Homoeopathic approach for pemphigus vulgaris
Abstract : Pemphigus Vulgaris is an auto immune disease characterised by symptoms affecting skin and mucous membranes. It is clinically manifested by the painful blisters and sores in the mouth, eruptions over lower lips and corners of mouth, inflamed and sore of gums, ulceration over the palate and margins of gum, crusty and moist eruptions over the scalp, itchy red eyes. The anti-inflammatory and steroidal treatment is available to control and treat the pemphigus vulgaris patient. But total recovery from the disease has not been reported up to date. Other alternative therapies like nutritional therapy, yoga therapy are used for the disease. Here, a 40 year female presented with symptoms of pemphigus vulgaris since 8 to 10 years. She was successfully treated by individualised homoeopathic medicine, Natrum muriaticum, selected on totality basis. After initial aggravation for few days, over the period of fifteen das of homoeopathic treatment, the patients presenting symptoms of Pemphigus Vulgaris were improved and with one year of homoeopathic treatment disease symptoms and overall condition of the patient were completely controlled. This case report suggests that homoeopathic intervention may be the sure solution for the resolution of Pemphigus Vulgaris.
Keywords
Pemphigus vulgaris, Natrum muriaticum, grief, weeps alone.
Abbreviations
ELISA – enzyme linked immunosorbent assay.
Introduction
Pemphigus Vulgaris is a rare, severe auto-immune disease characterised by blisters of various site on the skin and on the lining of mouth and other mucous membranes. Pemphigus Vulgaris occurs when the immune system mistakenly attacks proteins in the upper layers of skin. This leads to separation cell from each other and from lower layers of skin and mucous membranes leads to blister formation. It presents in the form of blisters in mouth and other areas of body and serious skin disease. It develops most often in middle aged or older peoples, affecting both genders. The blisters are filled with thin, watery fluid; which eventually burst, slough off and lead to sore spots. The common affected sites are mouth, genitals skin. It is chronic recurring, non-contagious disease. [1]
The changes at environmental, emotional psychological level lead to produce tremendous negative impact on our body especially on our immune system. This stresses prone the simple innocent immune system to act abnormally. [2]
There is no cure with conventional treatment, it can only help for temporary relief but the dysfunction at mental emotional and psychological level, the root triggering factors can only be corrected with homoeopathic remedies so Homoeopathy will stand first choice for Pemphigus Vulgaris.
Epidemiology
Pemphigus vulgaris has been reported to occur worldwide.
Pemphigus vulgaris is most common subtype of pemphigus in Europe, Japan and United States
Pemphigus vulgaris incidence varies from 0.5 to 3.2 cases per 100000 populations.
Epidemiological studies evaluating different european regions suggest that the incidence of disease tends to be lower at higher latitudes than lower.
Pemphigus vulgaris incidence is increased in patients of Ashkenazi Jewish descent and those of Mediterranean origin. [3]
Diagnosis:
It is best diagnosed clinically by an experienced eye.
Nikolsky’s sign – When the surface of unaffected area is rubbed with finger or cotton, the skin separates easily. This is called as positive Nikolsky’s sign. [4]
Skin or oral biopsy – It shows intra-epidermal vesicle caused by breaking of epidermal cells.
ELISA test – Anti desmogleins antibodies can be detected in the blood using this test. [5]
Case history:
A case of pemphigus vulgaris is presented in this article.
Patient information
A lady, 40 years old consulted on 10th October 2018 with painful blisters in mouth over lips and corners of mouth with itching, discharging eruptions over scalp.
History of present complaints
The patient had been suffering from painful blisters in mouth over lips and corners of mouth with itching, discharging eruptions over scalp. Before 8 to 10 years, she started with painful blisters and sores in the mouth, followed by over lower lips and corners of mouth associated with inflammation and soreness of gums with dribbling of saliva at night. Then she started developing ulcers over the palate and margins of gum. After six months of all these symptoms, she developed crusty and moist eruptions over the scalp discharging sticky, viscid discharge. The scalp and mouth eruptions and ulceration itch at night. The blisters in mouth were painful while talking and drinking water associated with burning in mouth after taking warm food. Then she started redness of eyes with severe itching. She was under the modern treatment with steroid before consulting me with temporary relief during treatment which is since second month of onset of disease till date.
Observations and finding:
Patient entered in clinic with profuse perspiration over body. She looks less talkative and gentle by nature. She is hesitating to answer my questions, just answering yes or no. It was actually getting difficult to collect the totality. One thing observed that at every answer she is looking to her husband who was sitting beside. Her husband wasked to seat outside in the waiting room.
