Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Book Review
Case Report
Case Series
Editorial
JISH Reviewers List
Obituary
Original Article
Pilot Research Projects/Observational Studies
Policy Paper on Homoeopathic Education/Research/Clinical Training
Review Article
View/Download PDF

Translate this page into:

Case Report
5 (
1
); 24-29
doi:
10.25259/JISH_29_2021

Irritant contact dermatitis treated with constitutional homoeopathic medicine – A case report

Department of Repertory, Madhav Homoeopathic Medical College and Hospital, Sirohi, Rajasthan, India
Department of Homoeopathic Materia Medica, Madhav Homoeopathic Medical College and Hospital, Sirohi, Rajasthan, India
Corresponding author: Hanuman Ram, Department of Homoeopathic Materia Medica, Madhav Homoeopathic Medical College and Hospital, Sirohi, Rajasthan, India. drhrchoudhary@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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].

Figure 1:: (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].

Table 1:: Analysis of the case.
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
Figure 2:: 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]

  1. Mind – Ailments from – anger – suppressed

  2. Mind – Company – aversion to – loathing of company

  3. Mind – Anxiety – family; about his

  4. Generals – Food and drinks – sweets – desire

  5. Stomach – Thirst – extreme

  6. Perspiration – Profuse

  7. Skin – eruptions – blackish

  8. Skin – eruptions – discharging – glutinous

  9. Skin – eruptions – discharging – thick

  10. Skin – unhealthy.

Repertorial analysis [Figure 2]

  1. Sepia officinalis – 12/7

  2. Calcarea carbonicum – 14/6

  3. Graphites – 14/6

  4. Lycopodium clavatum – 14/6

  5. 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].

Table 2:: Timeline including follow-up of the case.
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.

Figure 3:: (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].

Figure 4:: (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]

Table 3:: Assessment of the case according to the Modified Naranjo Criteria.
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.

References

  1. , , , . Contact Dermatitis Treasure Island, FL: StatPearls Publishing; .
    [Google Scholar]
  2. , , , , , . Contact dermatitis: Etiologies of the allergic and irritant type. Acta Dermatovenerol Alp Panonica Adriat. 2020;29:181-4.
    [CrossRef] [Google Scholar]
  3. , , . Contact dermatitis in patient with chronic venous insufficiency. Trakia J Sci. 2014;12:245-9.
    [CrossRef] [Google Scholar]
  4. , . Diagnosis and management of contact dermatitis. Am Fam Physician. 2010;83:249-55.
    [Google Scholar]
  5. , . Current Quality of life tools available for use in contact dermatitis. Dermatitis. 2016;27:176-85.
    [CrossRef] [PubMed] [Google Scholar]
  6. , . Irritant contact dermatitis with secondary infection treated with individualised homoeopathic medicine a case report. Int J AYUSH Case Rep. 2021;5:187-96.
    [Google Scholar]
  7. . RADAR 10. Archibel Homoeopathic Software Available from: http://www.archibel.com [Last accessed on 2021 Sep 19] Isnes, Belgium: Archibel; .
    [Google Scholar]
  8. . A Comparison of the Chronic Miasms, Psora, Pseudopsora, Syphilis, Sycosis New Delhi: B. Jain Publishers (P) Ltd.; . p. 1-86.
    [Google Scholar]
  9. . Lectures on Clinical Materia Medica in Family Order (4th ed). New Delhi: B Jain Publishers (P) Ltd; .
    [Google Scholar]
  10. . Principles and Practice of Homoeopathy (7th ed). New Delhi: B Jain Publishers (P) Ltd; .
    [Google Scholar]
  11. , , , , , , et al. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2:e088.
    [CrossRef] [PubMed] [Google Scholar]
  12. , , , , . The dermatology life quality index 1994-2007: A comprehensive review of validation data and clinical results. Br J Dermatol. 2008;159:997-1035.
    [CrossRef] [PubMed] [Google Scholar]
  13. , , , , , , et al. Evaluation of the modified naranjo criteria for assessing causal attribution of clinical outcome to homeopathic intervention as presented in case reports. Homeopathy. 2020;109:191-7.
    [CrossRef] [PubMed] [Google Scholar]
  14. . Homeopathic clinical case reports: Development of a supplement (HOM-CASE) to the CARE clinical case reporting guideline. Complement Ther Med. 2016;25:78-85.
    [CrossRef] [PubMed] [Google Scholar]
  15. , . Effect of individualized homoeopathic medicine in psoriasis: A case report. Natl Homoeo Rec. 2019;15:3.
    [Google Scholar]
  16. , , , . Plaque Psoriasis Successfully Treated with an Individualised Homoeopathic Medicine Lycopodium: A Case Report. 2020
    [CrossRef] [Google Scholar]
  17. , , , . A case report of vitiligo and its psychological impact managed with Homoeopathy. World J Pharm Med Res. 2020;6:240-6.
    [Google Scholar]
  18. , . A case report for successful treatment of atopic dermatitis (AD) with a constitutional homoeopathic medicine Natrum muriaticum. Int J Homoeopath Sci. 2020;4:46-51.
    [Google Scholar]
Show Sections