ABSTRACT: Warts are one of the common dermatological disorders caused by human papilloma viruses encountered in our day to day life. These are cutaneous or mucosal infection needs proper care and treatment to prevent its transmission and complete healing. Although mostly warts are dealt with the therapeutic approach, i.e. on the basis of its peculiar type and location but it can even be successfully treated by constitutional approach. This article is regarding a case of warts treated successfully with Nux vomica selected as the simillimum and proved its effectiveness in a short period of time.
KEYWORDS: Warts, human papilloma viruses (HPVs), homoeopathic treatment, Nux vomica, constitutional approach.
ABBREVIATIONS: outpatient department (OPD), human papilloma viruses (HPVs), potential differential field (PDF)
INTRODUCTION: Warts are considered as common, benign, epidermal lesions caused by human papillomavirus infection.1 On an average, 7-10 per cent of the population are affected by this disease. A peak incidence of warts is seen between 12 and 16 years of age.Transmission can occur by direct skin-to-skin contact, indirect contact by sharing things like towels or razors that have touched a wart. Genital warts can either be transmitted intra uterine or unprotected sexual activity.2,3 They are usually are asymptomatic, may be tender sometimes seen as small fleshy, grainy bumps with colours ranging from flesh-coloured to white, pink or tan.4 The type of wart is determined by its location and structure and are differentiated ascommon warts (verrucae vulgaris), filiform warts, plantar warts (verruca plantaris) and palmar warts, flat warts (verruca plana) , genital warts, periungual warts, mosaic warts and cystic warts.2 For diagnosis cardinal sign of the wart should be assessed, i.e. the absence of skin lines crossing their surface and the presence of pinpoint black dots (thrombosed capillaries) or bleeding when they are shaved is to be insured.1,2,4 In homoeopathy, wart type of growths are considered to fall under the Hahnemann’s sycotic miasm and majorly seen treated by its peculiar type and location.
CASE PROFILE – The patient, 28 year male, into the profession of hotel management reported in the OPD at Dr. Girendra Pal Homoeopathic Hospital and Research Centre on 12/08/2020, with the complaint of a fleshy wart on the chin area since 6 months with no itching, burning or discharge. The wart appeared suddenly and was gradually noticed by him due to its increasing size. Along with this, he also suffered from regular burning in the epigastrium and all through the oesophagus after eating (especially in the odd hours, due to his duty). Patient was very much bothered about his physical appearance due to the complaint and wanted to get rid of it as early as possible (impatient), mentioned that this was because he has to look presentable at duty.
Past history- He experienced severe bout of bloody vomiting 10 months back and took allopathic treatment for that and advised to limit his alcohol intake. Dengue 2 years back.
Family history- Maternal and paternal grandmother and grandfather have diabetes and hypertension. Mother is suffering from urticaria and hypothyroidism since long and is on allopathic treatment.
Personal history: He is a Non-vegetarian and likes spicy food and addicted to liquor on a regular basis but currently not taking it since march (at home). Desire for alcohol almost every alternate day.
Mental symptoms- He admitted that he is angered or irritated at trifles, if the work is not done according to his expectation. He cannot control his anger when crossed and can become violent.According to his peers, patient is leading a sedentary lifestyle, not inclined to any physical activity and has an irritable temperament. They confirmed his violent anger and that he is disposed to even throw things in anger; especially when his opinion is crossed. Not easily satisfied with the things done for him, gets offended easily.
Physical generals– Patient was towards chilly, sensitive to cold drinks, had throat affections readily. Appetite is hampered, when hungry he overeats and meals are at odd timing. Has burning along the oesophagus often which aggravates after eating, regularly takes antacids for that. Nausea and bitter taste in mouth in the morning. Frequency of the urine is increased. Ineffectual urging for stool, unsatisfactory, passed in small quantity. Loose stools follows the day after hard drinks. The sleep cycle is altered due to the odd duty hours, can’t sleep till late at night, woke up unrefreshed. Irritability when disturbed by any noise while sleeping. Perspiration reduced, overall dryness of skin. Desire for alcohol (every alternate day, 60ml approximately). He has tendency to bloody saliva in the morning occassionally.
Physical appearance: Drunken appearance of the face with slight ptosis of the eyes.
Particular symptoms: Single fleshy wart, filiform type on the chin, no tenderness present.
Analysis of the symptoms (Table 1):
|Irritable Can’t control his anger, can become violentAngry at triffling events, when crossedWants work according to him, not easily satisfiedNot inclined in any physical activity||Nausea and bitter taste in mouth in the morningOvereats when hungry, odd timing of mealsOften burning along oesophagus, <after eatingUnsatisfied by stools, ineffectual urging, defecated in small quantitiesLoose stools, indigestion day after hard drinksUnrefreshing sleep, can’t sleep till late at nightGreat longing for alcoholOverall dryness of the skin, decreased perspiration||Small, single, fleshy wart on the chin ; no burning, itching or bleeding; no tenderness|
Table 1: The analysis of case symptoms under different heads.
Evaluation of the symptoms: The symptoms based on their importance are graded in following descending order:
|Irritable temperament+++Angry at triffles, when crossed+++Violent anger, can throw things in anger+++Not satisfied with the work readily+++Nausea and bitter taste in the morning+++Burning along the oesophagus, aggravates after eating+++||Unsatisfactory stools, with ineffectual urging+++Great longing for alcohol+++Desires spicy food++Sleep disturbed easily, difficulty in sleep till late++Tendency for bloody saliva (once a week)++Small, fleshy wart on the chin++|
Considering the symptom totality of the patient, Kent repertory was selected and reportorisation was done using Radar10.0 software shown in Figure 1.8
Figure 1: Repertorial chart of the case.
