Abstract: A female reported with the complaint of dryness, cracked and ulcerated skin lesion over right foot for 5 years. She had no relief in complaints despite many treatments. A complete case taking followed by selection of an appropriate remedy relieved her completely which is described in detail below.
Keywords: Atopic dermatitis, Eczema, Graphites, Homeopathy.
INTRODUCTION
This case is an example of chronic Atopic dermatitis of the right foot sole which was cured with the help of Homoeopathy in the most rapid and gentle manner possible. Atopic dermatitis is an endogenous dermatitis triggered by external agents and is characterized by extremely itching and recurring eczematous lesions. Its clinical manifestations depend upon the age of the patients. It results from suitable environmental exposure of genetically susceptible individuals which results in defective skin barrier. It generally shows a personal or family history of atopy. Its incidence is increasing due to increasing exposure to pollutants, indoor allergens and decline in breastfeeding. There are increased IgE levels especially during acute flares. It can be diagnosed clinically by using Hanifin and Rajka criteria for diagnosis of atopic dermatitis. Prick test and serum IgE levels are measured to confirm its diagnosis[1]. It has been coded as L 20.9 under ICD-10 CM diagnosis.[2]
CASE HISTORY
Chief complaints
A female aged 36 years reported with the complaint of dry skin lesion over sole of right foot for 5 years.
History of present illness
Patient was apparently well 5 years back when she developed itching over her right foot. Later she developed some vesicles over there which burst and lead to desquamation of the skin which spread over her foot with immense itching and sticky yellowish discharge. Now she has presented with dry, hard, crusty skin lesion over her right foot which exudes a sticky discharge slightly on pressing (Figure 1). Also, there was an ulceration of skin present over the medial side of her foot. There is itching which gives a burning sensation after scratching. Itching aggravates at night and from warmth. There is aggravation of complaint every winter.
Treatment History
She took allopathic treatment for one year which didn’t help her.
Later she used some Ayurvedic ointment for 6 months which gave her slight relief but aggravated thereafter.
She was not taking any treatment for the last 3 months.
Figure 1.
Gynae & Obs History
Her last menstrual period occured on 18-10-2020 and had no associated complaints. Her menstrual cycle is regular, occurs for 3-4 days, every 32 days and without any abnormalities.
Past and Family History
She had a history of skin allergy 10 years back.
Her family history consists of asthma in her mother while her father had Type-II Diabetes mellitus.
Physical Generals
Patient was thirstless, used to drink less than 2 Litres of water per day during summers too. She had a desire for spicy food and a stronger aversion to sweets. Her bowel movements were irregular and had unsatisfactory stools. She had generalized; offensive, non-staining perspiration pattern. Thermally the patient was chilly.
Mind
Patient became lachrymose while telling about her complaint. On her visit she appeared to be an extrovert. Weep frequently. She had a fear that some misfortune would happen to her. Patient used to think that her death is very close now without any particular reason. According to her husband she does not keep things to herself. and cannot take decisions on her own. She had no desire to do her work and used to anticipate a lot about the future.
DIAGNOSIS
After ruling out all the other possible causes of eruptions, and according to the history of the disease, it was diagnosed as atopic dermatitis of the right foot[1].
CASE ANALYSIS
Analysis and Evaluation of symptoms
Given in Table 1.
| Symptoms of patient | Intensity | Common/ Uncommon | Miasm |
| Mental symptoms Thinks her death is very close | ++ | Uncommon | Psora[3,4] |
| Irresolute | ++ | Uncommon | Psora[3,4] |
| Discontented | ++ | Uncommon | Sycosis[3,4] |
| Anticipation about future | ++ | Uncommon | Psora[3,4] |
| Fear of misfortune | ++ | Uncommon | Sycosis[3] |
| Physical Generals | |||
| Desire- Spicy | + | Uncommon | Psora[3,4] |
| Aversion sweets | ++ | Uncommon | Psora[3,4] |
| Generalized perspiration, offensive odor | ++ | Uncommon | Psora[3,4] |
| Thermal reaction- Chilly | +++ | Uncommon | Psora[3,4] |
| Particulars Dry, hard, cracked skin with itching, <winters, warmth | +++ | Uncommon | Psora[3,4] |
Table 1. Analysis and Evaluation of symptoms with miasmatic analysis.
Repertorial totality
Synthesis 9.0 repertory was used for repertorization[5].
- Mind, Anxiety, future about
- Mind, Death, presentiment of
- Mind, Discontented
- Mind, Fear, misfortune of
- Mind, Irresolution
- Generalities, Food and drinks, sweets, aversion
- Perspiration, Odor, offensive
- Skin, Cracks, winter, agg.
- Skin, Eruptions, dry
- Skin, Eruptions, hard
REPERTORY CHART
Shown in Figure 2.
