Irritant dermatitis includes several inflammatory reactions, which follow non-immunological damage to the skin. This may be the result of an a/c toxic insult to the skin, or due to the result of repeated and cumulative damage from both physical and chemical agents. Irritant dermatitis is also called as the irritant contact dermatitis (ICD).Irritant dermatitis is not a uniform entity of disease each irritant exerts its particular noxious effects on the skin.
Dermatitis is a term used to denote a polymorphic pattern of inflammation of skin characterized by erythema, edema, vesiculation, oozing, crusting, papules scaling and lichenification.
Contact dermatitis includes:
1) Irritant contact dermatitis
2) Allergic contact dermatitis
3) Phototoxic, photoallergic and light aggravated contact dermatitis
4) Immediate type contact dermatitis
Irritant contact dermatitis is due to non-immunologocial damage to skin.
Allergic contact dermatitis leads to type IV hypersensitivity and cell mediated immune damage to skin. Here the offending agent is a hapten and it combines with skin protein to become antigenic.
Photo dermatitis involves immunological and non-immunological damage to skin due to exposure to sun.
Immediate type contact dermatitis also leads to both immunological and non-immunological damage to skin.
Irritant contact dermatitis due to soap detergents commonly affects housewives and cleaners who immerse their hands in water and detergent. It is presumably due to the combination of asteatosis, exposure to mild irritants such as soap and mild trauma. e.g. wringing out dishcloths.
ICD is one of the greatest health problems. This problem is on the increase as the new brands of soaps and detergents marketed are having many additives like perfumes, antibacterial, antimicrobials coloring agents etc which act as sensitizers. Hygienic measurements like avoidance of soaps and detergents is not wholly possible for many owing to the cultural and socio economic conditions. Modern school medication offers sudden relief for all the symptoms but there is resurgence of the symptoms on discontinuing the meditation and when the patient is again, exposed to soaps and detergents. Many patients are not able to continue modern medicines because of their disastrous side effects and also due to economic reasons. Homoeopathic medicines becomes their only hope and aid, as the cure affected is rapid, gentle and permanent without any deleterious effect.
Homoeopathy has for its foundation, solid concrete facts united by great natural principles. The practical demonstration of Homoeopathy is committed to its personal representatives whose ability, acquired technical proficiency and logical consistency can bring to the system a scientific stand and success. Master Hahnemann through years of closest observation and careful experimentation has constructed this system on the basic principles of similia similibus curenter, minimum dose and single remedy. The structure is further raised on the fundamental principles, which are consistent with the universal laws and the framework is being furnished by years of study and experiments by the younger generations of homoeopaths. A humble effort in this regard is made on attempting to study the efficacy of homoeopathic medicines in the management of irritant contact dermatitis due to soap and detergents with the help of experienced hands in homoeopathy.
It is not ICD as such, which is the object of our consideration, but the man affected with ICD. The man is affected in the internals and it is the manifestation of internals, which present as ICD. It should be given due thought that, all people exposed to the noxious effects of soaps and detergents are not having the disease manifestation. Why is some people peculiarly disposed to have this disease? What brought forth the disease manifestation? What is behind the cell disturbance or life perversion in the affected part?
Hahnemann through his diligent study and 12 years of accurate observation and experimentation came to the fact that the ostensible disease manifestation was a mere fragment of a much more deep seated primitive evil, which he called miasm. Thus miasms were discovered to be the unknown primitive malady, which caused all ailments and symptoms. Understanding miasm involves understanding sum total of all the sufferings of the patient, which in turn involves a comprehensive study of the etiology, symptamatology, pathology and life situation of the patient. So in the succeeding pages, the subject matter is dealt with, due stress on etiology, symptamatology, pathology, diagnostic criteria’s and miasmatic interpretation.
AIMS OF THE STUDY
To ascertain the effectiveness of homoeopathic medicines in the management of irritant contact dermatitis due to soap and detergents. There are many effective homoeopathic medicines for this malady but until now nobody has undertaken a scientific study in this manner based on statistical data.
In addition to this special attention is given to
1) Trace out the prominent miasm behind the malady.
2) Relation of irritant contact dermatitis to the socio-economic status of the patient.
3) Whether medicinal management is effective, if so to what extent.
4) Are there cases beyond the scope of homoeopathic treatment?
REVIEW OF LITERATURE
Irritant contact dermatitis is caused by direct chemical or physical damage to the skin. It is not a uniform entity of disease ,each irritant exerts its particular noxious effects on the skin and each occupation has its special risk of substance and mode of physical contact .Everyone is susceptible to the development of an irritant contact dermatitis if exposed to an irritant (toxic) agent is sufficient quantity. It occurs particularly where the stratum corneum is thinnest. Hence, it is often seen in the finger webs and back of the hands rather than the palms.
Observations and Discussions
20 patients who attended the organon of medicine and homoeopathic philosophy out patient department of Govt. Homoeopathic Medical College Hospital from April 2003 to April 2004 were studied.
