Hope, Heart & Homoeopathy – Dystrophic Epidermolysis Bullosa Treated with an Individualised Homoeopathic Remedy, Carcinosin

Abstract

Epidermolysis bullosa consists of a group of genetic hereditary disorders where patients frequently present with fragile skin, nails and mucosa that form blisters usually following even a minor trauma. Dystrophic epidermolysis bullosa is a subtype and particularly its recessive form is considered among the most severe forms.

Though research demonstrates the effects homoeopathic medicines have at the level of genetic expression, the role of homoeopathy in this domain has seldom been explored. A few published longitudinal clinical case studies, however, report a favorable disease management of EB cases with homeopathic remedies.

The author shares a case of DEB of 26 years long duration which has been treated exclusively with the homoeopathic remedy Carcinosin, in ascending LM potencies, for the last three and a half years. The homoeopathic treatment has not just drastically reduced the blister formation, improved the healing and avoided further surgical interventions improving her quality of life but also helped her realise her true potential.

Keywords

Epidermolysis bullosa, dystrophic epidermolysis bullosa, homoeopathy, Carcinosin

Introduction

Epidermolysis bullosa (EB) consists of a group of genetic hereditary disorders where patients frequently present with fragile skin, nails and mucosa that form blisters usually following even a minor trauma. More than 20 subtypes of EB have been recognized. Specific genetic mutations have been characterized for the different EB subtypes and variants. The most common oral manifestations of EB are painful blisters. [1]

Dystrophic epidermolysis bullosa (DEB) is a genetic skin disorder and particularly its recessive form (RDEB), is considered among the most severe forms. RDEB is due to a deficiency of the anchoring fibril-forming type VII collagen (C7) as a result of mutations in the COL7A1 gene.

Besides generalized mucocutaneous blistering and scarring, it presents a highly elevated risk of early-onset aggressive cutaneous squamous cell carcinoma. This form is characterized by deformities of the skin including coalescence of the fingers, blistering, scarring, nail changes and milia formation.

In the most severe cases, scars may cause either ankyloglossia or microglossia. The most common dental complication of DEB is the increased risk of caries. Excessive caries is a result of the presence and severity of the soft tissue involvement, which leads to alteration in diet (soft and frequently carbohydrate food); increased oral clearance time (secondary to limited tongue mobility and vestibular constriction); creation of an abnormal tooth/soft tissue relationship (i.e., buccal and lingual mucosa, which is firmly positioned against the tooth), and prevents normal oral hygiene measures.[2]

Approximately 400,000-500,000 people are estimated to be affected worldwide and no definitive treatments have yet been developed.[3] The conventional treatment for any variety of EB is aimed at symptomatic management. A few proposed therapies under scrutiny are protein replacement and cellular and genetic strategies that aim at C7 replacement to restore the dermal-epidermal adhesion.[4]

Though research demonstrates the effects homoeopathic medicines have at the level of genetic expression, the role of homoeopathy in this domain has seldom been explored at a larger level.[5] A few published longitudinal clinical case studies, however, report a favorable disease management of EB cases with homeopathic remedies.[6-8]

The author has been treating such cases with individualized homoeopathy and shares here a case with more than three and a half years of follow up.

Case report

A 26-year-old female visited for a homoeopathic consultation in September 2017. She was short statured with average build, dark eyes and hair, greasy face, extensive scarring on body with pseudosyndactyly.

Evolution of complaints (provided by patient and her mother)

1^st skin lesion was reportedly observed over left foot/ ankle while she was 1 month old and it later spread to other joints in the body. At the age of 5 years, she suffered with fever and extensive suppuration of lesions for the first time, which recurred thereafter and she received antibiotics time and again.

Over time she started experiencing severe GIT lesions followed by worsening episodes of dysphagia for which she underwent nearly 32 UGI endoscopic dilatations for oespophageal stenosis till her homeopathic consultation. She was diagnosed as a case of DEB in ~ 2013 through DNA testing and histopathology.

Also, a known case of migraine since ~ 19 years of age. Pain started over left periorbital and involved ipsilateral fronto–parieto–temporal region, and if extreme then occipital region also got involved. During the episode there was photosensitivity, phonophobia, nausea & vomiting. < travelling, sunlight; dust, 1 week pre and post menses, touch, pressure. > untying the hair, steam inhalation.

Intrauterine History
Not available since both the parents were deceased

Family History
Nothing significant since parents had passed away in an accident and she had been adopted by a Christian family and brought up in meagre circumstances.

