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Clinical Cases

Hope, Heart and Homoeopathy: A Clinical Snapshot of Pilonidal Sinus Disease

Dr. Gyandas G. Wadhwani presents a case of pilonidal sinus disease  in a man of 21.  An initial prescription did not give full relief but a subsequent nosode acted as the simillimum. 

Abstract

Pilonidal sinus disease mostly affects men and is also common in young adults and occurs in people who lead a sedentary lifestyle viz. the cab drivers, administrative and management professionals and is treated conventionally with antibiotics, phenol, lancing or surgery.

A 21 years old male with Pilonidal sinus disease of 12 months duration had been advised surgery after receiving numerous courses of antibiotics and opted for homeopathy. A single dose of the homeopathic medicine Staphylococcin 200 provided instantaneous relief from pain, swelling and pus discharge and completely resolved his disease. His tendency for recurrent folliculitis and furunculosis also recovered simultaneously.

Keywords: Pilonidal sinus disease, homeopathy, local maladies, folliculitis, furunculosis, Staphylococcinum

Introduction

A pilonidal sinus is a small tunnel in the skin ocurring in the cleft at the top of the buttocks. It may fill with fluid leading to the formation of a cyst (usually containing hair, dirt, and debris). When infected it may lead to pain, ooze pus and blood and have a foul odor due to formation of an abscess and fever. Pilonidal sinus disease  mostly affects men and is also common in young adults and occurs in people who lead a sedentary lifestyle viz. the cab drivers, administrative and management professionals etc.

Etiology

The exact cause is not known yet, but it’s is believed to be triggered by a combination of changing hormones (because it usually occurs after puberty), hair growth and friction from clothes or from spending a long time sitting. Activities that cause friction, like sitting, can force the hair growing in the area to burrow back under the skin.

The body considers this hair foreign and launches an immune response against it, similar to how it would react when dealing with a splinter. This immune response forms the cyst around your hair. Sometimes a person may have multiple sinuses that connect under the skin.

Conventional Treatment

The treatment is usually a course of antibiotics, phenol injection lancing or surgical intervention. The disease is known to have a high recurrence rate even after surgical intervention.[1]

Homeopathic perspective

The homeopathic perspective towards treatment of conditions like pilonidal sinus disease, or for that matter any similar medical conditions viz. gangrene, abscesses, osteomyelitis etc. can be gauged from the following aphorisms of Organon [2]:

§ 173

The only diseases that seem to have but few symptoms, and on that account to be less amenable to cure, are those which may be termed one-sided, because they display only one or two principal symptoms which obscure almost all the others. They belong chiefly to the class of chronic diseases. (Bold and underline, my own)

§ 174

Their principal symptom may be either an internal complaint (e.g. a headache of many years’ duration, a diarrhoea of long standing, an ancient cardialgia, etc.), or it may be an affection more of an external kind. Diseases of the latter character are generally distinguished by the name of local maladies. (Bold and underline, my own)

§ 185

Among the one-sided diseases an important place is occupied by the so-called local maladies, by which term is signified those changes and ailments that appear on the external parts of the body. Till now the idea prevalent in the schools was that these parts were alone morbidly affected, and that the rest of the body did not participate in the disease – a theoretical, absurd doctrine, which has led to the most disastrous medical treatment.

§ 186 Sixth Edition

Those so-called local maladies which have been produced a short time previously, solely by an external lesion, still appear at first sight to deserve the name of local disease. But then the lesion must be very trivial, and in that case, it would be of no great moment.

For in the case of injuries accruing to the body from without, if they be at all severe, the whole living organism sympathizes; there occur fever, etc. The treatment of such diseases is relegated to surgery; but this is right only in so far as the affected parts require mechanical aid, whereby the external obstacles to the cure, which can only be expected to take place by the agency of the vital force, may be removed by mechanical means, e.g., by the reduction of dislocations, by needles and bandages to bring together the lips of wounds, by mechanical pressure to still the flow of blood from open arteries, by the extraction of foreign bodies that have penetrated into the living parts, by making an opening into a cavity of the body in order to remove an irritating substance or to procure the evacuation of effusions or collections of fluids, by bringing into apposition the broken extremities of a fractured bone and retaining them in exact contact by an appropriate bandage, etc. But when in such injuries the whole living organism requires, as it always does, active dynamic aid to put it in a position to accomplish the work of healing, e.g. when the violent fever resulting from extensive contusions, lacerated muscles, tendons and blood-vessels requires to be removed by medicine given internally, or when the external pain of scalded or burnt parts needs to be homoeopathically subdued, then the services of the dynamic physician and his helpful homoeopathy come into requisition.

