Tinea Faciei in a Woman of 21

ABSTRACT: Tinea is the name of a group of diseases caused by a fungus. Types of Tinea include ringworm, athlete’s foot and jock itch. Tinea faciei is a term used to encompass several clinically distinctive infections of the skin of the face. A 21 years old female reported having Tinea faciei for the last 10 months. A complete case history was taken and on the basis of individualization, Sepia was given

CASE  STUDY:

A 22 year old unmarried Hindu female of  middle socio-economic  status  reported  at  my  clinic  with  her  brother  on  29^th  December  2018,  with  complaint  of  eruption  on  face.   Her  height  was  5’2”  and  build  was  normal.  She had an eruption  in  a  circular  pattern  since  10 months  ago on  the  right  side  of  her  face  in  front  of  the  ear,  extending  to  ear  pinna  and  covered  the frontal  region.

First, small  eruptions  in  a  circular  pattern  appeared  in  front  of  the  right  ear  with  itching.  Sometimes  the  skin  surrounding  the  rash  was  dry  and  flaky.  Itching and burning were  also  present  on affected  areas.  She was taking Ayurvedic – Paste (Leaf of Azadirachta Indica) but  there  was  no  improvement.

Clinical  Findings: Eruption  on  right  side  of  face.  Edge  of  the  rash  appears  elevated  and  is  scaly  to  touch.

Past  History:  History  of  typhoid  in  2015

Physical  Generals:  Patient  averse  to salty  food.  She  loves  to  eat  pickle.  She  had  unrefreshing  sleep.  She  was  thirsty  and thermally chilly.  Menstrual  periods  were  regular.

Mental  Generals:  She  was  talking  fast  (hasty) [confirmed observation].  She  wanted  to  study  further,  but  her  family  refused, due  to  which  she  was  angry.  Since  then  she  has had no  particular  interest  in  her  family. Indifferent  to  her  family.  She gets angry  when  someone  contradicts  her.   She said    many  times  that  she  is  worried  about  her  future.

ANALYSIS  OF  CASE

MENTAL  GENERALS

• Hasty talk
• Indifference to  her  family
• Anger when  contradicted
• Anxiety about  future

Physical  Generals

• Desire- Pickles⁺⁺ ,
• Aversion- Salt
• Sleep- Unrefreshing
• Thermal- chilly

Particular  General

• Eruption on  cheek  in  a  circular  pattern
• Eruption – edge of  the  rash  appears  elevated  and  is  scaly  to
• Itching and  burning  were  also  present  on  affected
• Side – right

Evaluation

• Hasty talk
• Indifference to  her  family
• Anger when  contradicted
• Anxiety about  future
• Desire- Pickles⁺⁺
• Thermal- chilly
• Eruption on  cheek  in  a  circular  pattern
• Eruption edge  of  the  rash  appears  elevated  and  is  scaly  to touch.
• Itching and  burning  were  also  present  on  affected
• Side – right

RUBRICS

REPERTORY SHEET

Fig-1  Repertorization  of  the case  from  Complete  Repertory  using  Cara  Professional  (Version 1.4)

ANALYSIS  OF  REPERTORIAL  RESULT

SELECTION OF MEDICINE

Sepia  seems  to  suit  the  case,  not  because  it  is  numerically  highest but  because  it  corresponds  to  the  type  of  patient.  Sepia has marked  aversion  to  salty  food,  desire  for  pickles and is chilly.  That would  not  rule  out  the  drug. Desires  and  aversions are  general  symptoms,  much  lower  in  the  scale  than  the  mental  symptoms. A strong mental  symptom  like  ‘indifference,  apathy  family,  would over rule  symptoms of  lesser importance.  Lycopodium  and  Arsenicum  Album  again  could  never  suit  this  case,  no  matter  how  great  its  numerical  value,  because  of  the  marked  ‘indifference,  apathy  to family.

