ABSTRACT

Atopic dermatitis is a term generally referred to a skin condition causing irritation and inflammation of the skin. It is usually multifaceted in origin. The clinical presentation of the disease varies in pattern and severity depending upon the individual susceptibility in different stages of their life. This article demonstrates one such cases of atopic dermatitis constitutional approach by homoeopathy proved to be very much effective in obtaining desirable results by prescribing Graphites as a constitutional remedy.

KEYWORDS

Atopy, Atopic dermatitis, Graphites, Patient Oriented Eczema Measure

INTRODUCTION

Atopic dermatitis is also called as an Atopic eczema It is very common skin condition affecting a man kind. In majority of the cases, it is seen in infancy, although the age and sex prevalence are not much evident in developing atopic dermatitis with slightly higher prevalence among females has been noticed previously. More than 75% of the cases developing atopic dermatitis shows a relevant family history of atopy such as bronchial asthma, allergic rhinitis, dermatitis.1 Atopic dermatitis can be developed without any familial history with a better prognosis of the case. Patient with atopic dermatitis presents with the complaints of rashes, itching moderate to severe, and changes in the morphology of the skin.Atopic dermatitis belongs to ICD -10-CM Diagnosis code L20.2

CASE PRESENTATION

Atopic dermatitis can be divided into 3 types:

1.Infantile atopic dermatitis:  usually occurs at the age of 2 months to 2 years of age. Eczema in infancy begins aa a rashes and scaling of the cheek rashes may also extend to the extensor aspect of the extremities. There may be oozing and infection leading to the crust and pustules.

2.Childhood atopic dermatitis: usually occurs at the age of 2 years to 10 years. In this phase lesions are localized to antecubital and popliteal fossa, flexor wrists, eyelids, face around the neck

3.Adult atopic dermatitis: Most of the adult atopic dermatitis gives a history of the childhood atopic dermatitis or any other atopy or allergies. They develop atopic dermatitis after the age of 18 years. Pruritis is a hallmark of the atopic dermatitis. patient may be presented with the erythema in acute stage and later in a long run the lesion might get dry, scaly and lichenified.3

DIAGNOSIS: Diagnosis is based on the clinical presentation .in rare cases it might require skin biopsy.

CASE REPORT:

         This is a case report of patient aged 42 years who is a home maker presented to a outpatient department of Taluk General Hospital bantwala on 4-06-2023 with the complaints of itching with blackish discoloration of the skin with sticky discharge since 1 year more since 6 month. The patient was apparently health till last year after which she gradually started with the complaints and got worsened day by day.

PAST HISTORY:

Patient is suffering from the constipation underwent medication for the same and complaints got temporarily relived.

FAMILY HISTORY:

Father – was apparently healthy attained natural death

Mother- Diagnosed Hypertensive at the age of 60 years under medication for the same

Elder brother- Apparently healthy

Younger sister- Apparently health.

PERSONAL HISTORY:

Diet- Mixed

Appetite- Normal

Thirst- Thirsty, drink 2liters/day

Bowel- Constipated once in 2 days

 Micturition- 4-6 times/day, 1/night

Desires- Nothing specific

Aversion- Nothing specific

Sleep- Normal, refreshing

Dreams- Nothing specific

Perspiration- Generalized

Thermals- Chilly

LIFE SPACE INVESTIGATION:

Patient was born and brought up in the low socioeconomic status. Her parents where from agricultural background. She has got 2 siblings 1 elder brother and 1 younger sister. Due to the financial crisis, she discontinued her studies in 6th standard. She got married at the age of 20. The relationship with husband was good initially later he started habit of consuming alcohol and started physically abusing her .She lost her husband at the age of 35 years and started living with her mother. Recently there arise a property dispute in a family she says after which she started with the complaints. She connects all her health issues to a god she says she is been bewitched and cursed after which she started with the complaints. She has become emotionally very sensitive and gets angered very easily and also complaints that her quality of life is been affected.