The statistical analysis is based on the data obtained from these patients, who completed the treatment.
Irritant dermatitis is not only an occupational problem, but also a cosmetic problem. Patients become reluctant to appear in the public due to the disfigurement of their hands. In this study 20 patients who attended O.P department of Organon of medicine from April 2003 to April 2004 were included. These patients belonged to various socio- economic status and of age group between 15 – 50 years. The results of the study were evaluated using statistical principles.
Maximum age groups affected were between 21-40 years. Housewives were found to suffer more than those who were pursuing other occupation. Looking into the socio-economic condition of the patient and analyzing whether there is any relationship between irritant dermatitis and socio-economic status it could be seen that a definite relationship existed. Lower middle class and lower class people were more prone to develop irritant dermatitis. About 30 % of the patients had previous history of infectious diseases and 25% had previous skin complaints .15% of patients had family history of similar complaints and 30% of patients had winter aggravation. Psora was found to be the miasm in the background and as pathology progressed Syphilis was found to become prominent.
The study aims at determining the efficacy of homoeopathic medicines in the management of ICD. The evaluation is based on clinical improvement. As per the advise of my guide, the major signs and symptoms were included as the basic criteria for the diagnosis.
All the cases had peeling, itching and erythema while only 80% of the patients had cracks on palms. 90% got relief for peeling of skin and in 5% of cases it completely disappeared. 80% got relief for erythema and 10% of cases it completely disappeared. 80% got relief for itching in 15% it was no more. In 25% of the cases there was complete disappearance of cracks and 62.5% had relief.
From the analysis of the above results it is obvious that the homoeopathic medicines are quiet effective in preventing the recurrence of the major features of ICD and also is effective in reducing the intensity of the chronic, long lasting manifestations.
The effectiveness of homoeopathic treatment was evaluated by statistical analysis of the pre-treatment and post-treatment disease intensity scores, which were given to each case. After statistical analysis, the calculated value was 10.86, which was well above the tabled value at 5% and 1% levels P<0.01. Thus this study provides an evidence to say that homoeopathic medicines are effective in preventing the recurrence of the complaints and lessening the intensity of the complaints .
Medicinal management was found to be very much effective, in 25% of the case Graphities was indicated, in 20% of the case Sepia was indicated, in15% of the case Sulphur was indicated, in 10% of the case Lycopodium was indicated, in 10% of the cases Ars Alb was indicated, Natrum Mur, Malandrinum, Petroleum, Ars iod were found to be indicated in 5% of the cases. One case treated with Graphities showed aggravation. All potencies ranging from 30 to CM were used. In one case 50 millesimal potency was used. There were no cases that were beyond the scope of homoeopathic management. An aggravation was found to happen on using Graphities in one patient. It needs assurance and confidence on the part of physician and patient while managing the aggravated condition.
Irritant dermatitis due to soap and detergents is one of the greatest public health problems as it interferes with the daily activities of the patient. It is also one of the social problems as majority of the patients belong to the poor socio-economic group. Inability to work with their hands means loss of work and money, which in turn leads to poverty.
Various steps are recommended on the basis of this study to improve the health status of the patient. If these measures are given due consideration it will improve the health status of the community.
It is seen that many manufacturing firms are adding perfumes, antimicrobials, antibacterial agents, colouring agents etc to soap and detergents in order to make their products attractive to the consumer. These agents acts as sensitizers and perpetuate and aggravate irritant dermatitis. Government should set up regulation to decrease the amount of sensitizers in soap and detergents. Legal measures should be taken against companies marketing soaps and detergents with strong sensitizing agents. Names of the ingredients should be labeled on the products, so that patients will be able to select a soap and detergent which is less irritant to them. As majority of the patients are from low socio – economic condition, compensation should be granted for the injury sustained at their work place. Protective clothing should be provided by the employees. Awareness programmes about the ICD should be conducted and patients should be advised to stick on to hygienic measures. Occupational site survey should be carried out by the officials to assess the problem in the workplace and initiate preventive and curvative measures.
When this study was summarized many suggestions for further investigation came up.
1) To assess the ph of soap and detergents and find out their relationship with irritant reaction
2) To assess the potential of soap and detergents to cause irritant reaction by testing on laboratory animals and on human volunteer subjects
3) To find out whether the soap and detergents causing a marked irritant reaction in the cruder form can be used as a curative agent in an some in a highly potentised form,
These suggestions are put forward for further study and research on this subject which may help to enrich this subject and enhance the scope of homoeopathy in this field.
The following salient conclusions have been drawn on the present study after summarizing its findings.
- Homoeopathic medicines are effective in the management of ICD
- There are no specific medicines for ICD but there is a specific medicine for each patient suffering from ICD
- Age group mostly affected in between 21 – 40 years
- Incidence is mostly seen in housewives
- More than one fourth of the cases shows winter aggravation
- There is also a chance for the family members of the patients to be affected by ICD
- Incidence of the disease is more in lower middle class and low socioeconomic classes and much scarce in upper middle class and high class families
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