A case report on the effectiveness homoeopathic medicine in the treatment of Tenia pedis

Dr Keerthana D

ABSTRACT:
Introduction: Athlete’s foot, medically known as tinea pedis, is a common fungus-induced skin ailments of the feet. Itching, scaling, cracking, and redness are typical signs and symptoms.

Athlete’s foot is most commonly observed between the toes (interdigital), with the space between the fourth and fifth digits (the little and fore toes) being the most afflicted. The skin may crack as the condition advances, resulting in bacterial skin infections and lymphatic vessel irritation. If athlete’s foot fungus is left to persist for too long, It may spread to infect the toenails and feed on the keratin, a condition known as onychomycosis.

Homoeopathic medicines have been found to be effective in treating skin illnesses; hence, this case report is an attempt to demonstrate the efficiency of the individualized Homeopathic medicine Mercurius solubilis in the treatment of tenia pedis.

Case summary:
A 10-year-old female patient presented with itching and scaly eruptions on both feet in OPD of Government Homoeopathic Medical college and Hospital, Bengaluru; following a thorough case history, Mercurius solubilis was prescribed, and the condition improved, demonstrating the effectiveness of a Individualized Homoeopathic Medicine in treating Tenia pedis. The before and after results were evaluated clinically.

KEYWORDS: Homoeopathy, Tenia pedis, Athlete foot, Individualized Homoeopathic Medicine, Mercurius solubilis.

INTRODUCTION:
Dermatophytes are the most common agents of superficial fungal infections globally, and they are more prevalent in developing nations, particularly tropical and subtropical

Countries such as India, where the ambient temperature and relative humidity are high. Other factors, such as greater urbanization, the usage of occlusive footwear, and Tight-fitting clothing, have been related to a higher frequency. ¹

Tinea pedis, a dermatophytic infection of the feet, can affect the interdigital web spaces or the sides of the feet and is a chronic or recurring condition.

Tinea pedis can manifest as one of numerous syndromes depending on the pathogen and anatomical distribution. There are usually three variants: interdigital, moccasin, and Vesicobullous.

• Interdigital tinea pedis is the most frequent type, which appears in the interspace between the fourth and fifth digits and can spread to the underside of the toes.
• The hyperkeratotic/moccasin kind of scale, typically brought on by T. rubrum, covers the sole and sides of the foot.
• Blisters, typically of the vesiculobullous variety, that are small to medium in size and typically affect the inner heel.

Patients frequently report itching and burning feelings on their feet, as well as an unpleasant odor.  ²

Anthropophiles are the most common etiological agents, followed by Trichophyton rubrum sensu stricto, Trichophyton interdigitale, and Epidermophyton floccosum.

It may manifest in a variety of clinical presentations, including intertriginous, hyperkeratotic, vesiculobullous, ulcerative, or a mix of these. It is commonly known as “Athlete’s Foot. Tinea pedis can be accompanied with dermatophyte infection of other areas of the body, such as the groin, hands, or nails. It is estimated to afflict

Approximately 15% of the general population, and is more common in closed communities such as army barracks and boarding schools, in warm weather, among individuals who

Frequent swimming pools, and when the feet are occluded by nonporous tight-fitting shoes. ³

Adult males are more likely than females to have tinea pedis. Tinea pedis is usually asymmetrical and may be unilateral. Risk factors include occlusive footwear, high perspiration, poor peripheral circulation, immunosuppressive medicines, and underlying immunodeficiency.

Tinea pedis development is also influenced by the patient’s overall health. Patients who are obese, elderly, or have systemic issues (such as diabetes mellitus) are at a higher risk. Trauma, excess wetness, occlusive clothes, and regular use of public baths and pools are all potential sources of infection.

A recent study in Israel found that repetitive foot washing among schoolchildren could cause delipidation and pH alterations in the stratum corneum, promoting fungal development.