§ 187

But those affections, alterations and ailments appearing on the external parts, that do not arise from any external injury or that have only some slight external wound for their immediate exciting cause, are produced in quite another manner; their source lies in some internal malady. To consider them as mere local affections, and at the same time to treat them only, or almost only, as it were surgically, with topical applications – as the old school have done from the remotest ages – is as absurd as it is pernicious in its results.

Thorough case recording as per the guidelines of aphorisms 83-99 is therefore critical for all patients presenting with local maladies since these diseases fall under the category of the chronic diseases.

Homeopathic therapeutics

Besides the usual nursing care of avoiding tight fitting clothes, usual hygienic measures, keeping the area and lesion dry and clean, which is a must for healing, the homeopathic materia medica and repertory offer a vast number of medicines suitable for such patients, as per the totality of symptoms. Sometimes, however, the following rubrics may prove to be instructive [3]:

Back: Abscess : Asaf., hep., iod., lach., mez., ph-ac., sil., staph., sulph., tarent-c.

Eruption, Coccyx : Bor., graph., merc.

Eruption, boil, Sacrum : Aeth., thuj.

Eruption, itching, Coccyx : Graph.

Eruption, moist, on sacrum : Graph., led.

Eruption, pustules : Agar., aur-m-n., bell., berb., calc., chin., chlor., clem., crot-t., dulc., kali-bi., kali-br., lach., nat-c., nat-m., petr., rhod., sep., sil., sulph.

Eruption, pustules, black points, with : Kali-bi.

Eruption, pustules, painful : Ant-t., Sil.

Eruption, pustules, sensitive : Nat-c.

Eruption, pustules, small-pox, like : Ant-t., sil.

Eruption, scabs, bloody : Rhus-v.

Eruption, scabs, bloody, Sacral region : Sil.

Eruption, scabs, bloody, Coccyx : Bor., graph., sil.

Heat, Sacrum : Sars., sep., sulph.

Heat, Coccyx : Agar., alum., arn., ars., bor., calc., carb-an., carb-v., caust., chin., colch., graph., hep., ign., laur., led., merc., mur-ac., ph-ac., phos., plat., rhus-t., spig., staph., sulph., zinc.

Heaviness, weight, Sacral region : Arg-n., berb., Chin., cimic., con., dios., ferr., hura., mag-s., phyt., rhus-t., sec., sep., zing.

sitting, while : Aloe., arg-n., hura., Rhus-t.

standing amel. : Arg-n.

stool, during : Arg-n.

walking : Arg-n.

weight : Arg-n., Chin., cimic., con., ferr.

Heaviness, weight, Coccyx : Ant-c., ant-t., arg-n.

sensation as if a heavy weight were tugging at : Ant-t.

standing amel. : Arg-n.

stool, during : Arg-n.

Itching, Sacrum : Agar., alum., bor., bov., fl-ac., graph., laur., led., med., merc., par., plb.

walking, while : Merc.

Itching, Coccyx : Agar., alum., bar-c., bor., bov., con., fl-ac., graph., lyc., spig.

burning : Fl-ac.

menses, during : Dros., graph., ph-ac.

warmth of bed agg. : Petr.

Ulcers, Sacrum : Arg-n., ars., crot-h., paeon., zinc.

burn like fire : Ars.

Ulcers, Coccyx : Paeon.

Patient Information

A 21 year old male patient of average height and build, with dark eyes and hair, with excessive bodily hirsutism especially on limbs, truncal region and the buttocks, consulted 5th Feb 2021 for left sided pilonidal sinus disease. The local lesion had been erupting on and off for nearly 12 months, with pain and pus discharge and rare episodes of bleeding. Had been prescribed a few courses of antibiotics without relief and finally advised surgery. He had also been prone to folliculitis and furunculosis, anywhere on the body since a few years.

Intra-uterine history

11 years elder sibling sister; 2-3 spontaneous miscarriages in between followed by D&C; accidental conception; very slight nausea in 1st trimester; episodes of palpitation and tachycardia intermittently all through pregnancy; LSCS delivery.

