Abstract: Baby girl of 1.6 years belonging to Mangalore has presented with the complaint of fever and vesicular eruptions around the mouth, buttocks and hands. Based on the presenting complaint and psychodynamic sphere of the patient, Lycopodium clavatum was prescribed which proved to be effective in curing the Impetigo. Patient improved in four days.
Keywords: homoeopathy, impetigo, Lycopodium clavatum , vesicular eruptions.
Abbreviations: group A beta haemolytic streptococci (GABHS), staphylococcal scalded-skin syndrome (SSSS), exfoliative toxin A (ETA), in-patient department (IPD)
Introduction: Impetigo is the most common bacterial skin infection of children. Most cases of non-bullous impetigo and all cases of bullous impetigo are caused by staphylococcus aureus. The remaining cases of non-bullous impetigo are due to group A beta haemolytic streptococci (GABHS)1. Impetigo is a highly contagious, superficial skin infection that most commonly affects children two to five years of age. The two types of impetigo are Non bullous impetigo (i.e. impetigo contagiosa) and bullous impetigo. The diagnosis usually is made clinically, but rarely a culture may be useful. Although impetigo usually heals spontaneously within two weeks without scarring, treatment helps relieve the discomfort, improve cosmetic appearance, and prevent the spread of an organism that may cause other illnesses (e.g. glomerulonephritis).2
Exfoliative toxin A, produced by staphylococcus aureus, causes blisters in bullous impetigo and its more generalised form, staphylococcal scalded-skin syndrome. The toxin shows exquisite specificity in causing loss of cell adhesion only in the superficial epidermis. Although exfoliative toxin 2A has the structure of a serine protease, a target protein has not been identified. In 1878, Baron Gottfried Ritter von Rittershain described a severe blistering disease of neonates that is now called staphylococcal scalded-skin syndrome (SSSS), or Ritter disease. This disease was soon recognized to be a more severe form of what had been called pemphigus neonatorum, which occurred in epidemics in neonatal nurseries, and of sporadic localized bullous impetigo. The blisters in these diseases are caused by toxins, most often exfoliative toxin A (ETA), produced by Staphylococcus aureus. In SSSS, a local infection releases the toxin into the circulation, whence it produces widespread skin blistering, whereas in bullous impetigo the toxin causes blistering locally at the site of
Patient started with fever initially. It was sudden in onset. After first day of fever patient started with small, reddish vesicular eruptions around mouth. Eruptions are aggravated by heat and amelioration by application of cold water. Later the eruptions spread to buttocks, hands and then whole body. The eruptions are painful due to which patient is weepy. Eruptions around the mouth are crusty. Patient is highly irritable mentally.
Family history: No family history of impetigo or any other systemic disease.
Personal history: Patient has reduced appetite, loss of thirst, and disturbed sleep due to the complaint.
General physical examination: Patient is well oriented with place, time and person.
Weight: 8 kg
Temp: On the day of admission in IPD: 100.70F.
Temperature dropped to 980 F.
On examination: vesicular eruptions around buttocks, mouth, hands.
Investigation: all the parameters are normal.
PROVISIONAL DIAGNOSIS: NON-BULLOUS IMPETIGO3:
- Crops of blisters around the mouth, buttocks, upper and lower extremities.
- Crusty eruption around the mouth.
DIFFERENTIAL DIAGNOSIS: HAND FOOT MOUTH DISEASE3
It was ruled out because:
The patient presented with eruptions more on palms, soles and inside mouth, while impetigo did not show up in mouth.
ANALYSIS OF THE CASE:
|COMMON SYMPTOMS: Fever.Reddish vesicular eruptions around the mouth, hands, buttocks.Crusty and painful eruptions.||UNCOMMON SYMPTOMS: Reduced appetite.Absence of thirst. Sleep disturbed. Irritability, obstinate, weeping, screaming.|
|Mental generals: Irritability.Weeping. Screaming.Obstinate.||Physical generals: Sleep disturbed.Absence of thirst. Reduced appetite. Irritability.||Characteristic particulars: Reddish, vesicular eruptions around the mouth, hands, buttocks.Crusty and painful eruptions.|
Though Arsenicum album gets 19 marks, Lycopodium clavatum was chosen based on the mental generals (highly irritable and obstinate) and characteristic particulars of the patient. Millesimal potency was chosen to avoid any kind of aggravation as it was impetigo and as also the child was extremely irritable, 0/1 potency given 1 teaspoonful every 3rd hourly gradually reduced the eruptions and irritability of the child.
Prescription: Lycopodium clavatum 0/1/ 1teaspoonful every 3rd hourly was given.
Patient improved in FOUR days.
|FOLLOW UP During the course of medication, the vesicular eruptions dried and crusted on buttocks, around mouth, hands, perineum. Appetite was slightly diminished. Sleep: better. New vesicular eruptions appeared on hands and slight crusting around mouth. All the generals are good||REMEDY Lycopodium clavatum 0/1 1tsp every 3rd hourly was given. Lycopodium clavatum 0/1, 1tsp-1tsp-1tsp|
|5-1-2022 6-1-2022||Patient was 70% better. All the other generals are good. Patient was completely better.||Lycopodium clavatum 0/1 1tsp- 1tsp- 1tsp. Lycopodium clavatum 0/1 was stopped , SL 1Packet was given|
Lycopodium: Clinicals ─Abdomen, distended. Abortion. Albuminuria. Aneurism. Angina pectoris. Aphasia. Bright’s disease. Cancer. Cataract. Constipation. Consumption. Corns. Cough. Cramps. Cystitis. Debility. Diphtheria. Distension. Dropsies. Dysentery. Dysmenorrhoea. Dyspepsia. Ear, eczema behind. Eczema. Ephelis. Epistaxis. Gall-stone colic. Glands, swelling of. Goitre. Gout. Gravel. Haematuria. Haemorrhoids. Hair, falling out. Hands, chapped. Heartburn. Heart, diseases of. Hemiopia. Hernia. Hydropericardium. Hypochondriasis. Hysteria. Impotence. Influenza. Intermittent. Intertrigo. Renal colic. Rheumatism. Rhagades. Sciatica. Sleep, abnormal. Speech, disordered; stammering. Strains. Sunstroke. Taste, abnormal. Throat, sore.
