INTRODUCTION/BACKGROUND: Irritant Contact Dermatitis (ICD) is an acute or chronic inflammation of skin often caused by exogenous factors such as detergents, solvents, alkalies. This condition has a global prevalence of 1.7-6.3%.
MATERIALS AND METHODS: Here describes a case of a 43-year-old female patient presented with the complaint of papular eruptions over right side of neck since 2 years, increased since 1 week. She was diagnosed with Irritant Contact Dermatitis. Case taking and repertorisation were based on the totality of symptoms that led to prescription of the constitutional homoeopathic medicine, Sepia. She was then treated with Sepia officinalis in 0/3 potency single dose, repeated for every 2 weeks once for 2 months.
RESULT/CONCLUSION: The patient was relieved from her complaint within 2 months; there was a significant change in Contact Dermatitis-Specific QOL Questionnaire (CD-S QoL-Q). This case serves as an example of how homoeopathic constitutional medicine can be used to treat chronic allergic dermatological disorders.
Constitutional Medicine, CD-S QoL-Q, Irritant dermatitis, Predisposition, Sepia
Irritant contact dermatitis (ICD) is a nonspecific, nonallergic reaction of the skin to direct chemical damage from a corrosive substance. It is caused by direct tissue damage following an exposure to a known irritant. Chronic irritant contact dermatitis brought on by irritants following repetitive exposure to less potent irritants, which can either be dry such as low humidity air, heat, and dusts, or wet such as detergents, organic solvents, soaps, mild acids, and alkalis.(1)Itching, scaling, minor edema, redness, and erythema are the symptoms of this condition. This condition significantly reduces the quality of life of an individual. For irritant contact dermatitis, there are no reliable diagnostic tests available. ICD is unfortunately not specifically treated in modern medicine; it is typically treated with antihistamines and topical or systemic corticosteroids, although these treatments are not long-lasting.
Sphere of Homoeopathy is broad in these types of skin cases including ICD. Constitutional medicine that helps to prevent the recurrence of the condition and reduces the susceptibility to the particular agent. It also helps to improve the quality of life of the person by acting on a mental as well as physical level in an individual.
The Prevalence of contact dermatitis was 4.38% in India, which was much less than western estimates of 15%–20%. (2) Predominance of ICD seen in females rather than males. Dermatitis occupied the first most common subgroup within the hypersensitivity diseases with a rate of 24.50% of the total. Among these contact dermatitis (17.54% of the total) is the most commonly detected skin disease in the community that mainly affects the quality of life of the people.(3) According to Aphorism 5, Hahnemann described about “the ascertainable physical constitution of the patient(especially if the illnes is chronic), moral and intellectual character, his occupation, mode of living , his social and domestic relations , his age, sexual function need to be considered in order to investigate the fundamental cause in chronic diseases.(8) Hence constitutional medicine is needed in these type of cases to reduce the predisposition to particular condition and maintains the overall good health.
An 43-year-old female patient came to the outpatient department of Sarada Krishna Homoeopathic Medical college and Hospital on April 29,2022.
The patient presented with the complaint of papular eruptions over the right side of neck since 2 years, increased since 1 week.
History of Presenting Illness:
The complaint started as papular eruptions over the right side of the neck for 2 years , increasing since 1 week. Complaints started when I stayed in Trichy for 2 years, as papular eruptions over my right forearm after using lizol for cleaning the toilet. Now it has turned into pale discoloration in my right forearm. Now she develops papular eruptions over the right side of neck, grouped in nature, round in shape after using lizol for cleaning. Eruptions over uncovered parts, Itching worse by perspiration, better by rubbing. No history of treatment taken for this complaint. No history of any drug allergy.
History of Chikunguniya at the age of 30 years took allopathic medication relieved
History of gastric ulcer since 2 years, no treatment taken.
Husband, aged 47 years is having psoriasis since 5 years
Mother and father are apparently healthy
Gynecological and Obstetrical History:
She attained menses at the age of 16 years. Her last menstrual period were April20 2022. Her cycles were regular and lasted 4 days. No complaints associated. History of recurrent abortion present.
She had a good appetite and satisfied thirst and sound sleep. Perspiration was generalized. Bowel and Bladder functions were normal. The patient had a desire for sweets and fish. She has an aversion to being fanned. Thermally, she was chilly.
While getting angered, remain silent. She has a fear of being alone. Consolation aggravation. Helping tendencies in the form of food, money. Worried that others would use her whenever they need any help.
The patient was conscious and well-oriented. She was lean and dark in complexion. Temperature: 98.60F ; Pulse: 68bpm; Respiratory rate: 14 breaths /minute; Blood pressure: 110/70mm Hg. On physical examination, the patient was found to be in good overall condition but presented with papular eruptions over the right side of the neck, round in shape, grouped eruptions with no discharge and no tenderness over the eruption.
The patient was diagnosed as Irritant contact dermatitis as per ICD-10(L24.9) (9) based on naked eye examination depicting the papular eruptions over the neck. This is shown in Figure.1 a and b.