GENERAL PHYSICAL EXAMINATION:

Height – 155 cm

Weight 56 Kg

No signs pf pallor, icterus, clubbing, cyanosis, Edema, Lymphadenopathy

VITALS:

Blood pressure-120/90 mmhg

Pulse rate-76 Bpm

Respiratory rate-16 cycles per minute

Temperature-Afebrile On examination

SYSTEMIC EXAMINATION:

Respiratory system: NVBS Heard, No added sound,

Cardiovascular system- S1, S2 heard, no murmurs
Gastrointestinal system- Bowel sound heard

LOCAL EXAMINATION OF THE SKIN:

On examination Findings- Dryness of the skin with blackish discoloration

The moist thin sticky discharge on the dorsal aspect of the feet and toes.

DIAGNOSIS: Atopic dermatitis

MIASMATIC DIAGNOSIS: After case taking and after careful analysis patient showed a psoric predominance in this case.

REPERTORIAL TOTALITY:

MIND-ANGER-easily

MIND-DELUSION-bewitched, she is

MIND-SESITIVE-to emotions

RECTUM-CONSTIPATION

SKIN-ITCHING-Scratching-agg-raw; must scratch until it is

SKIN-ROUGH

GENERALS-DISCHARGE-sticky

GENERALS-DISCHARGE-thin

GENERALS-CHILLY

PRESCRIPTION: (on 4-06-2023)

Rx Graphites 30, 1 dose early morning empty stomach

   Sac lac 1-0-0 alternate days for 1 month Before food

OBSERVATIONS & DISCUSSION

After Thorough case taking and examination of a case formed totality based on the systematic assessment of the symptoms. The severity of the case is been assessed using the patient-oriented eczema measurement. Since there was peculiar symptoms present in the case Kents repertorization was used and differentiation of the remedies are done with the help of Homoeopathic Materia medica. On repertorizing Following medicines covered a highest degree and symptoms – Graphites, Phosphorus, Causticum, Mercuries, Arsenicum album etc. By taking generals and peculiar symptoms into consideration Graphites was a chosen remedy. The graphites showed a slight improvement initially and significant improvements in a subsequent follow up are noticed by comparing the patient-oriented eczema measure before and after treatment. 

Patient oriented eczema measure- POEM6

           This scale is used to help the patient and clinicians to understand their POEM Score, the following bandings have been established -references below

0-2= almost clear

2-7=mild eczema

8-16=moderate eczema

17-24=severe eczema

25-28=very severe eczema

Total Poem score=28

CONCLUSION

This case reveals the effectiveness of the Constitutional homoeopathic approach. It also demonstrates that well selected homoeopathic remedy becomes successful in treating the atopic dermatitis without any adverse effects. This case shows a marked improvement in the patients’ health. However, this is a single case report additional research must be carried out to make the study useful.

CONFLICT OF INTEREST: None

FINANCIAL SUPPORT- Not available

DECLARATION OF THE PATIENT CONSENT- Patient consent is been taken for the images to be displayed in article.

REFERENCE:

1. Davidson S. The principle and practice of medicine: A textbook for students and doctors. Edinburgh: linvingstone; 1962.

2. Boericke W. Pocket manual of homoeopathic materia medica & repertory: Comprising of the characteristic and guiding symptoms of all remedies (clinical and pathogenetic) including Indian Drugs. New Delhi: B. Jain Publishers (P) Ltd.; 2018.

3. M. GCE, Bleiker TO, Creamer D, Ingram JR, Simpson RC. Rook’s Dermatology Handbook = Dermatology Handbook. Hoboken, NJ: Wiley Blackwell; 2022.

4. Munjal YP. API Textbook of Medicine. Mumbai: Dr. Yash Pal Munjal for and on behalf of The Association of Physicians of India; 2015.

5. Kent, J.T. and Kent, C.L. (1998) Repertory of the Homoeopathic Materia Medica. New Delhi: B. Jain Publishers.

6. Charman, C. R., Venn, A. J., Ravenscroft, J. C., & Williams, H. C. (2013). Translating Patient-Oriented Eczema Measure (POEM) scores into clinical practice by suggesting severity strata derived using anchor-based methods. The British journal of dermatology, 169(6), 1326–1332. https://doi.org/10.1111/bjd.12590

7. [Internet]. [cited 2024 Feb 11]. Available from: https://www.icd10data.com/ICD10CM/Codes/L00-L99/L20-L30/L20-