Sepia confirmed with Materia  Medica

According to Boger, Sepia has “Sadness  over  her  health  and  domestic  affairs,  Indifference.”^[5] Allen’s Keynotes states “Indifferent –  even  to  one’s  family.”^[6]  Farrington  says that “Eruption  is  dry,  or  soon becomes  moist”^[7], “Sepia  has  been  many  times  confirmed  as  a remedy  in  herpes  circinatus”^[8].  Boericke states: “Indifferent  to  those  loved  best, averse  to  family,  herpes  circinatus  in  isolated  spots” ^[9].  Dr. Sankaran  says,  “The  main  feeling  of  the  Sepia  woman  is  that  she  is  forced  to  undertake  things  opposed  to  her  intentions, to  do  what  she  doesn’t  want  to do.  It is a chronic situation in which  she  has  been  dominated  and  not  allowed  to  have  her  way”^[10].  Lippe writes “She  dreads  to  be  alone,  wants  company,  but  has  an  aversion  to  her  own  friends,  and  is  indifferent  to  her  household  affairs,  Herpes  circinatus  in  isolated  spots  on  upper  part  of  the  body”^[11]

PRISCRIPTION

FOLLOW  UP

Before treatment    During treatment      After treatment

This patient is still in contact with me as I treat other members of her family. She is still free of symptoms (5/2020)

CONCLUSION

This case  shows  the  effective  role  of  homoeopathy  in  the  treatment of  tinea  faciei.  The  patient  had  indifference  to  her  family.  Now she lives  happily with  her  family  and  shares  things  with  her  family.  This  case  shows the  constitutional  remedy acts  on  the  mental  level  also.  This  case  demonstrates  that  individualization  is important  for  effective  homoeopathic  treatment.  The patient and her family are still in contact with me and she is  fine as of April 2020.

REFERENCE

1. 1. M. , Roxburgh’s Common  Skin  Diseases.  17^th  edition.   Arnold.  2003.
2. Sainani G.S., Abraham,  Dastur  F.D.,  Abraham  P,  Dastur  FD,  Joshi VR,  et  al.  A.P.I.  Text  Book  of  Medicine.  6^th  Edition.  Association  of  Physicians  of  India  Mumbai,  1999.
3. Malhotra S. Malhotra SK. Aggarwal Y., Tinea  faciei  caused by  Trichophyton  mentagrophytes  in  a  20-day-old  neonate  Indian Dermatol  Online  J.  2015  Dec;  6  (Suppl 1):  S43–S46. doi:  10.4103/2229-5178.171045  Available  from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738516/
4. Robert A Schwartz.   Jacek  C  Szepietowski.  David  F  Butler.  Van Perry.  Dirk  M  Elston.,  Tinea  Faciei  Medscape  May  20,  2019  Available  from:  https://emedicine.medscape.com/article/1118316-overview#a4
5. Boger CM. Synoptic  Key  of  the  Materia  Medica.  New  Delhi,  B.Jain  Publishers,  2004.
6. Allen HC. Keynotes.  4th  Reprint  edition.  Indian  Books  & Periodicals  Publishers;  New  Delhi. 2009.
7. Farrington EA. Comparative  Materia  Maedica.,  B.Jain  Publishers  (P)  Ltd.  2017
8. Farrington EA. Lecture  on  clinical  materia  madeca  in  family  order.  B.Jain  Publishers (P) Ltd. 2009.
9. Boericke William. Pocket  Manual  of  Homoeopathic  Materia  Medica with  Indian  Medicine  &  Repertory.  Reprint  edition.  Indian  Books  & Periodicals  Publishers,  New  Delhi.  2009.
10. Sankaran R. The  Soul  of  Remedies.  Homoeopathic  medical publishers. 2017
11. Lippe AV. Keynotes  and  Red  Line  Symptoms  of  the  Materia Medica.  7th  Impression.  B.  Jain  Publishers  (P)  Ltd.;  New  Delhi. Part-II.  2015.