She was family caring and family orienting personality. She was born in the economically sound family. She was married before 13 years in a sound family. It was going well for first few years. But her husband was not taking a least care of family. She was just remaining in home, for months together, her husband didn’t talk to her in sympathetic mood. She was even restricted to go outside. He was sealing the land for his personal activities, which was creating tension in the family. For this he was blaming the patient that he sealed the land for her treatment only which is not getting cured. The patient also agreed to the fact that she was taking modern medicines since man years and not getting well. She has to routine visit for consultant. She grieved, but keeping silence. She says that my father taught to maintain the respect of him in front of all. Mazya wadilanchi shikwan ahhe. As it was her basic nature, she used to tolerate all things and at the extreme she weeps alone. She was keeping smile, so that no one can find my inner turmoil. She had done everything for her husband, but now she hated him due to his bad behaviour. Even though she hated him, she never showed it on her face. She was tired of life due to disease and the metal psychological suffering.
After much mental tension she got angry for one or two times, but she was insulted very badly in front of all family members by her husband. Having financial problem since last few years and the expenditure on her treatment is again disturbing her. Now it is easy, that she was becoming more familiar with me. Talk everything loudly and friendly. She said that the modern medicines were relieving her for few days and during treatment but even a gap of few days again brought the problems back, but she was sure that homoeopathic treatment will help to cure.
Generals:
She had good appetite.
Intermittently she had strong craving for salty food.
No particular food aversion
Profuse sweat all over body, even with very less exertion
Thermally she was hot patient.
Mind:
After having detailed and long talk with patient observed following mental conditions:
She was less talkative
She was family caring and family orienting personality.
She was hearted but suffering in silence.
She used to weep alone.
Bad effects of insult
Case analysis:
| Analysis of symptoms | |
| General symptoms | Particulars |
| Grief ailments from | Palate ulcers |
| Hatred | Gum ulcers |
| Hopeful | Eruptions over lips |
| Less talkative | Eruptions, corners of mouth |
| Sadness | Eruptions mouth around |
| Silent grief | Eruptions, itching |
| Can’t weep easily | Crusty eruptions over scalp |
| Weeps alone | Moist oozing eruptions over scalp |
| Bad effects of insult | Scalp eruption oozing sticky, viscid discharge |
| Desire Salt and salty food | Redness of eyes |
| Profuse sweat | Itching of eyes |
Evaluation of symptoms
| Evaluation of symptoms | |||||
| Sr. No. | Symptom | Type | Intensity | Miasm | Common/Uncommon |
| 1 | [Mind]Grief: Ailments from, agg. | Mental Generals | 2nd grade | Psora | Uncommon |
| 2 | [Mind]Hatred | Mental Generals | 1st grade | Syphilo-syco-psoric | Uncommon |
| 3 | [Mind]Hopeful | Mental Generals | 2nd grade | Tubercular | Common |
| 4 | [Mind]:Talk: desire to be silent, taciturn | Mental Generals | 3rd grade | Syphilitic | Common |
| 5 | [Mirilli’s Themes]Sadness | Mental Generals | 2nd grade | Psora | Uncommon |
| 6 | [Mind]grief | Mental Generals | 2nd grade | Syphilis | Uncommon |
| 7 | [Mind]Weeping, tearful mood: goes off alone and weeps as if she had no friends. | Mental Generals | 2nd grade | Syphilis | Uncommon |
| 8 | [Mind]:Weeping, tearful mood: Impossible, cannot weep: | Mental Generals | 2nd grade | Syphilis | Uncommon |
| 9 | [Mind]Insults, offenses: Ailments from, agg. | Mental Generals | 2nd grade | Syphilo-psoric | Common |
| 10 | [Complete][Generalities]Food and drinks: Salt and salty food | Particular | 2nd grade | Sycosis | Uncommon |
| 11 | [Complete][generalities] sweat: Profuse | Particular | 3rd grade | Sycosis | Uncommon |
| 12 | [Complete][generalities] Hot | Particular | 3rd grade | Uncommon | |
| 13 | [Mouth]:Ulcers: Palate | Particular | 3rd grade | Syphil0-Tubercular | Common |
| 14 | [Mouth] Ulcers: Gums | Particular | 3rd grade | Syco- Syphilitic | Common |
| 15 | [Face]Eruptions: lips | Particular | 3rd grade | Syco-Psoric | Common |
| 16 | [Face]Eruptions: lips: corners | Particular | 3rd grade | Syco-Psoric | Common |
| 17 | [Face]Eruptions: mouth, around | Particular | 3rd grade | Syco-Psoric | Common |