Past and  personal history
No major childhood illnesses.
Received all vaccines on time.
History of thread worm infestation.
Also underwent several dental implants for upper and lower anterior teeth in the previous 9 years.
Underwent corrective surgeries for flexion deformities in b/l hands and knees.
Menarche- 16 years
Menses: 1-2/ 35-60 days
Migraine aggravated 1 week pre and post menses
Craved more chocolates during menses; could definitely correlate that her cravings for these started post menarche.

Generalities
Thirst: ~ 2 litres / day; lukewarm or normal temperature
Appetite: Regular; non-vegetarian diet
Aversion: Fish
Desire: Chocolates ⁺⁺⁺; Sweets especially those prepared from milk, cream and strong sugar⁺⁺⁺
Intolerance: Beef (rashes over skin); pomegranate and mud apple (sneezing)
Sleep: Over left side mostly; in dark; post dental implants – salivation +
Dreams: Not remembered
Thermal reaction: Preferred winters; loved watching thunderstorm
Perspiration: Rolled down the temples and sides of the face and over the upper lip
Weight: 52.2 kg
Blood pressure: 110/70 mmHg

Life and circumstances
Life has been a struggle because of disease and financial backwardness though adopting family has been supportive emotionally and in numerous instances doctors and hospitals waived off charges for her treatment.

She has struggled to retain her job due to her disabilities and limitations. Wants to help and support her family (sense of duty) though they do not ask for it.

Mind and disposition
Fear of heights viz. looking down from high rise buildings
Fear of fire
Irritable
Desires company

Prescription and follow up

Date	Follow up	Prescription
September 2017		Carcinosin LM 1- 3 x 100 ml, OD
November 2017	Skin improved, blister formation decreased No episodes of migraine over last 6 weeks	Carcinosin LM 4- 6 x 100 ml, OD
May 2018	One severe episode of allergic rhinitis, without any identifiable trigger; lasted for 2 weeks (treated with placebo No migraine Lessening of blister formation, even after some bumps and minor falls	Carcinosin LM 10- 12 x 100 ml, OD
May 2019	No migraine Skin lesions better, blisters come up after repeated trauma viz from a tight footwear When present, the blisters heal better wants to get married, so met a few prospective grooms, but all turned her down. It left a bitter taste and feeling of dejection.	Carcinosin LM 22- 24 x 100 ml, OD
December 2020	Developed acne like lesions on face in last few months Passed thread worms Last few menstrual cycles last for 3-5 days Cravings for chocolates are still marked during the menstruation Still enjoys thunderstorms Blister formation has reduced and oral lesions are lesser; recovery faster Stressed because has not been able to hold on to any steady job due to Covid-19 Started her own social support group for physically and psychologically handicapped Did not catch Covid-19 even when other family members were infected.	Carcinosin LM 39- 42 x 100 ml, OD
January 2022	She has passed four years without endoscopic dilatation of esophagus Her own social support group for physically and psychologically handicapped is gaining recognition with some local NGO’s supporting her cause. Doing well	Carcinosin LM 52- 54 x 100 ml, OD
May 2022	Doing well	Carcinosin LM 56 x 100 ml, OD

Discussion
Carcinosin is a cancer nosode that is widely prescribed in our practice even though it has not received any classical Hahnemannian proving. The first to mention and use this was James Tyler Kent. He wrote, “The preparation of carcinoma, which I have used, for years, was obtained from a patient with mammary cancer. She had continual seeping of clear, colourless, watery discharge from the open cancerous lesion. A small quantity of this fluid was saved and potentised, and has served satisfactorily, in many cases of advanced carcinoma.” He prescribed it to relieve the sharp, burning and tearing pains in such cases and he observed that the malignant processes were delayed even when the disease could not be arrested. [9]

James Compton Burnett and John Henry Clarke were the next to use cancer nosodes especially Scirrhinum and Carcinosinum and used these remedies for non-malignant conditions viz. threadworms and psychiatric conditions and these are found in their writings. Burnett also recorded a fragmentary proving of Scirrhinum upon himself. A few lines on this remedy are found in Boericke’s Pocket Manual.[10-12]

However, we are primarily indebted to the astute clinical observations of D.M. Foubister which paved the way for this remedy in our day to day practice as he provided some marked constitutional features and signs.

