE guidelines [Table 3].[14]
| Domains | Yes | No | Not sure/NA |
|---|---|---|---|
| 1. Was there an improvement in the main symptom or condition for which the homoeopathic medicine was prescribed? | +2 | ||
| 2. Did the clinical improvement occur within a plausible time frame relative to the drug intake? | +1 | ||
| 3. Was there an initial aggravation of symptom? | 0 | ||
| 4. Did the effect encompass more than the main symptom or condition, that is, were other symptoms ultimately improved or changed? | +1 | ||
| 5. Did overall well-being improve? | +1 | ||
| 6. Direction of cure: Did some symptoms improve in the opposite order of the development of symptoms of the disease? | 0 | ||
| 7. 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 downwards |
0 | ||
| 8. Did old symptoms (defined as non-seasonal and non-cyclical that were previously thought to have resolved) reappear temporarily during the course of improvement? | 0 | ||
| 9. Are there alternate causes (other than the medicine) that with a high probability could have caused the improvement? (consider known course of disease, other forms of treatment and other clinically relevant intervention) | 0 | ||
| 10. Was the health improvement confirmed by any objective evidence? (e.g., laboratory test, clinical observation, etc.) | +2 | 0 | 0 |
| 11. Did repeat dosing, if conducted, create similar clinical improvement? | 0 | ||
| Total score | 7 |
Several previously published case reports show that well-selected constitutional homoeopathic medicines prescribed on the basis of totality of symptoms have been effective in dermatological disorders.[15-18] The primary limitation of this case study is the short duration of follow-up. As ICD is a chronic disease, the chances of recurrence are higher. An observation of at least 2 years is essential to evaluate further recurrence of these complaints.
CONCLUSION
The present case report provides concrete evidence of the successful treatment of ICD with constitutional homoeopathic medicine. This case has highlighted the importance of holistic approach in the treatment wherein the individuality of a patient is considered for remedy selection, not just disease symptoms. This case report can help clinicians enhance their knowledge about managing patients with ICD. However, more studies with large sample size having strategic approach, such as randomised controlled trials, are required to demonstrate the efficacy of homoeopathy in treating ICD.
Acknowledgments
The authors express their gratitude to the patient who actively participated in the case taking and for being patient throughout the follow-ups. We are also thankful to Dr. Deepti Diwan and Dr. Swati for the manuscript review and fruitful suggestions. The authors are also grateful to the pharmacist for their contribution.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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