Atopic Dermatitis Treated with an Anti Miasmatic Approach

Introduction:

Atopic dermatitis is characterized by endogenous eczema increased by an agent exogenous in nature ¹It is a hereditary disorder which is characterized by a urticaria pruritic lesion which is recurrent in nature. It is most common below the age of 5 years.².

Case: 

Chief complaint: This is a case report of a 2 -year-old male patient who presented with the chief complaints of recurrent eczematous eruption over his right cheek for 9 months. The eruption is scaly, reddish in color with severe burning and itching sensation, aggravated on getting too much warmth and at night. The child has become restless due to the symptoms.

Location	Sensation	Modalities	Concomitant
Face Right cheek O – Gradual D – 9 months P – Progressive	Itching3+ Redness Scaly	<- warmth2+, night2+	Restlessness2+

 

History of chief complaint: A 2 years male child presented with scaly, red patches on his right cheek. As per her mother the complaints started after applying a baby talcum powder. Patient was given allopathic treatment using topical ointment, steroidal creams at the age of 4 months for 2 months. After stopping the treatment, the eruptions reappeared.

Personal history:

Diet : Mixed

Habit : Nothing specific

Addiction : Nothing specific

Physical general:

Appetite : Fair

Thirst : 2 lit/day

Desire : sweet²⁺ ,

Aversion : Not specific

Dreams : Not specific

Perspiration : profuse²⁺

Urine : 4-6 times /day

Stool : Unsatisfactory, constipated

Sleep : disturbed due severe itching and burning at night

Thermals: Hot patient

Fanning : Not required

Bathing: nothing specific

Covering : Required

Past history:  chicken pox at age of 1 year.

Family history : Mother – Diabetes, Acne vulgaris

Birth history : Nothing specific.

Vital data: Pulse rate: 80 beats/min

Blood pressure: 110/70mm of Hg

Temperature: Afebrile

Respiratory rate: 24

Systemic examination : CNS – Conscious, well oriented

CVS – S1S2 +

RS – AEBE clear

PA – Soft, Non tender

Local examination: On examination, there were multiple scaly, red discoloured patches on his right cheek

Figure 1- showing images of before treatment in a 2- year- old child

  Mind: The child lives with his parents and siblings. The child has become restless due to complaints²⁺startles especially during sleep²⁺

Miasmatic analysis

As per the symptoms, the case shows predominant Psoric miasm

SYMPTOMS	PSORA	SYCOSIS	SYPHILIS	TUBERCULAR
Restlessness	Present	Absent	Absent	Present
Startles easily	Present	Absent	Absent	Absent
Desire sweets	Present	Absent	Absent	Absent
Hot patient	Present	Absent	Absent	Absent
Past history of suppression	Present	Absent	Absent	Absent
h/o exposure to allergen	Present	Absent	Absent	Absent
Red eczematous eruption	Present	Present	Present	Present
severe itching	Present	Present	Present	Present
Aggravation at night	Present	Absent	Present	Absent
Aggravation due to warmth	Present	Absent	Present	Absent

 

Analysis of symptoms:

MENTAL GENERAL

1.Restlessness²⁺ – Characteristic mental general

2.Startles easily during sleep²⁺– Characteristic mental general

PHYSICAL GENERAL

1. Perspiration profuse – Characteristic physical general
2. Hot patient- Characteristic Physical general

PHYSICAL PARTICULARS

1 Eruption eczematous night agg³⁺

2. Eruption eczematous with itching sensation³⁺
3. Eruption eczematous scaly
4. Eruption eczematous red

Evaluation of symptoms –

1. Restlessness²⁺
2. Startles easily during sleep²⁺
3. Perspiration profuse
4. Hot patient
5. Eruption eczematous night agg³⁺
6. Eruption eczematous with itching sensation³⁺
7. Eruption eczematous scaly
8. Eruption eczematous red

Repertorial totality:

DIFFERENTIAL REMEDIES –

1. SULPHUR
2. MERCURIUS
3. SILICEA

FINAL REMEDY –

SULPHUR

MATERIA MEDICA UNDERSTANDING –

1. According to Dr William Boericke, Sulphur is used for skin which is very dry and scaly. Skin is looking unhealthy. Used in eruptions with itching, burning and worse scratching and washing. Used in cases where itching is aggravated at night, worse in warmth. When eruption developed after applying local application ³
2. According to Dr SR Phatak, Sulphur is used for eruptions of all kinds. Skin is very dry, wrinkled and scaly. There is severe itching at night . ⁴
3. According to Dr. J..H. Clarke, Sulphur has skin effects of suppressed eruptions, it will bring out those. Eruptions are rough, dry, scaly with voluptuous itching. Used in skin complaints of desquamation with excoriation ⁵

POSOLOGY

Sulphur 1M was chosen

Reason – High susceptibility

Age – Small child

Pathology of symptoms is deep rooted

Characteristic symptoms are well marked

FINAL PRESCRIPTION Sulphur 1M single dose

Sac lac 7 pills bd

Follow up – after 15 days

DATE – 22/05/22

Auxiliary treatment

Avoid excessive touching over the face, do not use any talcum powder until advised..

Follow up

FOLLOW UP	SYMPTOMS	PRESCRIPTION
08/06/2022	Newer skin eruptions were significantly less intense. Previous eruptions started to suppurate. all other physical generals were same.	Sac lac 200 1 powder  Rubrum 200 4 pills bd for 15 days
23/06/2022	No new eruptions, old eruptions subsiding. physical generals were better	Sac lac 200 1 powder  Rubrum 200 4 pills bd for 15 days
07/07/2022	Itching better than before. Eruptions reduced, child is less restless than before	Sac lac 200 1 powder  Rubrum 200 4 pills bd for 15 days
23/07/2022	Few red smaller eruptions. Itching present scaling is not there physical generals were better	Sulphur 1m One dose for 15 days Rubrum 200 4 pills bd for 15 days
09/08/2022	No new eruptions, old eruptions subsiding. physical generals were better	Sac lac 200 1 powder  Rubrum 200 4 pills bd for 15 days
25/08/22	Skin was healing remarkably. Minimal to no new eruptions were observed.	Sac lac 200 4 pills tds was given and was told to report of symptoms relapsed

 

Follow up image- 25/08/2022

Figure 2- showing images after treatment in a 2- year- old child

 Discussion-

Atopic dermatitis is a most common disease of early childhood. The medicine was selected on the basis of totality of symptom along with considering the miasmatic background of the case. Hence sulphur 1M single dose was given to patient. After the remedy, the patient got much better and the eruptions  cleared.  One single dose of our remedy selected based on miasmatic analysis with symptom similarity yielded excellent results.

BIBLIOGRAPHY

1. Khanna N.Illustrated Synopsis of Dermatology and Sexually Transmitted Diseases (4th ed). Netherlands: Elsevier; 2011. p. 91-5
2. Justiz Vaillant AA, Modi P, Atopy JA. 2021. Treasure Island. FL: StatPearls Publishing; Available from: https://www.ncbi.nlm.nih.gov/books/NBK542187
3. Boericke William, Homœopathic Materia Medica
4. SR Phatak- Materia Medica Of Homoeopathic Remedies
5. Dr JH Clarke, Dictionary Of Practical Materia Medica