Dr. Smita Brahmachari,Dr. Smita Brahmachari,M.D. (Repertory) from N.I.H., Kolkata.M.D. (Repertory) from N.I.H., Kolkata.

M.O., Dept. of AYUSH, M.O., Dept. of AYUSH,

Govt. of NCT Delhi.Govt. of NCT Delhi.

The skin is the largest human organ. It fulfils a variety of functions, of which the most important are as follows :

Separation and protection Touch and contact Expression and representation Sexuality Respiration Excretion (sweat) Temperature regulation All these diverse skin functions nevertheless have a common theme

that hovers between the two poles of separation and contact. For us, the skin is our outermost physical boundary, and yet at the

same time it connects us to the outside world and brings us into contact with our environment. It is via our skin that we presents ourselves to the world.

For a start, skin serves as a reflective surface for all our internal organs.

The experienced practitioner is capable of seeing and feeling from the skin the condition of the various organs, and equally of treating these organs via their particular projection sites on the skin.

If the skin is the outward expression of what is going on inside us, then every attempt artificially to alter that expression is necessarily an act of dishonesty.

A male child of three years came with his father on 6th December 2013 with complaint of severe pruritic painful eruptions all over the body with thick scab formation along weeping and crusting of eruptions at various places especially face and scalp and swelling of face. The eruption on trunk and extremities were dry, scaly and thickened. The complaint started at 6 months of age in month of May. The eruptions were more aggravated since 15 days.

On observation the child was undernourished, dark complexioned, yellowish discolorization of sclera, brownish discolorization of hair and scalp full of eruptions. The child was very irritable, became restless on close examination of his eruptions, but sat quietly in his father’s lap. The child was totally covered up, could not bear being slightly uncovered as his eruption become more painful and cried on being exposed to open air. His father had brought the child to dispensary by keeping even his face being covered up with a shawl. His father reported that he cried when combing his hair and while urinating complaining burning micturition. He liked solitude, played with his own toys alone and closes the door if any neighbourhood child comes to play with him.

He has a great liability to take cold and hence suffers from recurrent attack of cough and cold and need multiple nebulization for asthmatic episodes.

The child was admitted in RML Hospital on 14th February 2013 with diagnosis of Atopic dermatitis, eosinophilia and UTI induced hypertension. During the time of admission, ultrasonography was done which revealed intusseception with multiple lymphadenopathy; haemogram revealed microcytic, hypochromic anaemia with anisopoikilocytosis, leucocytosis, tear drop cells and eosinophilia.

He had also recurrent attack of cystitis before being admitted and taken treatment from different hospitals. He was discharged from hospital in a stabilized condition with prescription of ointment for local application and antihistamine (cetrizine). Since then he is regularly taking the prescribed medicine.

Family history revealed asthma in maternal grandfather and allergic rhinitis in father’s elder brother.

The child liked potatoes, salt, and pickles in his diet and disliked vegetables.

He had a good appetite but as soon as he started eating feels nauseated after few mouthfuls.

His bowel movements were regular and 3-4 stools a day. He had urge for stool during eating and passed after meals.

He perspired normally from scalp and face. His stool and urine were offensive. He disliked bathing and uncovering as it

increased pain and caused violent itching, burning and scratching all over the body.

The case was started with Sulphur 30/1 dose as the child was under the repeated and prolonged use of skin ointments as local application for eruptions since the onset of complaint.

On the very second day after taking Sulphur 30, there was onset of fever with chilliness < night esp. at 12 – 1 am, thirsty during fever, waked up 4 times to drink water, was very irritable, shivering all over the body, at the same time heat of the head and cool hands and feet.

The case was now prescribed Arnica 30 on the keynote symptom…fear of being approached or being touched, in 9 doses, thrice daily for 3 days and later followed by placebo for 7 days.

The rubric taken into consideration for prescribing Arnica from KENT’s REPERTORY was…‘FEAR, approaching him, of others, lest he be touched’ (single medicine…ARNICA in highest grade).

Not to be forgotten other valuable guiding symptoms further confirming Arnica were “difference of temperature in various parts of body, sensitiveness of whole body and weeping skin eruptions with symmetrical distribution”.

The patient responded very well to Arnica and fever subsided with improvement in skin condition.

After continuing Arnica for few days, there was again appearance of old symptom….nausea while eating, irritableness increased, relapse and remission of febrile condition with mid night aggravation and skin symptoms reverting back to original condition, anorexia, frequency of stool increased to 4 – 5 times, defecating immediately and during meals.

The prescription was now changed to NITRIC ACID, the trimiasmatic polycrest medicine. He was prescribed Nitric acid 200, single dose on 23rd December and till today (29th january) on placebo.

