Tinea corporis and homoeopathic management: a case report

Dr Sushmita Mudenur

ABSTRACT
Ringworm or Tinea or Dermatophytosis , are the most common widespread superficial fungal infections seen throughout the world, with a higher prevalence of tinea corporis . Dermatophytes are responsible to cause a variety of skin lesions by infecting skin, hairs and nails. A male child , aged 1.4years presented with the complaint of eruptions over the abdomen and left forearm with severe itching since 20 days. Homoeopathic medicine Sepia was selected and administered on the basis of individualised case analysis. It shows the positive effect in the treatment of tinea corporis.

KEYWORDS – Homoeopathy, tinea corporis, sepia, dermatophytosis 

INTRODUCTION
Dermatophytes are the most common agents of superficial fungal infections worldwide and widespread in the developing countries, especially in the tropical and subtropical countries like India, where the environmental temperature and relative humidity is high. Other factors such as increased urbanization including the use of occlusive footwear and tight fashioned clothes, has been linked to higher prevalence.1

Dermatophyte infections are mainly caused by three genera of fungi such as Microsporum, Trichophyton and Epidermophyton. Depending on the site of infection of skin , the clinical manifestations vary and named accordingly: fungal infection of scalp (Tinea capitis), body (Tinea corporis), groin (Tinea cruris), axillae (Tinea axillaris), face (Tinea faciei) , beard area (Tinea barbae), hand (Tinea mannum), foot (Tinea pedis) and nails (onychomycosis). The clinical features depend on the infectious agent, body site and the immune status of host.2 

 Tinea corporis may result from contact with infected humans, animals, or inanimate objects and acquired from animals is more common in children.3

 In Tinea corporis the typical lesion may be described as an annular or polycyclic lesion with peripheral rim of activity and central clearing. The signs of activity include erythema, papule, pustule, vesicle and scaling. Children of all ages may be involved. The child is brought because of asymptomatic lesion alone or may be due to pruritic lesion.2

 Tinea corporis, tinea cruris, and tinea pedis can often be diagnosed clinically based on appearance. Newly developed polymerase chain reaction based techniques, although useful in rapid diagnosis of dermatophytosis, are still not widely available.4

Homoeopathic treatment focuses on the patient as a person as well his pathological conditions. The correct homoeopathic remedy tries to correct the disease predisposition. The following case represents the importance of homoeopathic treatment in tinea corporis.

CASE REPORT
A male child, aged 1.4 years , brought to the outpatient department of government homoeopathic medical hospital , Bengaluru ,by mother on  12/9/2019 , with the complaint of eruptions over the abdomen and forearm with severe itching since 20 days. 

HISTORY OF PRESENTING COMPLAINTS

Informant – Mother

20 days back gradually patient developed eruptions over the forearm and on the abdomen, first it started on the forearm then over the abdomen with severe itching. Probable exciting cause was not known. Onset was gradual.  

Complaints with duration Location and extension Sensations / character and pathology Modalities/ Aliments from Concomitants/ Associated symptoms with duration
  Skin eruptions since 20 days -On the abdomen

Side – left side of the abdomen 

-On the hand 

Side- left side on the forearm (on flexor medial surface)

No extension

Lesions – round shaped 

Because of scratching there is peeling of skin with white dry scales  and after there was redness and blackish discoloration (like crust formation)

Itching ++

Itching 

< evening, night

      ——

TREATMENT HISTORY-Took allopathic treatment for eruptions for 7 days, but not recovered.

PAST HISTORY– Suffered from similar skin complaints in the past when he was 10 months old and recovered by allopathic treatment but it took 1 month to resolve 

FAMILY HISTORY– Nothing significant

PHYSICAL GENERALS-Appetite was adequate, child was thirsty,  had desire for sweets. Thermally he was chilly. Bowel movements were regular. Micturition was 6-7 / 0-2 D/N. Perspiration was generalized.

MENTAL GENERALS- There was increased Irritability and weeping

LOCAL EXAMINATION OF THE LESIONS-

 Lesions – multiple over lt side of abdomen, single over lt forearm.

 Shape – round , edges raised over the lesion of forearm with scaling and blackish discoloration . (figure 1 and figure 2)

PICTURES TAKEN ON 12/9/2019

pastedGraphic.png pastedGraphic_1.png

          Fig 1 (Before treatment )    Fig 2 ( Before treatment )

CLINICAL DIAGNOSIS- Tinea corporis (ringworm of the body)

ANALYSIS OF THE CASE- After detailed case taking the symptoms were analyzed in the following manner

    Common symptoms Uncommon symptoms
  • Itching
  • White scaly dry patches
  • Peeling of skin
  • Blackish discoloration over the eruptions
  • Eruptions, on the left side of the body
  • Irritability
  • Weeping
  • Desires – sweets
  • Thirsty 
  • Chilly
  • Generalized perspiration

REPERTORIAL ANALYSIS- The following symptoms were taken for the repertorization- Irritability,Weeping, Eruptions-Ringworm, Left side, Desire – Sweets

Repertorization was done by Synthesis repertory using RADAR software. Repertorization chart is presented in the figure 3. 

pastedGraphic_2.png
 Fig 3 : Repertorization chart

BASIS OF PRESCRIPTION – Repertorial result shows that the Sulpur was covering all the symptoms with marks 14/5, Graphitis and Sepia were covering all symptoms with marks 13/5 . By considering patient’s constitution and thermals Sepia was selected as individualized remedy. 

FIRST PRESCRIPTION ON – 12/09/2019 

Sepia 200 , 2 doses OD for 2 days and placebo for 1 week was given.

With advises like – Keeping the affected areas clean. Washing towels, clothes, sheets frequently. Not to scratch the rash, Not to share towels and to keep separate soap

 FOLLOW UP OF THE CASE IS GIVEN IN BELOW TABLE

Follow up date Symptoms Medicine, potency and doses
19/09/2019 Eruptions cleared off

  (fig 4 and 5)

Itching reduced

No new eruptions

Placebo for 15 days
3/10/2019 No new eruptions

Irritability reduced

Generals good

Placebo for 1 month
3/11/2019 No new eruptions

Generals good

Placebo for 1 month
4/12/2019 No new eruptions 

Generals good

Placebo for 1 month

PICTURES TAKEN ON -19/09/2019

pastedGraphic_3.pngpastedGraphic_4.png          Fig 4 – 1st follow up (After treatment)                              Fig 5 – 1st follow up (After treatment)

CONCLUSION
Tinea can be successfully treated with Homoeopathic medicines based on detailed individual case analysis. Homoeopathic treatment can enhance the fast cure of the patient and also removes the predisposition state to the tinea infection.

DECLARATION OF PARENTS CONSENT – Parents consent was taken for images and clinical information to be reported for this article.

REFERENCES

  1. Alok Kumar Sahoo, Rahul Mahajan. Management of  tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian Dermatol Online J.2016; 7(2):77-86. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804599/ 
  2. Gupta Piyush, Menon PSN, Ramji Siddarth, Lodha Rakesh. PG Textbook of Pediatrics. 2nd/e. Jaypee Brothers Medical Publishers (P) Ltd, New Delhi; 2018; 3068.
  3. Lesher JL, Elston DM. Tinea Corporis [internet], 2019.[updated july 09, 2018]. Available from: https://emedicine.medscape.com/article/1091473overview 
  4. Hay RJ, Jones RM. New molecular tools in the diagnosis of superficial fungal infections. Clin Dermatol. 2010;28:190-6.

Dr Sushmita Mudenur
MD Part 1 -PG Department of Paediatrics,
Government Homoeopathic Medical College & Hospital
Bengaluru.

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