Learning Clinical Signs And Rare Medicines In Dermatological Disorders

Abstract: Dermatological disorders are one of the most common disorders. Skin disorders vary greatly in symptoms and severity, so sometimes diagnosis becomes a difficult task. Clinical signs refer to the observation or findings on examination, which retain unquestionable importance in treating skin disorders. Homeopathy is considered as one of the best alternative systems for treating skin disorders. Sometimes well-proven medicines do not produce desirable results and then rare medicines can be proved beneficial. This article is an attempt of explaining various clinical signs of dermatological disorders and exploring the literature available on rare remedies.
Keywords: Clinical signs, dermatological disorders, rare medicines, homeopathy.
Introduction
Skin disorders are very frequently and commonly occurring disorders, which may appear in the form of a simple rash to troublesome ulcerations, tumors, etc. It is usually wise to have a look at the lesions first to avoid unnecessary and irrelevant questions to the patients. Depending upon the type of lesions and probable diagnosis, further details may be enquired and noted. (9) Sometimes the diagnosis of dermatological disorders becomes difficult; in such conditions, clinical signs can be helpful to confirm the diagnosis. So, it is essential to have knowledge of these signs in learning skin disorders. Here some clinical signs are listed as below:
1.Antenna sign – It is seen in keratosis piaris in which individual follicles show a long strand of keratin glinting when examined in tangentially incident light. (11)
2.Asboe –Hansen sign (Bulla spread sign) – It is seen in Pemphigus Vulgaris and sometimes in bullous pemphigoid. Extension of the blister in a direction opposite to the side of pressure. On pressure, edge sharp in pemphigus and edge round in bullous pemphigoid. (14)
3.Auspitz sign – Most commonly seen in psoriasis. Pinpoint bleeding on grattage of affected areas (21). Other dermatoses where Auspitz sign can be positive is Darier’s disease and actinic keratosis. (12)
4.“Breakfast, lunch and dinner” sign – The bites of bed bugs (Cimex lectularis) usually follow a linear pathway in a group of three to five blood meals and are often referred to as “ Breakfast, lunch and dinner” or “Breakfast, lunch, and supper” sign. (8)
5.Carpet Tack sign – It is seen in lupus erythematosus. Removal of the overlying scales demonstrates the characteristic ‘carpet track’ or langue du chat (cat’s tongue) sign. (21)
6.Coudability sign – It is normal looking hair tapered at the proximal end in the perilesional hair-bearing scalp and easily be made to kink when bent or pushed inward. (23)
7.Crowe’s sign – Seen in Neurofibromatosis. Axillary or inguinal freckling. (25)
8.Darier sign – It is seen in mastocytoma. Rubbing or heating the lesions may result in its swelling and red halo. (15)
9.Friar tuck sign – This is described in relation to trichotillomania, where the patient plucks his own hair either in a wave-like pattern across the scalp or centrifugally from a single starting point. Hair over the occipital area is mostly spared in trichotillomania. (7)
10.Gottron’s sign – It is seen in Dermatomyositis. Symmetrical, linear, lilac papulosquamous plaques over interphalangeal or metacarpophalangeal joints, elbow, and knees. (13)
11.Hamburger sign – This sign has been described in relation to trichotillomania, wherein there is a vertically oriented split of hair shafts and proteinaceous material and erythrocytes are present in the split resembling a hamburger within a bun. (20)
12.Hang glider sign – This refers to the dark triangular biting apparatus of Sarcoptes scabiei seen at the end of the subcorneal tunnel. (18)
13.Hanging curtain sign – It is seen in patients with pityriasis rosea. When the skin is stretched across the long axis of the herald patch, the scale is noted to be finer, lighter and attached at one end, which tends to fold across the line of stretch.6
14.Hertoghe’s sign – It is seen atopic dermatitis. Thinning of the lateral eyebrows.21
15.Holster sign – It is seen in dermatomyositis. Pruritic confluent macular violaceous erythema of the lateral thighs.14
16.Hypopyon sign – It is seen in pyoderma and secondarily infected vesiculobullous disorders (eg. Pemphigus, bullous pemphigoid ) Where there is a transverse fluid level comprising of purulent material at the bottom when the patient is in a standing position. (24)
17.Nikolsky’s sign – It is seen in intraepidermal bullous disorder. Application of tangential pressure on normal skin results in the formation of new bulla. (13)
18.Nose sign – It is seen in exfoliative dermatitis in which there is a complete absence of erythema and scaling of the nose and perinasal areas. (1,13)
19.Oil drop sign – Oil spot lesions are yellow-brown spots seen through the nail surface. Psoriasis of the nail bed causes serum and scaling debris to accumulate under the nail plate. (25)
20.Pear sign – Positive in Pemphigus Vulgaris. Collection of fluid in the lower part of bulla due to gravity. (14)
21.Punshi’s sign – In young women and girls having from vitiligo the original white colour of vitiligo macules turns to red-pink during menstruation and after the menstruation, it turns to the original colour. (19)
22.Pup – tent sign – It is seen in nail lichen planus, in which the nail splits and elevates longitudinally with a downward angle of lateral nail edge. (4)