The basis for prescription were…symptom like Arsenic (the complementary chronic remedy was Acid nit); chilly patient, disposed to gastroenteritis, discharges being offensive (urine and faeces), craving for salty food, equally worse in hot and cold weather and excessive irritableness of mind and physical complaints.

There was no appearance of fever after taking Acid nit and patient as a whole is very much better. At initial visit he never responded at any question I asked him, sat quietly and but later after taking Nitric acid he has started answering by nodding his head and his parents say also that his mental irritableness has decreased.

At this juncture it’s too early to give any comment about the case. But the beautiful action of our medicines instills conviction in me to push up our boundaries and take up more cases of AD to nullify the unfair words written in various articles published in reputed peer reviewed homoeopathic journals that homoeopathic medicines have no action in dermatological skin disorders especially AD and hence should be never prescribed in such cases in paediatric population.

Case No.1…Initial visit

Case No.1….under Arnica 30

Case No.1….under Arnica 30

Case No.1….under Nitric acid 200

Case No.1….under Nitric acid 200

Name : Miss S., 10yrs, Female child. Date of 1st visit : 4.2.11.

A diagnosed case of Atopic dermatitis from Safdarjung hospital, New delhi.

P/C : Painful, violent itching, burning eruptions all over the body since 2 yrs < winter and summer especially hot humid weather; < bathing after. Eruptions were bilateral symmetrical. H/o of use of lutica lotion on affected parts, steroid ointments and antihistamines for 2 yrs from the mentioned hospital with relapse and remission of complaint.

Past H/O : Measles. Recurrent tendency to cough, coryza and A.S.O.M. from change of weather

Family H/o : Mother – Asthma and Brother – Crigler – Najjar syndrome

P/Gs : Desire for sour foods, craving for pickles (steals money for the same).

Bowel habits and Urine : Normal. Sweat from face, palms and soles

Physical appearance : the child is lean and emaciated, wheatish complexioned.

Medicine selected: HEPAR SULPH. Reason for selection : With

recurrent tendency to various illness from change of weather, unhealthy skin with painful eruptions; the guiding factor being strong craving for sour food. (SYNTHESIS REPERTORY : Generals, Food and Drinks, sour foods, acids, desire : 3 remedies in 1st grade : Cor-r., Hepar s., and Verat.)

For photographs see the attached word file.

Follow – ups : 4.2.11. – Hepar sulph 30, 4 globules, tds, 5 days. Advice to use Petroleum jelly on

affected parts and coconut oil after bathing when skin is wet and cotton clothes; report after 7 days.

12.2.11 – Pt. was better, complaints worse after bathing – placebo 30, 7 DAYS. 22.2.11 – skin eruptions persists – Repetition of the medicine in 30 th potency, 5

days. The pt. made visits on 27.2.11, 5.3.11 and 15.3.11. where only placebo prescribed. 21.3.11 – Sulph 30 / 2 doses – to clear up the ground for proper action of selected

medicine, remove the miasmatic taint with H/o of long contd. use of allopathic medications (in spite of giving well selected medicine skin unable to regain normal colour) (SYNTHESIS REPERTORY : Generals, History, medicine; of abuse of allopathic : Lach., Nux-v., Puls., Sulph., Thuja., and Zinc.)

26.3.11 – Hepar sulph 200 / 2 doses, OD, followed by placebo 30 , 10 days. 9.4.11 – Pt. was much better – Skin is regaining its normal colour and tone. For photographs see the attached word file reflecting both photos of initial and

last consultation.

These two cases of AD elaborated in this article opted for homoeopathic treatment ( as 2nd choice) after relapse and remission of skin lesions under prolonged modern medicine treatment.

The assessment of outcome was based on : Change in AD extension and severity, Change in pruritus, General and psychological wellbeing, Improvement in quality of sleep. Comparison of affected skin area between first and

last consultation showed significant improvement clinically.

Cases of AD require a long term follow-up as the lesions have tendency to recur.

The term ‘atopy’ was coined in 1923 by Edward D. Perry, comes from the Greek word atopia which means – ‘unusualness’, ‘strangeness’, ‘a being out of the way’.2

Atopy originally involved only asthma and allergic rhinitis, but in 1933 atopic dermatitis (AD) was also included in the group of atopic disorders, in recognition of the close link of this form of eczema with asthma and allergic rhinitis. AD is often the first manifestation of atopic diseases.3

Allergies generally start with AD, and develop towards food allergies in the form of gastro-intestinal, followed by respiratory conditions (rhinitis and asthma).