| 18 | [Complete][generalities] Eruptions: itching | Particular | 3rd grade | Psora | Common |
| 19 | [Head] Eruptions: Crusts, scabs | Particular | 3rd grade | Common | |
| 20 | [Head] Eruptions: Crusts, scabs: moist | Particular | 2nd grade | Syphilitic | Uncommon |
| 21 | [Head] Eruptions: glutinous moisture | Particular | 2nd grade | Syphilitic | Uncommon |
| 22 | [Complete][eye]: redness | Particular | 3rd grade | Tubercular | Common |
| 23 | [Eye]Itching | Particular | 3rd grade | Psora | Common |
Reportorial results:
Remedies:
The chief remedies for the case are Natrum muriaticum, Staphysagria and Mercurius solubilis. [6]
Let’s overlook the remedies
- Natrum muriaticum – The sadness with obligated to weep, tired of life, hatred to the person who has formerly given offences are the mental symptoms of the case matching with Natrum muriaticum . Cracked excoriated, ulcerated lips with granulated and ulcerated eruptions and burning on lips and corners of mouth. Burning and smarting ulcers in mouth, pain aggravates by contact of food and even drink. Crusty and moist eruptions over the scalp are the physical symptoms of the patient matching with Natrum muriaticum .
- Staphysagria – It is the chief remedy for physical symptoms due to suppressed anger. Staphysagria is very sensitive about the anger of those to whom he respects much like parents and even husband. It is predominant remedy for bad effects of insults. Husband is not considering her will, can be treated as a rejection by loved ones in repertory language. She had done everything for her husband, means she is devoted wife. All are the mental peculiarities of the patient matching with Staphysagria. The lips are scurfy, covered with ulcers and scabs with pain are one of the physical symptoms of drug.
Mercurius solubilis – It is a best remedy for crusta lacteal. The lips are rough and dry with swelling and ulceration of lips. There are yellowish scab, purulent pustules on the lip and chin. The burning, painful vesicles blister in mouth and on palate. These are physical symptoms are the patient matching the remedy. [7]
These three remedies are selected on the basis o uncommon mental symptoms and particular symptoms of the disease. First remedy prescribed for the patient was Natrum Mur 200 single dose. But it aggravated the symptoms by aggressive spreading the blisters around the mouth with slow improvement in terms of reduction of in mouth. As per Kent’s 12 observations there was long aggravation with slow improvement the second prescription was Staphysagria 200 potency. References – from www.nhp.gov.in an article about second prescription [8 ]
Follow up:
| Date of visit | Follow up | Justification for selection of remedy | Image of follow up |
| 10 October 2018 | Painful blisters in mouth over lips and corners of mouth with itching, discharging eruptions over scalp. Soreness of gums with dribbling of saliva at night. Crusty and moist eruptions over the scalp discharging sticky, viscid discharge and redness of eyes with severe itching | Natrum muriaticum 200/ 1 dose and 2 Rubrum 30/4 globules thrice a day | |
| 14 October 2018 | Condition aggravated. The blisters are spreading around the mouth with itching. Even though the skin condition is aggravated the blister in mouth are reduced and now she is able to eat soft food, having better sleep and feeling fresh. | No remedy prescribed | |
| 19October 2018 | The condition was badly aggravated. The blisters with pustules appeared around the mouth, increased salivation, increased thirst. Small blisters get ruptured and discharging yellow sticky fluid. The eyes are fire read with the eruption around the mouth. Strong desire for sex since last few days. | Staphysagria 200/ 1dose Rubrum four times a day As per Kent’s 12 observations there was long aggravation with slow improvement the second prescription was Staphysagria 200 potency.[9] | |
| 25 October 2018 | All the eruptions around the mouth get dried with smooth look of skin. Burning micturition and intermittently irritability on little matters. Few blisters and red spots in mouth causing difficulty in eating. | Rubrum, four times a day | |
| 11 November 2018 | Doing well with good appetite and sound sleep. Only few blisters forming here and there in mouth and getting healed within one or two days otherwise happy. | Rubrum, three times a day | NO IMAGE TAKEN |
| 18 December 2018 | Complaint of very small blisters in mouth and few times itching of scalp. Otherwise she was doing well with good appetite and sound sleep. She started gaining weight. Her skin is looking healthy. | Rubrum/ three times a day | NO IMAGE TAKEN |