23.Samitz sign – Dystrophic and ragged cuticle seen in dermatomyositis is called as Samitz sign. (21)
24.Shawl sign – It is seen in dermatomyositis. Symmetrical, confluent violaceous erythema extending from dorsolateral aspect of forearms and arms to deltoid region, shoulders and neck. (13)
Role of rare medicines
Homoeopathic medicines treat these disorders in a very effective manner. When homeopathic medicine is given internally, it removes the root cause of external manifestation of internal disease rather than suppression by external application. In Aphorism 190, “All true medical treatment of a disease on the external parts of the body that has occurred from little or no injury from without must, therefore, be directed against the whole, must affect the annihilation and cure of the general maladies by means of internal remedies, if it is wished that the treatment should be judicious, sure, efficacious and radical.”(10)
When well-proved remedies fail to cure, rare remedies can be beneficial. Some rare medicines along with objective and subjective symptoms are listed below:
Astacus fluviatilis
Objective-Nettle rash all over the body, Crusta lactea, with enlarged lymphatic glands, Swelling of cervical glands.Jaundice. (3)
Subjective-Itching on various parts. (2)
Castor Equi
Objective- Psoriasis Linguae. Warts on the forehead and breast. Chapped Hands, Brittle Nails, Cracked and ulcerated nipples.Brittle Nails. (3)
Subjective- Violent itching in the breast. (3)
Chloral Hydrate
Objective-Red blotches, like measles.Urticaria worse, spirituous liquors, hot drinks. Malignant pustules and carbuncles. Wheals come on from a chill; better warmth. Purpura. (3)
Subjective-Intense itching.Stinging and biting here and there as of insects. Pruritus of the whole skin and mucous outlets. Sensation as of a hair on the nose. (2)
Comocladia Dentata
Objective-Redness all over, like scarlatina.Erysipelas.Deep ulcers with hard edges.Leprosy.Red stripes on the skin.Eczema of the trunk and extremities; also of the pustule type. (3)
Subjective-Painful burning in face and arms, violent itching.Tormenting itching and burning over whole body; violent itching and burning, accompanied with an erysipelatous redness. (2)
Copaiva Officinalis
Objective- Nettle rash, isolated patches, pale or bright red, with violent itching; (2) Hives with fever and constipation. Roseola.Bullous eruptions. (3)
Subjective- Itching, raw spots between fingers, Delirium, drowsiness. Itching in the skin with scanty urine and burning in the urethra after urinating. (2)
Euphorbium Officinarum
Objective-Erysipelatous inflammation, especially of the cheek. Biting and stinging, red, swollen.Vesicular erysipelas.Carbuncle; Old torpid ulcer, pustules; Gangrene.Ulcerating carcinoma and epithelioma of the skin. (3)
Subjective-Biting, Stinging, gnawing; burning itching induces scratching.Biting exanthema, torpid, indolent ulcers with biting, lancinating pain. (2)
Hydrocotyle Asiatica
Objective-Dry eruptions.Great thickening of epidermoid layer and exfoliation of scales (ichthyosis).Psoriasis gyrate on trunk and extremities, palms and soles.Pustules on chest. Circular spots with scaly edges. Acne, Leprosy, Elephantiasis.(3) Copper coloured eruptions. (5)
Subjective- Intolerable itching, especially of soles.16Pricking on different parts, itching in several places. (5)
Juglans Cinerea
Objective- Numerous and extensive patches of eruptions on body and extremities, varying in size from a dollar to man’s hand. Chronic eczema of hands, the ichorous and semi- purulent secretion oozing upon exercising the hands, would crust over again, causing most intolerable itching and soreness. (24)
Subjective- Painful itching causing an irresistible inclination to tear off the crusts; could neither sit nor lie with any comfort. (24)
Mancinella
Objective-Intense Erythema.Vesicles.Erysipelas.Large blisters, as from scalds.Pemphigus. (3)
Subjective- Heat rising to face and soon thereafter painful itching, stitching, and burning, continuing all day. (3)
Pix Liquida
Objective- Acne, Eczema, (16) psoriasis. Eruptions on the back of hands. (3)
Subjective-Cracked; itches intolerably; bleeds on scratching. (3) Itching <scratching, < night. Foul-smelling dark coloured discharges. (16)
Rhus Veneta
Objective-Vesicles (herpes). Erysipelas; skin dark red.Erythema Nodosum. (3)
Subjective-Itching; relieved by hot water (chilblains).Nocturnal itching and pain in the long bones. (3)
Vespa
Objective– Cheek much swollen and skin of bright red tint, redness spread rapidly in all directions overhead and down neck, shoulders, back and front of the chest. Prurigo – like, pinkish, lentil shaped spots on hand and forehead, on the neck and all over to feet. (24)
Subjective- Intense itching of part (right side of neck) every day about 3 to 4 a.m, lasting about half an hour. Itching all over to a dreadful degree. (24)
Xerophyllum
Objective- Erythema with vesication and intense itching, Blisters like little lump. Skin rough and cracked. Dermatitis, especially around the knees. Inguinal glands and popliteal fossa swollen. (3)
Subjective -Intense itching with stinging and burning. Sensitive skin. (16)
Conclusion
Clinical signs play a vital role in treating dermatological disorders. So we have to pay attention to these signs in our routine practice which we often neglect. The role of Homoeopathic medicines is very pivotal in dermatological disorders. So we must consider the rare remedies in our clinical practice when well indicated constitutional medicines do not give effective results.
