OBJECTIVE: – TO UNDERSTAND THE SCOPE OF HOMOEOPATHIC CONSTITUTIONAL TREATMENT IN CHRONIC DERMATOLOGICAL DISEASE.
INTRODUCTION: – Nummular (meaning round or “coin shaped”) dermatitis or eczema is an inflammatory skin condition characterized by the presence of well-demarcated round-to-oval erythematous plaques. The term nummular dermatitis has been used both as an independent disease and as a description of lesion morphology that can be found in many different diseases, including atopic dermatitis, contact dermatitis, and asteatotic eczema. This discussion focuses on the disease entity that has been described in the literature. Other names have included discoid eczema or orbicular eczema.
Nummular eczema was first described by Deverigie in 1857 as coin-shaped lesions on the upper extremities. Since then, it has been reported in all age groups and in all body areas but is most commonly found on the upper and lower extremities.
Nummular eczema, also known as discoid eczema and nummular dermatitis, features scattered circular, often itchy and sometimes oozing patches. The word “nummular” comes from the Latin word for “coin,” as the spots can look coin-shaped on the skin.
Causes- Nummular eczema can occur at any age, and males tend to develop it more often than females. Its causes aren’t clear, but triggers can include very dry or sensitive skin and trauma to the skin from insect bites, scrapes or chemical burns.Nummular eczema may also develop as a reaction to some other types of eczema and their triggers, such as contact dermatitis and nickel. When it appears on the legs, it can be linked to poor blood flow in the lower body and the stasis dermatitis those circulation problems can cause.
Symptoms -Symptoms of nummular eczema can include:
- coin-shaped lesions on arms, legs, torso and/or hands
- itching and burning
- lesions that are oozing liquid or have crusted over
- red, pinkish or brown, scaly and inflamed skin around the lesions
- NAME: – MS XYZ
- AGE: – 20 Years
- SEX: – Female
- RELIGION: – Hindu
- EDUCATION: – Degree 2nd year, BAMS
- OCCUPATION: – Student
- MARITAL STATUS: – Unmarried
- RESIDENCE: – Bengaluru.
- OPD No. – 41362
- DATE OF CASE TAKING: – 08/ 06/2022
CHIEF COMPLAINTS: –
The patient presented with complaints of eruptions with severe itching,, and dryness of skin all over the body except the head and neck region for 4 years.
History of presenting complaints: – Patient was apparently healthy 4 years back, she started getting redness of skin and itching over bilateral great toes- initially she did not take any treatment for this but within a month, she also started developing eruptions over legs (left to right) with intense itching. She consulted a general physician in her locality who prescribed her some ointments and tablets. Itching was slightly better after applying ointment, but within 4 to 5 months eruptions started appearing on thighs, hip region, abdomen and chest as well. So, she consulted a dermatologist who diagnosed a case as psoriasis[?] and prescribed steroids and ointments and she was under treatment for almost 3 years without any relief. Eruptions started appearing on arms also with severe itching so stopped ointments and started with Ayurvedic medicine from past 1 year, but without any relief.
Initially lesion starts with redness of skin with itching. Later eruptions appeared and on scratching there will be serosanguinous discharge then there will be development of crusts and scales with blackish discoloration of skin. Itching is very severe that it is affecting her daily activities and she is not able to attend classes, night her sleep disturbed due to itching, she said that she never slept well since these complaints started, hardly she can sleep for 2-3 hours, and she wakes up in midnight and keeps scratching till 3-4 AM. Scratching causes more itching. Itching aggravated by washing, during winter and midnight
There is no history exposure to any chemicals, oedema, cracks, petechiae, allergies.
- Medical history: – nothing significant
- Treatment history: –Allopathic and Ayurvedic treatment for presenting complaints.
- Surgical history: – Nothing significant.
- Allergic history: – Not allergic to drug, diet and dust.
Family history: –
- Father- apparently healthy- 43YRS
- Mother- apparently healthy- 40YRS
- Maternal Grandmother- complaints of joint pains 70 YRS.
- Maternal Grandfather- Died in old age, at 80yrs
- Paternal grandparents – dead ( cause not known)
- Siblings- 2 younger sisters, apparently healthy.
- Diet – Mixed
- Appetite- Good, can tolerate hunger
- Thirst- Thirstless, hardly 1 litre /day, from before I don’t drink much water. I drink only after eating.
- Craving- Sweets+, Spicy food
- Aversions- Nil.
- Bowel habits- Regular, stools – soft
- Bladder habits- Regular.
- Sleep- Disturbed due to itching since 3 years
- Dreams- Of father since 4 years
- Perspiration- Scanty, only on exertion, no odour, no staining
- Thermals- Hot (I cant tolerate hot weather)
- Addictions- Nil.
- Menarche- at the age of 13 years.
- Cycle- regular, once in 30 days.
- Flow- normal.
- Days of flow- 5 days.
- Number of pads changed per day- 2/3/3/2/1
- Passage of clots- nil
- LMP- 15/05/2022
- Associated symptoms-lower abdominal pain and backache during first 3 days of menses
LIFE SPACE INVESTIGATION
Family background-Patient hails from lower socioeconomic family, father – daily wage worker and mother runs a small grocery shop. She has 2 younger sisters.
Childhood- Father was alcoholic and he always use to fight with my mom (verbal fights) but he was very much attached to us (daughters). I was average student in studies and very mild, would not participate in any extracurricular activities, because I was not interested. I was very much attached to father, every day he used to bring chocolates and sweets for us.