Past illness

Thread worms in 1st decade

Family history

M- IBS

F-HT

Maternal aunts- Asthma and Parkinsonism

Generalities

Diet- Non vegetarian

Cravings- Grilled mutton+++, Non vegetarian +++, Spicy foods- especially street food++

Aversion- Plain milk++, green veggies++, fruits+

Sleep- partly on belly and sides with one leg drawn up; in dark; occasionally startled

Dreams- unremembered

T/R- prefers cool weather

Life & circumstances

Born and brought up in a middle-class family, pampered for being a male child and that too a younger one; above average in studies; leads a comfortable life with no responsibilities

Mind & disposition

Fearful of heights

Enjoys magnetization++

Figure 1: Pre-treatment 5-Feb-21

Homeopathic Treatment and Follow-Up

Silica is a remedy for unhealthy skin with a tendency for suppuration and craving for magnetization. Therefore, a single dose of Silica 10M, prescribed on the 5th of February, 2021, which provided only a temporary relief in pilonidal sinus disease symptoms and folliculitis continued.

In the middle of April, the pilonidal sinus became swollen and tender again. James Tyler Kent in his 6th observation on prognosis mentions this as too short relief of symptoms [4], and it made me question my prescription of Silica. In hindsight, I also realised that neither did the patient have the characteristic lack of vital heat nor did he have a similar intensity in craving for magnetization. Silica therefore seemed to be an incorrect prescription, with only partial similarity.

The case was reviewed again and on 23rd April 2021, he received a single dose of Staphylococcinum 200. A marked relief with reduction of pain and swelling and discharge initiated within 4-5 hours and over the next few months the lesion kept on reducing as the follow-up pictures reveal. He has been asymptomatic since 30th July 2021 till this date. He also hasn’t suffered with any episodes of folliculitis and furunculosis during this period.

Discussion and conclusion

Nosodes are homeopathic preparations either obtained from diseased pathological secretions/excretions or from microbial cultures of microorganisms. Proving data for nosodes is rudimentary, but evidence of their clinical effectiveness in various           diseases has been reported/experienced. [5]

Staphylococcinum is a nosode prepared from the bacterial endotoxins of staphylococcus pyogenes aureus. The prescription of the nosode was purely empirical on the basis of recurrent pyoderma and in the absence of any other definite symptoms, its prescription seemed justified. Though the remedy has been proved by Central Council For Research in Homoeopathy, India, and some indications have been mentioned by various authorities, there are no clear-cut guidelines for its application. [6-9]

The remedy still demands a thorough Hahnemannian proving.

Figure 2: 23-April-21

Figure 3: 4-Jun-21

Figure 4: 30-July-21

References

1. Underwood C. Pilonidal sinus [Internet]. 2018. Available at  https://www.healthline.com/health/pilonidal-cyst

2. Hahnemann S. Organon of Medicine. New Delhi, India: B. Jain Publishers; 2016. Pp 141-145

3. Kent JT. Repertory of the Homoeopathic Materia Medica. New Delhi, India: B. Jain Publishers; Reprint edition 2004. Pp 884-951

4. Kent JT. Lectures on Homoeopathic Philosophy. Chicago, Illinois: Ehrhart & Karl; Memorial edition 1919. Pp 272

5. Wadhwani G, Hernandez K. Typhoidinum in Clinical Practice: Some Preliminary Observations from a Case Series. Homeopathy 2018; 107(S 01): Pp 55-78

6. P.S. Chakraborty et al. Staphylococcinum – A multicenter clinical verification study. Indian Journal of Research in Homoeopathy Vol. 6, No. 1 & 2, January – June 2012. Pp 15-21

7. Julian O.A. Materia Medica of Nosodes with Repertory. Reprint 2nd revised Edition. New Delhi: B. Jain Publishers (P) Ltd. 2003. p. 558-67.

8. Stearns G. B. Nosodes [Internet]. 2001. Available online at http://www.homeoint.org/cazalet/stearns/nosodes.htm

9. Central Council for Research in Homoeopathy. CCRH Quarterly Bulletin. Staphylococcinum. 2002. 24(3-4): 22-24.

About the author

Gyandas Wadhwani

Gyandas G. Wadhwani M.D.(Hom) Consultant Homeopathic Physician & Inde-pendent Researcher Holistic Homoeopathic Clinic & Research Center, New Delhi, India. Member Aude Sapere groups: South Africa & New Delhi Editorial board member: American Journal of Homeopathic Medicine Former Chief Medical Officer (NFSG) (Homeopathy), Directorate of Ayush, Govt of National Capital Territory of Delhi, India. Former Senior Lecturer Organon of Medicine & Homeopathic Philoso-phy, Dr B R Sur Homoeopathic Medical College, Hospital & Research Centre, Govt of National Capital Territory of Delhi, India. Email: [email protected]

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