Abstract: Verruca Vulgaris is the commonest skin disease seen in dermatological practice. These are benign growths due to infection with papilloma viruses, which occur mainly on the hands and feet. Verrucae accounts for approximately 5%-10% of the skin conditions seen in patients in many countries.
Our Aim was to ascertain the efficacy of Homoeopathy in cases of Verruca Vulgaris by comparing two arms i.e. interventional and placebo following a holistic approach using the Complete Repertory, and simultaneously establishing the fact that Verruca Vulgaris requires medical intervention and is not merely a self limiting disease.
Results were assessed on the basis of scores of scales viz DLQI (Dermatological Life Quality Index), Patient Global Assessment Index and Physician Global Assessment Index at first and final follow up, within one year of duration. Patients were reviewed for minimum six visits.
In interventional arm, 6 (20%) cases achieved cure, 7 (23.33%) cases showed mild improvement, 4 (13.33%) patients showed marked improvement, 8 (26.66) were status quo and 2 (6.66%) got worse, whereas, control arm, 1(3.33%) case was cured, 2 (6.66%) cases showed mild improvement 22(73.33%) cases were status quo, 5(16.66%) cases got worse.
The holistic approach of Homoeopathy using the Complete Repertory proved effective in the treatment of the Verruca Vulgaris. After prescribing the indicated remedy in appropriate potency and doses, patients started improving depending upon their vitality.
Simultaneously it can be concluded that either longer study duration is required for better results with centesimal scale potencies, or that 50 millisemal scale potencies are may cut short the period of medication to establish the better efficacy of Homoeopathy in treatment of Verruca Vulgaris.
Introduction: Verruca Vulgaris are the Common Warts. They occur when the skin is infected by the warts virus or a type of Human Pappiloma Virus. These viruses are DNA viruses which grow only in the epidermis. It is commonly seen on the hands, forearms and face. These are usually asymptomatic. Verruca Vulgaris falls in the psycho-physiological category of psycho-dermatologic disorders which can be exacerbated by stress and emotional factors.
This study is intended for the betterment patients who are affected by Verruca Vulgaris. Because it is a psycho-dermatologic disorder, a holistic approach was considered, using the Complete Repertory for repertorization of cases.
Research Question of this study: “Do Patients with Verruca Vulgaris receiving Homoeopathic treatment have more improvement than patients receiving placebo?”
This was a hospital based study in which 60 patients were allotted in the study from which 30 patients each were chosen randomly for the intervention arm and control arm. Medicine was dispensed following homoeopathic principles, considering totality of the symptoms using Complete Repertory 4.5 from RADAR 9.0 along with proper management.
Aims and Objectives:
Aim: To ascertain the efficacy of Homoeopathy by comparing the effects of homoeopathic medicine with placebo in treatment of Verruca Vulgaris
Objectives: 1) To study the effectiveness of Homoeopathy over Placebo arm in the cases of Verruca Vulgaris using Complete Repertory 4.5 from RADAR 9.0. 2) To study the extent of improvement in cases using DLQI, Patient’s GAI, and Physician’s GAI.
Materials and Methods: Study comprises 100 patients with Verruca Vulgaris (Common Warts) who attended the OPD & IPD of the Dr. M.P.K. Homoeopathic Medical College, Hospital & Research Centre, Jaipur, INDIA for a duration of 12 months w.e.f. September 20th, 2014.
Detailed case taking and clinical examination was carried out to arrive at the diagnosis. Effectiveness of the homoeopathic treatment was assessed according to statistical principles on the basis of change in the score taken before and after treatment, as well as the subjective feeling of improvement.
- Patients of all age groups and of both sexes presenting with Verruca Vulgaris.
- Cases of Verruca Vulgaris of any size, at any site, of any number.
- Mixed presentation of verruca vulgaris with any other form like Verruca Planaris, Verruca Filliform , Plantar warts.
- Verruca Vulgaris associated with skin tags.
- Patients fulfilling the eligibility criteria were enrolled and systematically randomized to receive either the Homoeopathic intervention or Placebo.
- Medicines were given in 6c, 30c, 200c, 1m, 10m potency as per the prescribing totality.
- Repetition of medicine depended upon the potency and complaints of the patient in accordance with the principles of Homoeopathy
- Repertorisation was done with the Complete Repertory (Dr Roger Von Zandvoort. )
- Homoeopathic medicines were given on the basis of totality of symptoms and individualization from the Hospital OPD.
- Selection of potency was decided according to the susceptibility of the case.
- The follow–up of the cases were done at an interval of 1-15 days, as per gravity of the case for the duration of 6 months.
Type of Study:
Benefits of the Study:
- Study will provide strong evidence of efficacy of homoeopathic interventions.
- Allows standardization of study maneuver and outcome assessment.
Discussions and Summary:
The results show that there is a significant difference after giving individualized homoeopathic medicines as compared to the placebo group.
