Homoeopathic management of dyshidrotic/pompholyx eczema through a case study

Dr Deepak R  

ABSTRACT :
Eczema is a general term used to describe a group of medical conditions that cause red, inflamed and itchy skin. There are many types of eczema like atopic eczema, contact dermatitis, Dyshidrotic eczema, Nummular/Discoid eczema, seborrhoic dermatitis, Stasis eczema, Lichen simplex chronicus or Neurodermatitis. People with one type of eczema may also develop other eczema types depending on genetics and exposure to environmental triggering factors.

In this article lets discuss about dyshidrotic eczema in detail, along with a case study.

Key words: Dyshidrotic Eczema, Genetics, Environmental triggering factors.

INTRODUCTION:
Dyshidrotic eczema is a type of Eczema/Dermatitis of unknown cause that is characterized by a pruritic vesicular errutions on the fingers, palms and soles. It may be acute, recurrent or chronic.

A synonym of this eczema is pompholyx, which means bubble. The clinical course of  Dyshidrotic eczema can range from self limited to chronic, severe, or debilitating. The unresponsiveness of case to the treatment can be frustrating for the patient and physician.

Etiology: A 2009 Case report provided clear histopathologic evidence that sweat glands do not play a role in dyshidrosis.

Atopy- D.E. may be associated with atopy and familial atopy. Of patients with dyshidrosis, 50% have atopic dermatitis.

Exogenous factors- For eg.: contact dermatitis to nickel, balsam, cobalt; sensitivity to ingested metals; dermatophyte infection; bacterial infection; may trigger episodes. These exogenous antigens may act as haptens with a specific affinity for palmoplantar proteins of stratum lucidum of the epidermis. The binding of these haptens to tissue receptors  may initiate the pompholyx.

Emotional stress and environmental factors (eg: seasonal changes, hot or cold temperatures, humidity) repeatedly exacerbate dyshidrosis.

Symptoms: Symptoms follow a sequence which is as follows.

  • Deep set blisters on the edges of the fingers, toes, palms and soles of the feet.
  • Itching
  • Redness
  • Scaly, cracked skin
  • Flaking
  • Pain.

As this type of eczema interferes with job and household chores due to its sphere of affection and severity. It’s a challenge to deal with it medically. Nearly 40% of patients with eczema reported that they turned down a job or an educational opportunity in cases of children.

General managementThe diet regimen is rarely successful in managing with dyshidrotic eczema. But still there are few general managements thought to help patients in this condition.

  • The diet requires avoiding food rich in nickel such as canned foods, foods cooked using nickel plated utensils.
  • Try to avoid oysters, asparagus, beans, mushrooms, onions, corns, spinach, tomatoes, peas, whole grain flour, pears, rhubarb, tea, coca, chocolate and baking powder.
  • For cobalt sensitive patients, consider a low cobalt diet that avoids apricots, beans, beer, beets, cabbage, cloves, chocolate, coffee, liver, nuts.

Case study:

Presenting complaint: A 21yr old male patient presented with the complaints of pustular eruptions with itching and pain with mild offensiveness over left foot for the past 2 weeks.

H/o chief complaint:Patient was apparently well 2 weeks back, and then slowly noticed few vesicular eruptions over anterior portion of plantar aspect of left foot and over toes, with slight itching. Next day he could see multiple vesicular eruptions severe itching which he used to become more on pressure but get ameliorated by rubbing against the sharp edges of table. And he tend to open the vesicles which used to leave behind a raw burrowed portion of skin.

After 3-4 days patient noticed pustules instead of vesicular eruptions with pain. Pain was more on walking. And as his usual habit he tried open it n waited for a day. Since the pain and the condition of the wound was becoming worse, patient started his self dressing with the aid of calendula Q and felt better for next 3 days without any internal medication. But after 3-4 days of self experiment, patient’s condition went on getting worse with severe pain for which he came to government homoeopathic medical college and hospital on OPD basis.

Course in hospital on OPD basis:Patient’s wound was cleaned and dressed with EchinaceaQ. And was prescribed Gun powder 6x TID for 7 days with alternate days dressing.

Patient was better with symptoms of pain after 2 days. And at the end of 7thday wound healed 90% with red granulation tissue. So pt continued the treatment for the next & days and was completely better with his complaints.

Patient returned back after 2 wks with similar complaints of vesicular eruptions and itching over same spot. So the case was taken in detail, and constitutional medicine Lachesis 200, one dose was given. And asked to come for follow up after a week. The patient returned back after a wk with no any new eruptions and itching. He was given with Sac Lac powder once in alternate days for 2 wks and advised for follow up after that period. And in follow up there was no any relapsing of his complaints. So Later the patient never returned back.