Figure 2. Repertorial Chart
THE REMEDY
Reportorial results show Graphites as the prominent remedy which covers all the symptoms presented by the patient. After corroboration with the knowledge of materia medica, Graphites was the remedy of choice as it covers the mental disposition as well as the physical disposition of the patient[6,7]. Also, the patient was chilly while Sulphur is hot, Mercurius is ambithermal while Graphites is chilly thermally[8]. Hence, Graphites 30C/ 3 doses were prescribed to the patient.
30C potency was selected according to the susceptibility of the patient. Susceptibility of the patient was moderate due to the more deranged physical state of the patient. The patient belongs to the middle age group and has a moderate level of physical exertion and so was her susceptibility[9].
FOLLOW-UP
First prescription (14/11/2020)- Graphites 30C/OD/ 3 days; Sac Lac/ TDS/ 15 days.
| Date | Symptoms | Prescription |
| 30/ 11/ 2020 | Skin ulceration and cracks – better Dryness- same Anxiety about future- same Stools- satisfactory, irregular (As the skin complaints were getting better, only placebo was given[10]) | Sac lac/ TDS/ 2 Weeks |
| 16/ 12/ 2020 | Skin ulceration and cracks – same Dryness – same No major relief Anxiety about future- same Stools- satisfactory, regular (Since there was no major relief in the skin complaints of the patient but her bowel movements became regular, hence, the same medicine and the same potency was repeated.[10]) | Graphites 30C/OD/ 3 days (Early morning, empty stomach) Sac Lac/ TDS/ 15 days |
| 3/ 01/ 2021 | Skin ulceration and cracks – better Dryness – better Itching increased in the foot. Anxiety about future- same No other complaints. (As the physical complaints of the patient reduced but the mental sphere was not getting better, with an increased susceptibility, hence the potency was raised to 200C.[9,10]) | Graphites 200C/ 1 dose (Early morning, empty stomach) Sac Lac/ TDS/ 15 days |
| 20/ 01/ 2021 | Skin ulceration and cracks healed up. Dryness- better No peeling of skin Itching better Anxiety about future- better (As all the complaints were getting better, only placebo was given.[10]) | Sac Lac/ TDS/ 15 days |
| 10/ 02/ 2021 | Skin dryness and cracks – healed up. Itching- better Anxiety about future- very few thoughts now No other new complaints (As the improvement continued, only placebo was given[10]) | Sac Lac/ TDS/ 15 days |
| 25/ 02/ 2021 | Skin healed up, itching- absent (Figure 3) Anxiety about future- negligible No other new complaints. (Since all the complaints were relieved, only placebo was given for 15 days and the treatment was stopped thereafter.[10]) | Sac Lac/ TDS/ 15 days |
Figure 3.
DISCUSSION
This case report shows the effectiveness of homeopathy in atopic dermatitis. It also shows the importance of taking a complete case over the therapeutic prescription and is the only means of curing the sick from inside out which in this case has shown by relief in unsatisfactory stools and irregular bowel movements. As the case was repertorized and corroborated with materia medica, it also tends to confirm the symptoms written in Homoeopathic materia medica and repertory.
The main drawback in this case was absence of diagnosis via prick test and serum IgE levels but it was confirmed clinically and with the history of the lesion.
CONCLUSION
From this case report the well established fact of effectiveness of homoeopathic treatment in skin diseases has been confirmed and shows that Homeopathy is effective in the cases of atopic dermatitis. It also shows that if the medicine is accurate for the case, it can cure the patient in the most rapid and gentle way. It further proves the effectiveness of Graphites in cases of atopic dermatitis and enlightens the homoeopathic literature in terms of modern medicine.
REFERENCES
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4. Speight P. A Comparison of the Chronic Miasms (Psora, Psuedo-psora, Syphilis, Sycosis). 1st ed. Rustington: Health Science Press; 1961.
5. RADAR Version 10.0
6. Kent J.T. Lectures on Homoeopathic Materia Medica. New Delhi: B.Jain Publishers (P)
Ltd.; 2013.
7. Boericke W. Boericke’s New Manual of Homeopathic Materia Medica with Repertory. New
Delhi: B.Jain Publishers (P) Ltd.; 2013.
8. Kent J.T. Repertory of the Homoeopathic Materia Medica. New Delhi: B.Jain Publishers (P)
Ltd.; 2013.
9. Close S. The genius of homoeopathy Lectures and Essays on Homoeopathic Philosophy. New Delhi: B. Jain Publishers (P) LTD.; 2015.
10. Kent J.T. Lectures on Homoeopathic Philosophy. New Delhi: B. Jain Publishers (P) LTD.; 2015.
About the authors
1. Dr Priyanka Verma
MD Scholar, Department of Materia medica
Dr MPK Homoeopathic Medical College, Hospital and Research Centre, Jaipur, Rajasthan.
2. Dr Prashant Singh
MD Scholar, Department of Repertory
Bakson homoeopathic medical college and hospital, Greater Noida, Uttar Pradesh.