AD is a chronic, itchy and inflammatory skin disease caused by the interaction between susceptibility genes, environment, drug reactions, skin barrier defects, and immunological factors.4

Recently there has been a constant spurt in the number of cases of allergy, particularly in both developed and developing countries, to such an extent that expressions like “disease of the third millennium” and “allergic epidemic” have been used to describe the phenomenon.5 The upward trend is also true in Indian context.

Included under scaling lesions in dermatological disorders. 6

Looks different at different ages and in people of different races.

Pattern of appearance of lesions…acute weeping lesions, sub acute or scaly lesion or chronic, dry, lichenified lesions.

Onset in childhood in most patients. Onset after age of 30 is very uncommon.

Tendency to recur. Also helpful are : 1. A personal or

family history of atopic disease (asthma, allergic rhinitis, atopic dematitis), 2. Xerosis – ichthyosis, 3. Facial pallor with infraorbital darkening, 4. Elevated serum IgE and 5. Repeated skin infections.

Diagnostic criteria for atopic dermatitis must include pruritus, typical morphology, distribution (flexural lichenification, hand eczema, nipple eczema and eyelid eczema in adults) and chronicity.6

The association of pruritus and the chronic relapsing character of the disorder, along with age-specific morphology and distribution of lesions are the most important features of AD.

The extent of involvement may range from mild and limited, to generalized and severe.

Sleep disturbance is a common occurrence in both the child and his family.

Severe and chronic pruritic, exudative or lichenified eruption on face, neck, upper trunk, wrists and hands and in the antecubital and popliteal folds.

Pigmented persons may have poorly demarcated hypopigmented patches (pityriasis alba) on cheeks and extremities.

During acute flares, widespread redness with weeping, either diffusely or discrete plaques is common.

Lab findings include…eosinophilia and increased serum IgE levels are present.

Must be distinguished from• Seborrhoeic dermatitis (less pruritic, frequent

scalp and face involvement, greasy and scaly lesions, and quick response to therapy).

• Secondary staphylococcal infections may exacerbate AD and should be considered during hyperacute, weepy flares of AD. Fissuring where the earlobe connects to the neck is a cardinal sign of secondary infection.

• Since virtually all pt.s with AD have skin disease before the age of 5, a new diagnosis of AD in an adult over the age of 30 should be made cautiously.

• Atopic like dermatitis associated with marked elevation of IgE; recurrent staphylococcal abscesses; recurrent pneumonia with pneumatocele formation; and retained primary dentition may indicate hyper-IgE syndrome.

Other conditions that must be excluded are scabies, allergic contact dermatitis, cutaneous lymphoma, psoriasis and ichthyosis.

Topical corticosteroids (TC) Topical calcineurin inhibitors Wet-wrap therapy (a damp cotton

dressing+emollients or TC) Antibotics ( for staphylococcus

aureus colonization complicating AD). Antihistamines (sedative effect) Leukotriene antagonists (when with

atopic triad). Systemic immunosuppressants

Patient education…gentle skin care. Use of homoeopathic medicines. General measures: AD have hyperirritable skin. Anything that dries or irritates the skin will

potentially trigger dermatitis. Atopic individuals are sensitive to low humidity and often get worse in

the winter. Adults with atopic disorders should not bathe more than once daily,

washcloths and brushes should not be used, after rinsing, the skin should be patted dry (not rubbed) and then immediately covered with an emollient or coconut oil.

Atopic pt.s are irritated by scratchy fabrics including wools and acrylics. Cottons are preferable. Other triggers of eczema in some pt.s include sweating, hot baths and animal danders.

Once symptoms have improved, constant application of effective moisturizers is recommended to prevent flares.

AD runs a chronic or intermittent course.

Poor prognostic factors for persistence into adulthood in AD include onset in early childhood, early generalized disease and asthma.

Only 40 – 60% of these patients have lasting remissions.

The physician should monitor for skin atrophy. AD may be superimposed with eczema herpeticum.

According to Homoeopathic guidelines, the patient is to be treated not his organs or parts or systems or tissues.

So also in a case of AD our objective of treatment is patient himself not the skin lesions [‘no real cure can take place without a strict particular treatment, individualization of a case of disease’….Aph.82, Organon of Medicine].7

The constitutional treatment is the only way for radical cure of AD.

Our aim is not merely to reduce the hypersensitivity of skin along with skin lesions, but to have improvement in both subjective and objective sphere of the patient as a whole.