Some other authors including Nebel, M Solvey, Jacques Hui Bon Hoa and Dorothy J Cooper thereafter published clinical cases and descriptive papers which brought out a few more characteristics which govern our clinical application of this yet unproved remedy.[13-16]

Let us review some of the characteristic features of Carcinosin:

Objective signs

• Tics, Twitchings
• Tears skin around nails; Nail biting
• Yawning often, even after adequate rest and sleep
• Perfectionist/ Fastidious- obsessing more on orderliness than on substantive nitty-gritties
• Blue or brown Sclera
• Café au lait complexion
• Numerous moles/ Naevi; brownish liver spots
• Grimaces
• Recurring styes on upper eyelids with stinging pains
• Sleeps on abdomen/ knee elbow position

Family history

• Domination and/ or demanding attitude of parents/ teacher/ boss/ spouse/ children etc.
• Carcinoma
• Diabetes mellitus
• Tuberculosis
• Pernicious anemia
• Autoimmune disorders
• Sudden unexplained deaths of young family members
• Depressive psychosis with suicidal inclinations
• A combination of all of these, especially on both sides of the family

Diathesis

• Allergic
• Tubercular
• Anemic
• Diabetic
• Cancerous

Tendencies

• Depressive/ pessimistic outlook
• Suicidal
• Heightened sexuality- unusual and abnormal
• Constipation
• Infections- recurrent in certain organ systems
• Aphthae
• Tumours and growths- especially in generative organ systems
• Anticipation causes- diarrhea and/ or vomiting

Past history

• Restricted life with superimposed self/ parental/ psycho-social control since childhood
• Demands in life overwhelming and struggles
• Prolonged fear/ anxiety/ stress/ unhappiness
• Prolonged experience of neglect, despair, being unloved and unwanted
• An absence of usual childhood diseases
• Severe reaction to vaccination(s)
• Never been well since an episode of Infectious Mononeucleosis/ Fever
• Never been well since an episode of infectious diseases

Generalities

• Thermal reaction: Hot; sensitive to cold
• Craving for CHOCOLATE, BUTTER, eggs, cold drinks, spices
• Aversion/ Intolerance to Milk, Fruits
• Trembling of muscles
• Takes long time to sleep
• Better from perspiration
• Sleeps on belly or knee chest position
• When cocktail of symptoms of more than one polychrest remedies
• Contradictory/ alternating states
• Constant changing of symptoms

Modalities
<

• Seashore
• Short sleep
• Physical exertion
• Sea bathing
• Undressing
• Vaccination
• Contradiction
• Speaking
• Laughing
• Periodically- Yearly
• Storm- during and at approach of
• Thunderstorm
• New moon

>

• Evenings
• Seashore
• Open air
• Approach of storm
• Stormy weather
• Full moon
• New moon
• Physical exertion
• Lying in knee elbow position
• In natural surroundings
• Warmth
• Rest
• Short sleep
• Firm massage

May > or <

• Seashore
• Approach of storm
• During storm
• New moon
• Physical exertion
• Short sleep

Mind and disposition

• ‘Feels and lives’ the burden of responsibility since very young age due to a strong sense of duty, guilt if he misses out even on a trifle
• Disobedience- does not like or refuses parental control (alternating state)
• Rebellious towards any authority (alternating state)
• OFFENDED EASILY
• Industrious- mania for work
• Enjoys travelling (Tub)
• VERY SENSITIVE/ SENTIMENTAL
• Intense sympathy for the suffering of others (Caust)
• Affectionate
• Feels and enjoys dancing, rhythm and music
• Cheerful during thunderstorm
• Loves nature and natural phenomenon
• Loves animals but no sympathy for humans
• Melancholic temperament
• Aversion to consolation
• < conversation

Children types and tendencies

• Tendency for masturbation
• Backward
• Obstinate
• Problem child
• Mentally deficient or retarded
• Arrested development
• Late learning in walk, talk and study
• Insomnia with a ‘need for rocking’
• Wants rocking
• Scared
• Sensitive to reprimand
• Restless
• Destructive
• Childhood migraine

Particular symptoms

• Head injury (Arn, Cic, Cup, Glon, Hell, Hyper, Nat m, Nat s)
• Migraine > warmth, massaging firmly, distractions (slightly and temporarily), while in nature viz at seaside or in greenery
• Inflammation of right lobe of ear (Sepia)
• Abdominal symptoms > bending double
• Menopausal syndrome
• Asthma < anticipation, fear, fright; > seaside, while in nature
• Coughing- < bathing, cold air, eating, talking, uncovering > warmth especially of steam, massaging firmly, better near nature
• Pain in legs > heat and massaging firmly