Miasm to be taken: Depending on the appearance of rashes and its prognosis( vesicular rashes, itching, dryness, peeling of skin followed by cracks), it can be classified under psora. But in this case, looking at the course/ prognosis it can be classified under psoro-syphilis.

Conclusion: Dyshidrotic eczema can be well treated under homoeopathy, where its recurrency can be stopped with the use of constitutional medicines.

SPECIFIC APPROACH THROUGH DIFFERENT REPERTORIES:

1) KENT’s Repertory:

EXTREMETIES, eruption, hand,

  • Palm, vesicles: anthr, bufo, canth, caust, kali-c, mag-c, merc,ran-b, rhus-t,rhus-v, ruta.

Itching: kali-c, rhus-t.

Large: anthr.

Transparent: merc.

Yellow: anthr, bufo, rhus-t, rhus-v.

  • Ulnar side of, vesicles: ant-c, lach, sel.
  • Between the fingers, vesicles: anag,apis, caalc, canth, hell,iod, laur, nat-m, olnd, phos, psor, puls, rhus-t, rhus-v, ruta, sel, sulph.

Burning: canth.

Itching: canth, psor, sulph.

  • Between index finger and thumb, vesicles: grat, nat-s,sulph.
  • Between first and second finger, vesicles: sulph.
  • Third and fourth fingers, vesicles: mag-c.

Fingers, vesicles: bell, bor, calc, cit-v, clem, cupr, cupr-ar, cycl, fl-ac, graph, hep, kali-c, kali-s, lach, mag-c, mang, mez, nat-c, nat-m, nat-s, nit-ac, ph-ac, phos, plb, puls, ran-b, rhus-t, rhus-v, sars, sel,sep, sil, sulph.

Becoming ulcers: calc, graph, kali-c, mag-c, nit-ac, ran-b, sil.

Bluish: ran-b.
Burning: ran-b.
Itching: ran-b.

EXTREMETIES, eruptions, foot, sole of, vesicles: Ars, bell, bufo, calc, kali-bi, kali-c, manc,  nat-m, sulph.

Bloody serum: nat-m.
Corroding, eating: Ars, sulph.
Fetid water, with: ars.
Spreading: ars,calc.
Ulcerating : Ars, calc, psor, sulph.
Yellow fluid, with: Ars, bufo.

2) MURPHY’s REPERTORY:

HANDS, Eruptions,

hands, cracked: alum, lyco, merc, petr.

Desquamation: all-c, alum, am-c, am-m, bar-c, ferr, graph, laur, merc, mez, nat-m, phos-ac, phos, rhus-t, sep, sulph.

Dry: anag, bov, lyc, merc, psor.

Itching: ars, CARB-V, daph, graph, jug-r, mez, mur-ac, nit-ac, phos, psor, sanic, sep, staph, urt-u, zinc.

Fingers, Desquamation: agar, bar-c, choco, elaps, graph, merc, mez, rhus-v, sabad, sep,stil, sulph.

Dry- anag, psor.

Between: canth, carb-s, graph, hell, lach, lyco, nit-ac, olnd, phos, psor, puls, rhus-v, sep, sulph, sul-ac.

FEET Eruptions,

Soles, of- anan, ars, bell, bry, bufo, chin-s, con, elaps, kali-bi, manc, nat-m, pip-m, sulph.

Desquamating: ars, chin-s, elaps, manc,sulph.

Scales: pip-m.

Cracked, skin- aur-m, carb-an, com, eug, GRAPH, hep, hydr, lach, nat-m, PETR, sabad, SARS,SIL, sulph.

                 Heels: lyc.

                 Soles: ars.

                 Toes between: aur-m, carb-an, eug, GRAPH, hydr, hydrog, lach, NAT-M, PETR,

                  sars, sabad, SIL.

                  Deep- hydr.

                  Under toes: hydrog, sabad.

                 Violent itching: nat-m

Dryness: soles – bism, manc, phos.

3) SYNTHESIS REPERTOY:

extremeties, eruptions,

Hand: cracked: alum, lyco, merc, petr.

Desquamation: all-s, alum, am-c, am-m, bar-c, ferr, graph, laur, merc, mez, nat-m, phos-ac, phos, rhus-t, sep, sulph.

Itching: ars, Carb-v, cist, daph, graph, jug-r, mez, mur-ac, nit-ac, phos, psor, sanic, sep, staph, verat, zinc.