‘An older, more chronic disease will yield somewhat later together with all traces of discomfort by the use of several doses of the same more highly potentized remedy or after careful selection of one or another more similar homoeopathic medicine’….Aph.148, Organon of Medicine7

‘In non-venereal chronic diseases those, therefore, that arise from psora, we often require, in order to effect a cure, to give several antipsoric remedies in succession, every successive one being homoeopathically chosen in consonance with the group of symptoms remaining after the expiry of the action of previous remedy (which may have been employed in a single dose or in several successive doses)’…..Aph. 171, Organon of Medicine7

T.P.Paschero writes, “Every writes, “Every experienced homoeopath knows experienced homoeopath knows positively that unless he reaches the positively that unless he reaches the dynamic, constitutional background dynamic, constitutional background of the patient, unless he had of the patient, unless he had penetrated and understood the penetrated and understood the psychological personality and the psychological personality and the vicissitudes of adaptation of life vicissitudes of adaptation of life which give the earlier symptoms of which give the earlier symptoms of neurovegetative dystoria neurovegetative dystoria determining the nature of his determining the nature of his character and its pathology, he will character and its pathology, he will never be able to cure”.never be able to cure”. 8 8

Conventional medical treatment of childhood eczema is again a sad example of symptom suppression.

Homoeopaths understand that skin diseases are not simply skin problems but are the result of an underlying internal disorder.

Using steroid medicines suppresses the natural defensive effort of the body. Although they are highly effective in suppressing symptoms, they do not treat the internal disease. Parents often note that the eczema returns, sometimes worse than before, when conventional medical treatment is stopped.

Most commonly homoeopaths see the suppression of skin symptoms later resulting in a lung condition, usually asthma. The skin does much breathing for the body and acts as a “third lung”, it is predictable that disease would attack the superficial lung first. Then, as the condition is either ineffectively treated or suppressed, it attacks the two primary sources of life’s breath.

Conventional physicians commonly note that eczema and asthma are linked, although they, unlike homoeopaths, generally treat them as separate illnesses and prescribe different medications for them. These physicians do not recognize this internalizing of the disease as suppression or as a worsening of the child’s illness.

Homoeopaths assume that whenever treatment simply controls or suppresses symptoms, true cure will remain elusive, and disease is likely to penetrate deeper into the person.

Homoeopaths understand eczema Homoeopaths understand eczema as a internal disorder, so they as a internal disorder, so they need to choose a medicine need to choose a medicine individually based on a full individually based on a full evaluation of the infant’s evaluation of the infant’s physical, emotional and mental physical, emotional and mental characteristics as well as his or characteristics as well as his or her genetic endowment. An her genetic endowment. An infant’s body is still in a delicate infant’s body is still in a delicate stage of development and should stage of development and should be treated with the utmost care.be treated with the utmost care.1010

AD is frequently seen in homoeopathic practice. Homoeopathic treatment is believed to be effective in this disorder as in eczema in general, including severe cases. But conclusive research defining its real efficacy and best homoeopathic therapeutic strategies is still insufficient.

Although the lack of sufficient research assessing homoeopathic treatment of AD might lead to a negative view of its possible effectiveness, the fact that about half of patients with this disorder resort to this alternative treatment may be an indirect indicator of their dissatisfaction with conventional approaches.

These cases suggests that homoeopathic treatment could be regarded as an effective choice for patients with AD.

It is important for all of us to work more meticulously, on modern scientific parameters, creating enough documentary proofs as per the need of the hour, without jeopardizing the tenets of Homoeopathy, so that our studies leave no gaps when such analyses are repeated.

References1. Dethlefsen T. The skin. The healing power of illness. Brisbane: Element Books Limited, Reprinted

1994.

2. Available from : http://www.etymonline.com (last accessed on 26.1.13)

3. Spergel JM, Paller AS. Atopic dermatitis and the atopic march. J Allergy Clin Immunol 2003; 112: 118 – 127.

4. Leung DY, Bieber T. Atopic dermatitis. Lancet 2003; 361(9352): 151 – 160.

5. Holgate ST. The epidemic of allergy and asthma. Nature 1999; 402: B2 - B4.

6. Mcphee J.Stephen and Papadakis A.Maxine. Dermatological disorders. Atopic dermatitis. Current Medical Diagnosis and Treatment 2012, 51st ed. McGraw Hill Publication, 2012. p. 102 – 104.

7. Hahnemann S. Organon of Medicine, 5th ed. New Delhi: Pratap Medical Publishers (P) Ltd, Indian edition; 1994.

8. Paschero T.P. Homoeopathy. New Delhi: Elsevier, A division of Reed Elsevier India (P) Ltd, South Asian edition; 2007.

9. Ullman Dana. Paediatrics. Discovering Homoeopathy: Medicine for the 21st century. Berkeley, California: North Atlantic Books, 1988. p. 99.

10. Sankaran P. Pathology in Homoeopathy. The Elements of Homoeopathy, Vol.II. Bombay: Homoeopathic Medical Publishers. p. 539