References
1. Agarwal S, Khullar R, Kalla G, Malhotra YK. Nose sign of exfoliative dermatitis: A possible mechanism. Arch Dermatol 1992; 128:704
2. Allen JH. Diseases and Homoeopathy Therapeutics of the skin, Reprint edition, B.Jain Publishers (P) Ltd. 2004
3. Boericke William.New Manual of Homoeopathic Materia Medica with Repertory.Third Revised & Augmented Edition, New Delhi: B.Jain publishers (P) Ltd. 2007
4. Boyd As, Neldner Kh. Lichen planus. J Am Acad Dermatol 1991; 25:593-619
5. Clarke JH.A Dictionary of Practical Materia Medica. Vol-I, Reprint edition, New Delhi: B.Jain publishers (P) Ltd. 2003
6. Dhar S, Kanwar AJ, Handa S. ‘Hanging curtain’ sign in pityriasis rosea. Dermatology 1995; 190: 252
7. Fallen RS, Gooderham M. Bedbugs, An update on recognition and management, Skin Ther Lett 2011; 16: 5-7
8. Gupta Ramji, Manchanda R.K. Textbook of dermatology for Homoeopaths, 4th edition, B.Jain Publishers (P) Ltd, 2011
9. Hahnemann Samuel, Organon of medicine 5th and 6th edition combined, B.Jain publishers (P) Ltd, 2015
10. Judge Mr, McLean WH, Munro CS. Disorders of Keratinization. In Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s Textbook of Dermatology. 7th edition Oxford, Wiley Blackwell, 2004
11. Kangle S, Amladi S, Sawant S. Scaly signs in dermatology. Indian J Dermatol Venereol Leprol 2006; 72:161-4
12. Kanwar AJ, Dhar S, Ghosh S. ‘Nose sign’ in dermatology. Dermatology 1993; 187:278
13. Khanna Neena, Dermatology and Sexually Transmitted Diseases, 5th Edition, Elsevier, Reed Elsevier India Pvt Ltd. New Delhi 2016
14. Khanna Neena, Singh Saurabh, Bhutani’s Color Atlas of Dermatology, 6th edition, Jaypee Brothers Medical Publication (P) Ltd. 2015
15. Marks Ronald, Roxburgh’s common skin diseases, 17th Edition. Hodder Arnold 338 Euston Road, London NW1 3BH, 2003
16. Master Farokh J. Skin Homoeopathic Approach to Dermatology Second Revised Edition, B.Jain publishers (P) Ltd. 2006
17. Neynaber S, Wolff H. Diagnosis of scabies with dermoscopy. CMAJ, 2008; 178:1540-1
18. Punshi Sk, Abroal Sk, Liv.52 in vitiligo. Probe, 1970; 1:12-3
19. Royer MC, Sperling LC. Splitting hair; The hamburger sign in trichotillomania. J Cutan Pathol, 2006; 33:63-4
20. Samitz MH. Cuticular changes in dermatomyositis. A clinical sign. Arch Dermatol 1974; 110:866-7
21. Sehgal Virendra N, Textbook of Clinical DermatologyDiagnosis, 5th edition, Jaypee Brothers Medical Publishers.2011
22. Shuster S. ‘ Cloudability’ A new physical sign of alopecia areata. Br J Dermatol 1984; 111:629
23. Singh S, Gupta S, Chaudhary R. Hypopyon sign in pemphigus vulgaris and pemphigus foliaceus. Int J Dermatol Venereol Leprol 2009; 48:1100-2
24. Sivaraman P., Skin troubles cured by Homoeopathy, 1st edition, B.Jain publishers (P) Ltd, 1994
25. Thomas P Habif, Skin disease, Diagnosis and treatment, 2nd edition, Elsevier, a division of Reed Elsevier India Private Limited.
About the Authors
Dr Charu Agrawal is the Assistant Professor in subject Physiology. She is teaching Physiology for last 3 years at Swasthya Kalyan Homoeopathic Medical College and Research Centre, Sitapura, Jaipur. She has completed her graduation in Homoeopathy Rajasthan Vidyapeeth Homoeopathic Medical College Udaipur and she has completed her MD in Materia Medica from Dr. Madan Pratap Khunteta Homoeopathic Medical College, Hospital and Research Centre, Jaipur. She has own clinic in Pratapnagar, Jaipur.
Dr Keerti Pathak is the Assistant Professor in subject Practice of Medicine. She is teaching Practice of Medicine for last 3 years at Swasthya Kalyan Homoeopathic Medical College and Research Centre, Sitapura, Jaipur. She has completed her graduation in Homoeopathy from Chandola Homoeopathic Medical College and Research Centre, Uttarakhand and she has completed her MD in Repertory from Dr. Madan Pratap Khunteta Homoeopathic Medical College, Hospital and Research Centre, Jaipur.