In 2018 my father suddenly left us and went, he didn’t come back home after his work. He had taken loans and debts, he was very much worried how to repay it, he was under pressure. He use to tell that he was not able to take the pressure and woud leave home and go. All our relatives searched for him in all places but did not find any traces of him anywhere. I was very sad and upset but still I’ve hopes that he will come back home. Mother was very much tensed and worried after this incident. Being an elder daughter, I consoled my mother. I did not express much sadness because I’ve to console mother and my younger sisters. I keep on thinking about my father, cry when I’m alone. I don’t want to show my sufferings and difficulties to friends, people and even to family members. If people get to know our difficulties, they start showing sympathy which I don’t like, and I don’t want to be weak in front of anyone, but I feel very sad when my friends talk about their father and upload their pic with father in social media. Its very difficult to digest the fact that – if people ask about my father what to answer- appa illade iroru illa antha helabahudu, appa iddavaru appana bagge helabahudu, but naanu yenu helali- idare antha helala or illa antha helala yenantha namage gothilla, devaru yaake namage eethara sthithi ge tandhubitta. Yelru chenagidhare nange maathra yaake eethara aagthide Avaru kudili jagala maadali sala maadali avaranna naavu chennagi nodkoteve but avaru manege vapas bandare saku.
College days-I got BAMS degree seat in Bengaluru. I Had to face lot of difficulties initially like financial troubles, adjustment with people, place, language, surrounding etc. Sometimes I didn’t have money to go to hometown during holidays, mother is the only sole earner for the family, she is running a grocery shop but there also no much profit. Because of all these I’m not able to enjoy anything. I feel sad when my friends go for outings, trips etc but at the sametime I do also think about my family situation and my responsibilities. I want to study well, settle and look after my mother and sisters well.
Attitude towards her disease condition-EXPLAINED IN KANNADA( PATIENTS OWN LANGUAGE) I feel embarrassment because these skin eruptions are visible outside, nan vayassina hudugeeru chennagiro batte yella haakondu yeshtu maja maadthidare but nanagyake ee thara. Obba hudugiyaagi eethara eroke tumba kashta agutte yeshtu dina antha idannella cover maadkondu tirugaadali, yeshte muchi itkondru roommates ge gottagutte avaru onthara keelage kaantare ,I know being a medical student I don’t share clothes, soaps or anything. Still nan friends nanna muttoke hinde munde nodtare, eethara agiddu nan tappa nan madkondidda idu? Ommomme sayabeku ansutte aadre nan amma nan thangiyarige yaaru gathi, nan ammanige dhairya innu nan thangiyaru chikkavaru nanage naane samadhana madkondu dhairya thagondu badukidini. Duddu illade idru badukabahudu,but eethara kaayile itondu badukodu kashta adu ondu hennige tumba kashta agutte, some seniors bandu help madtare duddu kodok bartare they purchase things for me, samadhana madoke bartare but nanmage adu ishtaagalla, nanage aathara support bekilla nanage ellara jothe kushiyaagi irbeku, but ee rogadinda ellanu kalkotidini, yeshtu dina antha eethara kai kaalu muchkondu tirugaadali, college fest time nalli nan friends ella saari haktare nanage haakoke agalla. yella kade treatment maadidru kammi agalilla jaasthi agtane ide, heege adre nanna yaru maduve agtare. Nanna ammanige finanacial du ondu tension , appa ellidano eno annodu innondu tension adaralli nanna ee kayile bagge mattashtu tension , maduve vayassalli eethara skin condition iddare yaaru maduve agtare nanna? Nam kashtagalige konene illa, ivagalu nanage husharagtini anno nambike illa, but nan senior heliudlu antha nim bali bande.
General physical examination-
- Moderately built and well nourished
- Well oriented with time place and person
- No signs of pallor, icterus, cyanosis clubbing, oedema and lymphadenopathy.
- Oral hygiene well maintained.
- Nails- healthy
- Skin –All over body except head, face and neck. Dry, eruptions- scales with crust formations. Blackish discoloration of skin in affected parts [ PIC]
- RS- NVBS, No added sounds.
- CVS- S1 S2 heard no murmur.
- CNS- NAD
Investigations done- she tore all investigation reports and prescriptions and discarded out of frustration saying they are of no use as she was not getting better with any medicines
PROVISIONAL DIAGNOSIS ” Nummular eczema
The aim of Homeopathy is to treat the underlying cause of the disease rather than merely treating symptom superficially. Homoeopathy treats skin affections with individualized internal medicines as these are not local maladies but internal affections and need to be treated internally. It treats the disturbances of the immune system and treats the roots of this disease.
Informed consent has been obtained from the patient and the patient has given his consent for her photographs and other clinical information to be reported in the journal. The patient was made to understand that his name and initials will not be published and due efforts will be made to conceal his identity.
- Nummular Eczema | National Eczema Association [Internet]. National Eczema Association. . Available from: https://nationaleczema.org/eczema/types-of-eczema/nummular-eczema/
- Miller, J.Nummular Dermatitis: Background, Pathophysiology, Etiology. medscape.com. Available at: https://emedicine.medscape.com/article/1123605-overview .
- Lectures of Homoeopathic materia medica, Natrum Muriaticum
- Soul of remedies by Dr Rajan Shankaran
- Synthesis repertory mobile application.
Under The Guidance Of Dr Vijaykrishna V
Professor and PG Guide
Department Of Materia Medica
GHMC & H Bengaluru.
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