Bullous disorder is a relatively common autoimmune disease encountered in India. It is most commonly seen in the elderly and manifests as tense blisters on urticarial base. The diagnosis can be confirmed by histology, direct and indirect immunofluorescence. Several new diagnostic techniques have also been developed. Treatment is based on the extent and rate of progression of the disease. Bullous disorders have an impact on the daily lives of affected individuals, interfering with physical activity, disturbing sleep, impairing social functioning, mental well-being, and reducing productivity at work and reducing the quality of life. Homoeopathy has great scope in bullous disorders may it be of autoimmune, infectious or metabolic origin and the Homeopathic medicine MANCINELLA helps in improving the quality of life.
Blistering disorders, bullous disorders, pemphigus, scales, homoeopathic medicine Mancinella.
Depending on their size, cutaneous blisters are referred to as vesicles (<1 cm) or bullae (>1 cm).
Local hypoxemia secondary to decreased cutaneous blood flow can also produce blisters, which explains the presence of bullae over pressure points in comatose patients (coma bullae). In diabetes mellitus, tense bullae with clear sterile viscous fluid arise on normal skin. The lesions can be as large as 6 cm in diameter and are located on the distal extremities. There are several types of porphyria, but the most common form with cutaneous findings is porphyria cutanea tarda (PCT). In sun-exposed areas (primarily the hands), the skin is very fragile, with trauma leading to erosions mixed with tense vesicles. These lesions then heal with scarring and formation of milia; the latter are firm, 1- to 2-mm white or yellow papules that represent epidermoid inclusion cysts. Associated findings can include hypertrichosis of the lateral malar region (men) or face (women) and, in sun-exposed areas, hyperpigmentation and firm sclerotic plaques. An elevated level of urinary uroporphyrins confirms the diagnosis and is due to a decrease in uroporphyrinogen decarboxylase activity. PCT can be exacerbated by alcohol, hemochromatosis and other forms of iron overload, chlorinated hydrocarbons, hepatitis C virus and HIV infections, and hepatomas. ;
•The primary autoimmune blistering disorders include pemphigus vulgaris, pemphigus foliaceus, paraneoplastic pemphigus, bullous pemphigoid, gestational pemphigoid, cicatricial pemphigoid, epidermolysis bullosa acquisita, linear IgA bullous dermatosis(LABD), and dermatitis herpetiformis.
•Vesicles and bullae are also seen in contact dermatitis, both allergic and irritant forms. When there is a linear arrangement of vesicular lesions, an exogenous cause or herpes zoster should be suspected.
•Bullous disease secondary to the ingestion of drugs can take one of several forms, including phototoxic eruptions, isolated bullae, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN).
•Clinically, phototoxic eruptions resemble an exaggerated sunburn with diffuse erythema and bullae in sun-exposed areas.
•The most commonly associated drugs are doxycycline, quinolones, thiazides, NSAIDs, voriconazole, and psoralens. The development of a phototoxic eruption is dependent on the doses of both the drug and ultraviolet (UV)-A irradiation
• Several metabolic disorders are associated with blister formation, including diabetes mellitus, renal failure, and porphyria.1
Homoeopathy and bullous disorders
Homoeopathy has great scope in autoimmune disorders than any other system of medicine, because it is the only system of treatment that considers the symptom as a whole and remove the disease as a whole. Homoeopathy can also be beneficial for those condition where exact etiology of this bullous disorders is not known.
Mancinella is a species of the Euphorbiaceae, and has all the virulent properties of the family in a high degree. It is one of the trees around which the upas legends have clustered. “It is certain that the juice, which resembles pure white milk, does possess a considerable amount of acridity, and that some persons suffer great pain from incautiously handling it. Perhaps its most dangerous property is that of causing blindness, if by chance the least drop of the milk, or smoke of the burning wood, comes in contact with the eyes. Dr. Seeman states that at Veraguas some of the ship’s carpenters were blinded for several days by the juice getting into their eyes while cutting down Manchineel trees; while he himself suffered from temporary loss of sight from merely gathering specimens; and that the same accident happened to a boat’s crew from making a fire. Salt water is said to be an efficacious remedy” (Treas. of Bot.). Manc. was introduced into homoeopathy by Bute, who proved it. It was also proved by Mure and Ackermann. The symptoms induced were very intense. Burning was experienced in all parts, vesication and ulceration of the skin and mucous membranes. Head, eyes, throat, abdomen and rectum were the parts most affected. A leading feature of many symptoms was < by drinking cold water. Cough < from drinking water. There is general > from heat when lying down; but warmth of stove < headache; and there is inclination to uncover. Med. Cent. (ii. 112) quotes from Revist. Omeop. the case of a lady who for several years was possessed with the fixed idea that she would become insane. She had become a wife and mother, but still the idea possessed her. Happening to see in Puhlmann’s Therapeutics that Manc. has “fear of getting crazy,” she took Manc. 12 and was permanently cured.2
ACCORDING TO J H CLARKE
Redness of skin (hands). Small vesicles, followed by desquamation. Sequelae of scarlatina. Favours rapid healing of wounds. Fungoid growths, esp. syphilitic
The symptoms induced were very intense. Burning was experienced in all parts, vesication and ulcelration of the skin and mucous membranes.
Face: swollen; pale; pale, yellow, bloated. Heat rising to face; soon after, painful itching, stitching, and burning, lasting all day; next morning face swollen; towards noon minute vesicles with yellow fluid; next day, desquamation. Lips pale; pricking pains. Lower lip hangs down. Numerous small vesicles on chin which desquamate. Lower limb
Quivering and jerking in legs in attacks. Trembling of legs. Needle-like stitches in legs; under heel from within, out. Tingling in feet when sitting.Burning in soles; with dry feeling.─Desquamation of soles at end of fever.Large vesicles, esp. on soles 2
ACCORDING TO WILLIAM BOERICKE
Skin symptoms most marked. Dermatitis, with excessive vesiculation, oozing of sticky serum and formation of crusts.
Intense erythema. Vesicles. Fungoid growths. Erysipelas. Large blisters, as from scalds. Heavy, brown crusts and scabs. Pemphigus 3
ACCORDING TO S R PHATAK
• This remedy produces marked skin, throat and mental symptoms esp. depressed states at puberty an d climaxis with exalted sexuality
• Swollen, spotted.
• Herpes on lips
• Biting vesicles on soles; desquamation and dryness of soles.
• Vesicles. Large blisters as from scalds. Brown crusts and scabs.
• Pemphigus.Dermatitis; with extensive vesiculation, oozing of sticky serum and formation of crusts.4
ACCORDING TO HERRING
Large number of small vesicles on chin
Large vesicles especially on the soles.5
1.(2018). Harrison’s principles of internal medicine (20th edition.). New York: McGraw-Hill Education.
2.Clarke J. A Dictionary of Practical Materia Medical, Volume 3. New Delhi:
3.Boericke W. New manual of homoeopathic materia medica & Repertory including the Indian drugs, Nosodes, uncommon remedies, Relationship, side of the body & drug Affinities. Reprint ninth edition. New Delhi: B. Jain (p) Ltd; 2006.
4.S R Phatak. Concise materia medica of Homoeopathic remedies. Fourth edition. B Jain publisher Pvt ltd;2003
5.C Herrings. Condensed materia medica. 2nd edition more condensed,revised,enlarged and improved.
Dr. Rushali. Sudhir. Gugaratti
BHMS, MD (Part1)
Department of Repertory.
Father Muller Homeopathic Medical College