Mind ─ Silent, melancholy, and peevish humour; despair of eternal salvation. Desponding, grieving mood. Sadness when hearing distant music. Anguish, esp. in region of epigastrium, with melancholy and disposition to weep; especially after a fit of anger, or on the approach of other persons. Sensitive disposition. Dread of men; desires to be alone, or else aversion to solitude. Excitement after a glass of wine, almost mischievous. Irritability and susceptibility, with tears. Irascibility. Obstinacy. Estrangement and frenzy, which manifest themselves by envy, reproaches, arrogance, and overbearing conduct. Disposition to be very haughty when sick; mistrustful; does not understand anything one says to them; memory weak Aversion to speaking. Fatigue from intellectual exertion, and incapability of devotion to mental labour. Giddiness. Inability to express oneself correctly; misapplication of words and syllables. Confused speech. Confusion about everyday things, but rational talking on abstract subjects. Inability to remember what is read. Stupefaction. Dullness.
Skin ─ Gnawing and itching in daytime, on getting heated, or in evening, before lying down. Tendency of the skin to become chapped. Painful eruptions. Nettle-rash (chronic). Large red spots on skin. Itching maculae hepaticae. Insensible tetters, of a yellowish brown, wrinkled or moist, purulent, full of deep cracks and thick scabs. Large furunculi, which return periodically. Mercurial ulcers. Bleeding ulcers, with shooting pain, which burn while being dressed, or with nocturnal tearing and itching. Fistulous ulcers, with callous, red edges, reversed and shining, sometimes with inflammation and swelling of the part affected. Excoriated places on the skin of children; the sore places are humid. Impetigo; raw places bleeding easily. Skin unhealthy, corrosive vesicles. Naevus maternus, moist; scurfy; tearing and painful., Want of action of the skin. Itch, burning; creeping. Skin scurfy; sticky; clammy. Brown mortification. Pale swelling. Varices suppurating. Chilblains. Great dryness of the skin.5
The 50 millesimal scale was introduced by Dr Hahnemann in the 6th edition of organon of medicine in aphorism 270. This name was given by Dr Pierre Schmidt of Geneva. Potencies prepared under this method are named by Dr Schmidt as fifty millesimal potencies as the material part of the medicine is said to be decreased by 50000 times for each degree of dynamisation. Hahnemann himself termed this new method as renewed dynamisation.
In India and Bangladesh, the potency prepared by this scale is designated as 0/1, 0/2, 0/3, 0/4 and M/1, M/2, M/3, M/4 ETC. In the west it is designated as 1/0, 2/0, 3/0, etc.
Minimum homoeopathic aggravation—Homoeopathic aggravation may be avoided, minimised, even controlled due to less quantity of material quantity. It can be used even in the most deplorable cases without the fear of dangerous and violent aggravation.
Quick cure of chronic diseases –Long lasting and complicated and intractable chronic diseases may be cured within the shortest period of time
Frequent repetition permissible-Both in the acute and chronic diseases the remedy can be frequently repeated without the fear of medicinal aggravation. It can be repeated daily or every 1, 2, 3, 4 or 6 hours.
Skin and mental diseases-Very useful in skin and mental diseases where least aggravation may be very much harmful to the patient and confusing to the physician. This potency can affect the cure smoothly without least aggravation.6
As Lycopodium clavatum matches with mental generals and characteristic particulars of the patient, it was selected. Lycopodium clavatum proved to be useful in treating impetigo.
This case highlights the usefulness of homoeopathic medicines in treating non-bullous impetigo. Patient responded positively to the homoeopathic treatment and relieved her of impetigo. Lycopodium clavatum 0/1 potency was useful in curing the patient.
- Cole, Charles, and John D. Gazewood. Diagnosis and treatment of impetigo, 2007.
- Hartman-Adams, Holly, Christine Banvard, and Gregory Juckett., Impetigo: diagnosis and treatment, 2014.
- Amagai, Masayuki, Toxin in bullous impetigo and staphylococcal scalded-skin syndrome targets desmoglein ,2000.
- Dr Kent JT, Repertory of Homoeopathic Materia Medica, B Jain publishers.
- Dr Clarke, A practical dictionary of Materia Medica, B Jain publishers.
- Hahnemann S. (1982) Organon of Medicine, 6th ed. B. Jain Publishers, New Delhi.
About AUTHOR: DR AMALA.A(MD-1)
DEPARTMENT OF PAEDIATRICS
FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,
DERALAKATTE, MANGALURU- 575018
Under the guidance of: DR JYOSHNA SHIVAPRASAD
PROFESSOR AND HOD, PAEDIATRICS
FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,
DERALAKATTE, MANGALURU- 575018