Clinical Cases

Atopic Dermatitis Treated with an Anti Miasmatic Approach

Drs. Prajot N. Parmar and Kinjal Sanghavi present a case of atopic dermatitis in a two-year old boy. Startled during sleep and face discolored red were among the symptoms leading to the simillimum.

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+

  1. Eruption eczematous with itching sensation3+
  2. Eruption eczematous scaly
  3. 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

About the author

Prajot Parmar

Dr Prajot N Parmar - MD Homoeopathic Paediatrics, Asst. Professor, Department of Anatomy, Virar Homoeopathic Medical College.

About the author

Kinjal Sanghavi

Dr. Kinjal Sanghavi - MD Homoeopathy

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