Prescription and justification: After the in depth case taking and considering all the aspects of the case, the patient was prescribed Nux vomica 200CH, single dose, at night, followed by placebo for 15 days. In this case, the mental symptoms and physical generals of the patient were more valuable than the particular complaint so emphasis was laid on these for the selection of Nux vomica (Figure 1).8 The characteristic mental symptoms of the patient were gathered both from the patient and cross verified from the attendants to rule out any veil, thus Kent repertory was preferred for reportorisation. Also, there were many physical generals kept in mind as PDF (potential differential field) to reach out to the simillimum.9 Patient was advised to maintain proper hygiene of the face and avoid any kind of fancy shaving creams or any local application and be cautious while shaving not to cut off the wart voluntarily.
Follow ups –
|26/08/2020||Slight itching/irritation in the wart since last week. Feeling as if the wart is increasing in size. Burning along the oesophagus ameliorated (not regularly experienced as before) Nausea in the morning is better. Slight more worried about the wart, whether it will be removed or not, not confident due to that.||Placebo 30 for 15 days|
|10/09/2020||No irritation of the wart at present. No burning in the oesophagus experienced after eating. Nausea in the morning ameliorated No episode of bloody saliva. Gained confidence about the treatment||Placebo 30 for 15 days|
|23/09/2020||Slightly detached feeling at the base of the wart. Not increasing in size. Burning along the oesophagus relieved. Nausea in the morning is relieved. Patient feeling more confident on his duty.||Placebo 30 for 15 days|
|14/10/2020||Wart detached on its own few days back. No burning along the oesophagus. No episode of bloody saliva. Patient confident enough.||No prescription.|
Table 2. Shows the follow up dates with the indication for prescription.
Figure 2: Picture of patient before treatment Figure 3: Picture of the patient after treatment
Discussion: There are many potential medicines for treatment of warts in homoeopathic materia medica, be it therapeutic or constitutional. It is evident from some studies that Thuja occidentalis has effectiveness in verruca vulgaris, verruca plana and verruca plantaris.6 Also effectiveness of other medicines like Ruta graveolens, Calcarea carbonicum, Antimonium crudum, Causticum, Nitric acid, Dulcamara, Natrum muriaticum and Opium on different types of warts have also been reported.7 But the key indicator for homoeopathic prescribing is the totality of the symptoms, thus when the case is studied in depth, the simillimum selected can relieve the patient of all the troubles apart from the chief complaint as in this case. Although Nux vomica is never considered a chief remedy for warts nor it comes to our mind, but when a medicine seems indicated based on the totality, it should never be ignored even if it is not amongst the first grade medicine for the particular complaint, as it is evident from the above case. Also there was no need felt for repeating the medicine in the subsequent follow-ups as patient showed overall marked improvement after the first dose.
Conclusion: In a case of warts, although many medicines are indicated therapeutically, based on its type or location in different materia medica and repertory, but it is also possible to get results if there is proper simillimum found. This case report reconfirms that warts can be successfully managed by individualised homoeopathic approach, as Nux vomica managed to do and prevent the resulting morbidity for the patient in a short period of time.
- Dinulos J. Warts – Dermatologic Disorders – MSD Manual Professional Edition [Internet]. MSD Manual Professional Edition. 2020
- Khanna N. Illustrated synopsis of dermatology and sexually transmitted diseases. New Delhi: Reed Elsevier India Pvt. Ltd.; 2016.
- Aboud, A. and Nigam, P., 2020. Wart (Plantar, Verruca Vulgaris, Verrucae). Available at: <https://www.ncbi.nlm.nih.gov/books/NBK431047/> [Accessed Feb 2021].
- Common warts – Symptoms and causes [Internet]. Mayo Clinic. 2020 [cited 11 February 2021]. Available from: https://www.mayoclinic.org/diseases-conditions/common-warts/symptoms-causes/syc-20371125
- Warts: Types & Home Treatment [Internet]. Healthline. 2020 [cited 12 february 2021]. Available from: https://www.healthline.com/health/skin/warts#when-to-see-a-doctor
- Gupta R, Bhardwaj OP, Manchanda RK. Homoeopathy in the treatment of warts. Br Homeopath J 1991;80:108‑11.[Internet]Available at: https://www.slideshare.net/IlyaRazinkov/documentslidecomhomoeopathyinthetreatmentofwarts-1991[Accessed 20 Feb. 2021].
- Manchanda R.K., Mehan N., Bahl R., Atey R., “Double Blind Placebo Controlled Clinical Trials of Homoeopathic Medicines in Warts and Molluscum contagiosum,” CCRH Quarterly Bulletin, 1997; 19: 25-29. [Internet] Available at: https://www.littlemountainhomeopathy.com/warts[Accessed 20 Feb. 2021].
- RADAR [computer program]. Version 10.0. London: Archibel Homeopathic software.
- Kent J.T, Repertory of the Homoeopathic materia medica. B.Jain Publication.
About the author:
Dr Nanritam Chopra, MD Scholar, Dept. of Materia Medica, Dr. M.P.K. Homoeopathic Medical College, a constituent college of Homoeopathy University, Jaipur