| 27 January 2019 | Visited with redness and painful, bleeding ulceration in mouth and cracks over lower lips. She was fresh and happy. Her face is looking absolutely clean, fresh, glowing and smart. Except few cracks over lower lip nothing was there. There was no burning micturation. Her appetite and sleep was good. Her weight gain by six kilogram. | Rubrum/ three times a day | |
| 17February 2019 | Visited with complaint of redness of eyes, few cracks on lower lips and small painful blisters in mouth associated with thirst for large quantity of water since last few with occasional dribbling saliva during sleep. Appetite is good but food taste bitter. | Rubrum/ 4 times a day | |
| 20 March 2019 | Few very less painful white patches on gums. Only hot food causes burning and stitching pain. Thirst was normal, no dribbling of saliva. On observation a yellowish thrush found over lower lip which appears at morning and subside up to afternoon. Severe headache for three times, once when she was at marriage function, second when travelling on motor cycle and third when she walked in sun heat. Appetite, sleeps are good. Marked irritability on contradiction. | Rubrum/ 3 times a day | |
| 17 April 2019 | No ulceration and blisters in mouth since last 20 days. Cracked lips get healed. Mentally and physically she is doing well. | Rubrum/ 3 times a day |
Discussion and conclusion
Thus, homoeopathy plays a positive role in auto immune diseases like pemphigus vulgaris. Mental symptoms are of prime importance in homoeopathic treatment. The homoeopathic remedies help to treat the patient at mental and physical plane. The suppressed emotions were eradicated by Natrum muriaticum and the final work for the case was done by Staphysagria.
Problem during treatment
After first prescription of Natrum muriaticum 200 the symptoms starts aggravating, even waiting for nine days there was no relief. Patient was willing for relief. Group discussion with Dr Deepak Shah, Dr Atique Shaikh and Dr Nasser Shaikh helped a lot.
Learning from case:-
Homoeopathic aggravation is the key of cure, but severe aggravation also prone to think. As the skin condition gets aggravated it will be difficult to manage and there was fear that patient may leave homoeopathic treatment. Consideration of other key mental symptoms helped for second prescription. This case established a clear relationship between mind and body. It also confirmed that Auto Immune diseases can be surely helped with homoeopathy. More well-designed research studies are required for establishing the effectiveness of homoeopathy in auto immune diseases. A comparative study can be carried out to assess whether treatment results vary with individualised medicines, either the intercurrent medicines plays a supportive role with constitutional remedy.
Acknowledgements
The author acknowledges the participation of Dr Deepak Shah (HOD, Dept of Organon of Medicines, Sonajirao Kshirsagar Homoeopathic Medical College, Beed), Dr Atique Shaikh (HOD, Dept of Pharmacy, Sonajirao Kshirsagar Homoeopathic Medical College, Beed) and Dr Nasser Shaikh (PG dept of Materia Media from Sonajirao Kshirsagar Homoeopathic Medical College, Beed) for giving their input and help for this case.
References
- Pemphigus Vulgaris by Michael Kaspekiewicz, Christoph T. Ellebrecht and Masayuki Amagai. Available from: www.ncbi.nlm.nih.gov
- Autoimmune disease and stress: is there a link by Robert H. Shmerling, MD. Available from : Harvard Health Publishing July 11, 2018
- Article on Pemphigus Vulgaris by Daniel M. Peraza, MD, Geisel School of Medicines at Dartmouth University. Available from : www.msdmanuals.com
- Nikolsky’s sign- a clinical method to evaluate damage at epidermal-dermal junction by Abhishek Soni,Department of oral medicines and radiology, Modern dental college and research center,MP, India. Available from : www.jiaomr.in
- ELISA Medically reviewed by Timothy J. Legg,, PhD. PsyD on June 22,2017- written by Tricia Kinman. Available from : www.healthline.com
- Repertorisation sheet- Hompath WildFire LAN from HOMPATH software
- Allen T.F. Allen’s Handbook of Materia medica and Homoeopathic therapeutic, reprint edition, B. Jain Publishers Pvt. Ltd, New Delhi.
- Second Prescription. Available from www.nhp.gov.in
- Kent J.T. Lectures on Materia medica, Reprint edition 1998. Jain Publishers Pvt. Ltd, New Delhi
About the author
Dr Ladda S.P. is presently working as an Associate Professor, Dept of Anatomy at Sayali Charitable Trust College of Homoeopathy,Mitmita, Aurangabad