Clinical tips

• Undue fear of cancer or constantly living in doubt of cancer (Dr Jnan Majumdar)
• Before undergoing any surgery/ plastic surgery- a dose of Carcinosin reduces the chance for formation of keloid etc. (Prof Lal Mohammed Khan) [17]

Clinical practice also gives an opportunity to appreciate the profoundness of what Hahnemann wrote in Organon, ‘If the two dissimilar diseases meeting together in the human being be of equal strength, or still more if the older one be the stronger, the new disease will be repelled by the old one from the body and not allowed to affect it. A patient suffering from a severe chronic disease will not be infected by a moderate autumnal dysentery or other epidemic disease. The plague of the Levant, according to Larry,1 does not break out where scurvy is prevalent, and persons suffering from eczema are not infected by it. Rachitis, Jenner alleges, prevents vaccination from taking effect. Those suffering from pulmonary consumption are not liable to be attacked by epidemic fevers of a not very violent character, according to Von Hildenbrand.’[18]

Therefore, this patient did not catch the Covid-19 infection (which is caused by a weaker strain of virus) because of an underlying stronger disease process.

Also, during pregnancy, childbed (birth of child), puerperium and menstrual cycles, all the hidden and underlying miasmatic tendencies are highlighted. That is the reason why during pregnancies women manifest gestational diabetes or hypertension, which highlight the morbid manifestations of posterity.

Similarly, if any girl or woman manifests rheumatic pains, breast pains, bowel changes, headaches, weakness etc. during the peri-menstrual times, they are also morbid manifestations of posterity. Also, the food cravings, disliking and intolerances, perspiration, thermal reactions and personality changes also carry a weightage and require a thorough assessment, as during other times these might not be that apparent.

Hahnemann, therefore, highlighted in Organon, ‘In chronic diseases of females it is specially necessary to pay attention to pregnancy, sterility, sexual desire, accouchements, miscarriages, suckling, and the state of the menstrual discharge. With respect to the last-named more particularly, we should not neglect to ascertain if it recurs at too short intervals, or is delayed beyond the proper time, how many days it lasts, whether its flow is continuous or interrupted, what is its general quality, how dark is its color, whether there is leucorrhoea before its appearance or after its termination, but especially by what bodily or mental ailments, what sensations and pains, it is preceded, accompanied or followed; if there is leucorrhoea, what is its nature, what sensations attend its flow, in what quantity it is, and what are the conditions and occasions under which it occurs?’[18]

That is why amongst the other features, craving for chocolates in peri-menstrual time seemed so relevant to the choice of the remedy.

Conclusion

There is currently no accepted cure for EB patients and treatments are aimed for disease management to ease and control the symptoms, avoiding the skin damage, infections and complications and improving the quality of life.

In the conventional system of medicine it usually requires an interdisciplinary team of doctors and para-medical staff including a dermatologist, dentist, surgeon, dietician, counsellor, physiotherapist, specialist nurses etc.

Homoeopathy with its holistic approach has a more individualised patient-centric methodology in their unique heredo-familial make up and bio-psycho-social micro-environment. Without much fuss and elaborate setups, homoeopathy not only provides an adequate and cost-effective treatment but also establishes a bond of support and comfort for the entire familial unit.

In the above-mentioned case study of DEB we see the therapeutic response with a single homoeopathic remedy Carcinosin, which not only resolved the challenges posed by the disease and prevented further surgical interventions but also addressed the psychological challenges posed by the disease so that she was able to carve a better identity for herself and was able to work for others with physical and psychological handicaps. This is what Hahnemann defines in Organon as the ‘higher purposes of living’.[18]

References

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9. Kent, New Remedies, Lesser Writings, Clinical Cases, Aphorisms and Precepts, p. 523f.
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15. Hui Bon Hoa J. Carcinosin- A clinical and pathogenetic study. Br. Hom. Journal; 1952; pp 189-199
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17. Khan, L.M, Dr.,”National journal of homoeopathy”,” Love affair with carcinosin at bedside”. May-June-2004, vol-4, no-3
18. Hahnemann S. Organon of Medicine- §36, f.n. to 94, 9. New Delhi, India: B. Jain Publishers; 2016:pp 74,75,107,64