In this study, it has been observed that maximum incidence of Verruca Vulgaris was observed in the age group 21-30 years i.e. 27 cases (45%) whereas according to literature Verruca Vulgaris is more common in younger age group especially in school children.
It has been observed that maximum cases of Verruca Vulgaris were observed in male patients i.e. 43 cases (71.66%) as compared to female i.e. 17 cases (28.33%). But according to literature, there is no sex predominance of Verruca Vulgaris.
In this study, Lycopodium clavatum was prescribed to maximum no. of cases i.e. 8 cases (26.66%) followed by Sulphur in 6 cases (20%), Causticum Hahnemanni in 5 cases (16.66%), Lachesis mutus in 4 cases (13.33%), Natrum muriaticum in 3 cases (10%), Nitric acid in 3 cases (10%), Calcarea carbonicum, Pulsatilla nigricans, Medorrihinum, Argentum nitricum in 2 cases (6.66%) whereas, Calcarea sulphuricum, Calcarea phosphoricum, Phosphorus, Baryta carb, Sepia, Dulcamara, Thuja, Bacillinum in minimum no. cases i.e. 1 case (3.33%). The variability of selection of medicine is according to individuality of the patient.
In this study, 200C potency was prescribed in maximum no. of cases i.e. 15 cases (50%), followed by 30C potency in 11 cases (36.66%), 30C-200C in 7 cases (23.33%), 200-1M in 3 cases (10%), 1M in 3 cases (10%), 30C-1M in 2 cases (6.66%) minimum prescribed potency was 1M-10M i.e. in 1 case each (3.33%), Variability in potency administration is due to variable susceptibility of different patients at the time of presenting.
Result: In this study, in interventional group 8 cases (26.66%) were status quo, 7 cases (23.33%) showed mild improvement, 6 cases (20%) were cured, 4 cases (13.33%) showed marked improvement, 3 cases (10%) got moderate improvement and 2 cases (6.66%) got worse, 5 cases were dropped out from the study (did not arrive for follow ups etc). Whereas, in control arm 23 cases (76.66%) were status quo, 5 cases (16.66%) got worse, 2 cases (6.66%) showed mild improvement, 1 case got cure (3.33%), there were no cases of marked and moderate improvement. Cure and improvement rates were better in interventional arm than control arm.
Table: Comparison of Results of Interventional and Control arm
According to statistical analysis, in intervention arm t(tab)= 2.052 and t(cal)= 4.856 (of DLQI score), t(cal)= 4.551 (of Phy. GAI) and t(cal)= 4.596 (of Pat. GAI) i.e. t(cal) > t(tab), whereas in Control arm t(cal)= 0.404 (of DLQI), t(cal)= 0.579 (of Phy. GAI) and t(cal)= 0.223 (of Pat.GAI) i.e. t(cal) < t(tab) at 5% level of significance. Thus patients had significant improvement after receiving homoeopathic medicines
In testing of difference of means, in DLQI, Phy.GAI, Pat. GAI of interventional arm t(cal) >t(tab) whereas in DLQI, Phy.GAI , Pat. GAI of Control arm t(cal) < t(tab) at 5% level of significance. Thus Patients of Interventional arm had significant improvement than Control arm.
Conclusion: The inference drawn from the study is as follows:
- According to the results obtained, interventional arm showed significantly more improvement than control arm. Thus the aim of the study is fulfilled.
- Complete Repertory by Dr. Roger Von Zandvoort proved to be a useful aid in the selection of the simillimum.
Before treatment After Treatment
- DLQI, Phy.GAI, Pat.GAI proved to be a significant assessment tool in this study.
- It can be clearly concluded with the aid of statistical test viz. paired t-test and difference of means that homoeopathic medicinal intervention is effective over placebo in treatment of Verruca Vulgaris and it is not merely a self limiting disease and it surely calls for medicinal intervention.
- Maximum incidence of cases of Verruca Vulgaris was observed in age the group 21-30 years. Population of this age group has a stressful lifestyle which can make the individual more susceptible to infection.
- Verruca Vulgaris has more male preponderance.
- According to the study, 200C is the more preferable potency to start the treatment based on a holistic approach and due to psychosomatic cause of the disease.
- After this result was obtained, it has been inferred that a longer study period is required in treatment of Verruca Vulgaris following the holistic approach. Six visits in 7-14 days of interval did not suffice, and most of patients who continued their treatment after 6 visits showed remarkable improvement.
- It was also found that cases with history of suppression through cauterization and external application were more resistant to treatment and had shown no or little improvement. Thus the homeopathic approach helps prevent the complications associated with suppressive methods like cauterization etc.
- In this study it was also seen that male patients with Verruca Vulgaris on the face, especially the beard region had a history of visiting barbers for shaving, suggesting the infectious spread of the disease.
Limitation of study
The study period was short and so long term studies are essential. Studies using 50 millesimal scale should be conducted to determine their effect on Verruca Vulgaris (this potency can be repeated in shorter time intervals), so effects may be better assessed in short term studies.
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