Figure 1 a and b — Before and After treatment photographic evidences
- Before RX – baseline status(29/4/22) (b) After RX with sepia (10/06/22)
As per Hahnemannian guidelines of case taking in Organon of Medicine, a detailed case taking was done and the symptoms were elicited. The case was analysed and it is shown in Table 1. The case repertorisation with repertorial result using RADAR 10 Synthesis Treasure edition. was shown in Table2.
Table1 — Analysis of case.
|Consolation aggravationFear of being aloneEasy satiety
|Desire for sweets and fishHot patient.LeanDark complexion
|Papular eruptions over right side of neck, grouped in natureRound eruptionsAfter using lizolEruptions with itchingItching < perspiration, > rubbingEruptions on covered parts
After carefully analyzing the symptoms and referring to the Boericke Materia Medica, Sepia officinalis was selected as the most appropriate remedy for the case. In the first prescription, after giving a dose of Sepia officinalis 0/3 (one poppy-seed sized medicated globule in 15 grains of sugar of milk taken orally as dry dose for 1 day), . During Follow-up, changes in signs and symptoms were assessed from time to time and the marked improvement was elicited in the case.
Table 2 — RADAR 10 SYNTHESIS REPERTORY
Sepia officinalis 0/3 – 1 dose (one poppy-seed sized medicated globule in 15 grains of sugar of milk taken orally as dry dose for 1 day). These were prescribed on the first (April 29, 2022)
Followup and Outcomes:
The improvements were assessed in the follow-ups with the continuation of the same medicine . Details of the follow-ups were given in Table3.
Table3 – Detail of the Follow Ups:
|Papular eruption over right side of neck reduced Generals: GoodP: 109/72 mm of HgPulse : 64 beats per minute
|RxSEPIA 0/3 / 1 DOSE (Morning)B.PILLS 3 x TDSFor 15 days
|Papular eruption over right side of neck reduced but persistsGeneral improvement in mental statusGenerals: Good
|RxSEPIA 0/3 / 1 DOSE (Morning)B.PILLS (3XTDS) for 15 days
|Papular eruption over right side of neck relievedItching relievedImprovement in quality of lifeGenerals: Good
|RxSEPIA 0/3 / 1 DOSE (Morning)B.PILLS (3XTDSFor 15 days
Homoeopathy is a system of medicine that embraces a holistic approach for treating patients. A thorough case taking is necessary to clarify the patient’s constitutional make-up and a single remedy is chosen based on totality of symptoms.This case study demonstrates how the Homoeopathic constitutional approach to treating ICD can be effective without the use of medication externally. In this instance, Sepia 0/3 potency was administered over time, which not only relieved her mental state but also helped with the skin symptoms.
Improvement status was assessed on the basis of the Contact Dermatitis-Specific QOL Questionnaire. The CD-S QoL-Q is a simple, reliable monitoring tool to know the difference in severity of symptoms of contact dermatitis. Higher the score, the greater the impairment of QoL. In this case, it changed from 625 to 300, which indicates highly significant improvement. Table.4 shows the improvement in the QoL of the patient.
Table.4 Improvement in Quality of Life
|BEFORE TREATMENT:1-3 ITEM4-9 ITEM10-20 ITEMTOTAL SCOREQOL 100345180625Fair QoLAFTER TREATMENT:1-3 ITEM4-9 ITEM10-20 ITEMTOTAL SCOREQOL 5017080300Good QoL
According to a number of previously published case reports, dermatological problems have been successfully treated with carefully chosen constitutional homoeopathic medicines that were recommended based on the full spectrum of symptoms.(4-7) Even there is no recurrence of the complaint in the further follow ups.
Neverthless external application as ointments was the ultimate requirement and also spontaneous remission can happen in these types of cases, Homoeopathic medicine as a constitutional one shows its effectiveness in preventing the relapse of these cases and reduces the predisposition of the affected person. Clinicians who want to learn more about treating patients with ICD will benefit from reading this case report. To show the effectiveness of homoeopathy in treating ICD, more large scale studies including randomised controlled trials, are needed.
- Available from: https://emedicine.medscape.com/article/1049353-overview#a2
- Ghosh, Shinjini, Kundu, Sourav et al. Epidemiological pattern of contact dermatitis among urban and rural Patients attending a tertiary care center in a semi-urban area in Eastern India. Indian Journal of dermatology; 2020 Jul 1:65(4), 269-273
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- Ram H, Kamboj M. Effect of individualized homoeopathic medicine in psoriasis: a case report. National Homoeo Recorder. 2019;15(2):3.
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- Hahnemann S. Organon of Medicine. 6th edition. NewDelhi: B.Jain Publishers (P)Ltd; 2011, p.32.
- Available From: https://www.icd10data.com/ICD10CM/Codes/L00-L99/L20-L30/L24-/L24.9
About the Author:
P. Meenakshi Nandhini – PG Scholar, Department of Organon of Medicine, Sarada Krishna Homoeopathic Medical College, (Affiliated to Dr.M.G.R Medical University, Chennai), Kulasekharam, Kanniyakumari District, Tamilnadu-629161, India
M. Murugan – PG and Ph.D Guide, Department of Organon of Medicine, Sarada Krishna Homoeopathic Medical College, (Affiliated to Dr.M.G.R Medical University, Chennai), Kulasekharam, Kanniyakumari District, Tamilnadu-629161