Red: bell, berb, bov, canth, carb an, cic, cycl, jug-r, lyc, merc, ran-s, spig, spong, sulph-ac, sulph, verat.

Scales: anac, anthraci, arn, clem, graph, hep, merc, mur-ac, petr, psor, sars, sec, sep, sulph.

Vesicles: anag, ant-c, aran, arn, ars, borax, bov, Carb-ac, carbn-s, caust, chin, clem, cocc, com, hell, hep, kali-ar, kali-bi, kali-c, kali-i, kali-s, kali- sil, lac-ac, lach, mag-c, mag-m, merc, merl, mez, nat-m, nat-s, petr, phos, plan, psor, ptel, ran-b, rhus-t, rhus-v, ruta, sanic, sars, sec, sel, sep, sil, spig, squil, sulph, ter, vip.

Foot: desquamation: agar, ars, berb, chin, chinin-s, dulc, Manc, merc, mez, sulph, thlas, thuj.

           Itching: androc, aster, bov, calc, con, mez, sep, sil.

                        Biting: calc

                        Burning: bov, mez.

            Red: androc, bov, crot-c.

          Scaly: Rhus-v

          Vesicles: ars, aster, carbn-o, caust, con, elaps, graph, lach, manc, nit-ac, phos, rhus-v, sec, sel, sep, sulph, tarax, vip, zinc.

Suppurating: con, graph, nat-c, sel.

4) BBCR:

Upper extremeties, eruptions,

  • Cracked, fissured, chaps: Sil.
  • Hand: ALU, grap, kali-c, kre, lach, Mag-c, merc, nat-c, nat-m,Nit-ac, PETR, sil, SUL, ZINC.
  • Painful: grap, merc, PETR, sul.
  • Finger: bar-c, Flu-ac, kali-c, PETR.
  • Finger joints: Phos.

Desquamatinon :

  • Hand: alu, am-c, am-m, anac, ars, bar-c, cic, fer, hep, kre, merc, nat-m, pho, pho, Pho-ac, rhus-t,rut, sep, sul.
  • Palms: am-c, arn, am-m, calc-f, cor-r, Graph, merc, rhus-t, sele, sep.
  • Dorsae- ars-io
  • U: merc, stro.

Fingers: bar-c, merc, nat-m, saba, sul.

              Tips: bar-c, elaps, manc, Pho, Pho-ac, sab, thea.

              Between: am-m, lau.

              Nails, about the: sele.

Dryness, palms: bar-c, bell, bism, cham, crot-hol, gel, ham, hep, kali-bi, lau, lyco, nat-c, rhus-t, sul, thuja.

                Fingers: anac, ant-t, Flu-ac, sil.

                              Tips: ant-t, sil.

                              Feeling of, joints: canth.

                              Finger joints: anac, ant-t, Pul, Sil.

Lower extremeties:

Dryness: Foot: Ars, Chel, Sep.

                Of soles: Bism, Pho.

Euption: blisters, vesicles.

                 Foot: ars, caust.

                          Soles: ars, bell, calc. carb, kali-bi, manc, nat-c, nat-m,sul.

                          Heel: graph.

                 Toes: graph, lach, nat-c, nit-ac, phos-ac, rhus-t, ruta, sec-c, zin.

Desquamation: Foot:  ars, bur-p, chin, dul, Manc,sul.

Itching,  foot, soles of: alu, amb, am-c, am-m, ant-t, bell, bov, caust, cham, china, , con, dros, euphor, hep, kre, mur-ac, old. Ol-an, psor, ran-s, rhe, sabi, , sars, Sil,spy, stry, sul, tarx.

BIBLIOGRAPHY:

  • https://emedicine.medscape.com/article/1122527-overview#a5
  • Kent J. T. Extremeties, Repertory of the homoeopathic materia medica, B. Jain publishers Pvt . Ltd., New Delhi, 1921, P-(995-1003).
  • N D Murphy Robin, Feet and Hand, Homoeopathic Medical Repertory, B. Jain Publishers(p) Ltd, New Delhi, 1921,P-(614,615,835,836).
  • Schroyens Frederik, Repertorium Homoeopathicum syntheticum, B. Jain publishers(P) Ltd., New Delhi, 1921, P-(1197-1205).
  • Boger C.M. upper extremities and Lower extremities, Boenninghausen’s Characteristics and Repertory, B. Jain Publishers(P) Ltd, New Delhi, 1921, P-(810-860).

Dr Deepak R
PG scholar
Department of organon of medicine

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