Complications of Tinea pedis:

• Tinea pedis infections, which are often interdigital in nature, can be worsened by cellulitis. Wet, occlusive conditions occur in the infected interspaces, resulting in skin maceration and fissuring. This reduces the skin’s natural barrier and could allow harmful microorganisms to enter.
• Tinea unguium is a fungal infection of the matrix, plate, or nail bed caused by a dermatophyte. It is frequently linked with tinea pedis.
• Dermatophytid, often known as the “ID” reaction, is an immune response to tinea pedis and other tinea infections.
• Asthma and atopic diseases

Diagnosis of Tinea pedis:
Tinea pedis infections are usually simple to identify and diagnose. In addition to direct microscopy of a potassium hydroxide (KOH) preparation, the diagnosis of tinea pedis is

Based on the patient’s history and the clinical appearance of the feet. Skin scrapings are used to confirm the diagnosis and are sent for microscopy in potassium hydroxide, where segmented hyphae may be seen. Histological analyses or cultures are not always necessary. A Wood’s lamp can be used to rule out alternative diagnoses, such as an infection with Malassezia furfur or erythrasma, but it is often not helpful in detecting tinea pedis. ⁴

In the traditional system, the sole options are oral antifungal medications and topical antifungal creams, which must be taken continuously throughout life. Recurrences are common and may require at least 4 weeks of topical treatment. Homoeopathy is based on individualization and holistic approach as man as a whole is affected and not just an organ as man is prior to the organ. Homeopathic remedies treat the underlying cause of a condition rather than merely alleviating the symptoms.

Homoeopathic medicines have a direct effect on vital energy, which in turn produces equilibrium, and those parts of the body that are susceptible due to imbalance become a

Part of the whole unit’s normal healthy functioning.

CASE: This is a case report of a female patient aged 10 years, a student by profession in Bangalore, who presented to the outpatient department of Government Homoeopathic Medical College and Hospital with complaints of itching and scaly eruptions on both feet for one year.

HISTORY OF PRESENTING ILLNESS: The patient appeared to be in good health prior to the symptoms of itching and scaly lesions on both feet which started one year. The patient was taking conventional Medications that were not effective for her.

Complaints began with the left leg foot and progressed to the right.

LOCATION: Toes of both feet, extensor and plantar surfaces and between the toes.

SENSATION: Itching and burning pain.

CHARACTER: Scaly eruptions, peeling of skin, redness, dryness, slight bleeding on scratching, offensive discharge.

MODALITY: Itching <evening, night.

>warmwater application.

Itching and scratching leads to bleeding.

No concomitant symptoms.

PAST HISTORY:
Three years ago, there was a history of recurrent fever with circular eruptions all over the body. The patient took allopathic treatment and recovered.

FAMILY HISTORY: Father suffers from asthma, while mother and one younger sister are apparently healthy.

PERSONAL HISTORY
Appetite is good. Desires lemon and sweets. Thirsty. Urine and stool were regular and satisfactory. Refreshing sleep; sleeps sideways. Drooling during sleep. Dreams of robbers

And animals. Perspiration on exertion. Thermally, chilly patient.

GENERAL PHYSICALPHYSICAL EXAMINATION:

• BUILT AND NOURISHMENT: Lean and thin.
• HEAD: Healthy scalp and hairs.
• EYE: Pink conjunctiva and clear sclera.
• ENT (Ear, Nose and Throat): NAD
• ORAL CAVITY: Hygienic, White coated tongue, Pink gums.
• EXTRIMITES: Eruptions on both right and left toes of foot, dryness with roughness and slight bleeding.
• No signs of icterus/pallor/oedema.

 VITAL SIGNS:

• BLOOD PRESSURE: 110/70 mmHg.
• PULSE RATE: 84bpm.
• RESPIRATORY RATE: 18cpm.
• TEMPERATURE: Afebrile

SYSTEMIC EXAMINATION:

• CNS – Conscious and oriented with respect to time, place and person.
• CVS – S1 and S2 heard.
• RESPIRATORY SYSTEM- Bilateral normal vesicular bronchial sounds heard.
• GIT: NAD

LOCAL EXAMINATION:

INSPECTION:

LOCATION- Both right and left foot toes.

Eruption between the toes and both extensor and plantar surface, cracks on extensor surface. Slight bleeding. Dryness and roughness of the skin.

DIAGNOSIS: Tinea pedis based on the clinical history and examination.

ANALYSIS OF CASE: After thoroughly analysing the case, the following symptoms were considered: scaly eruptions with moist discharge, itching that worsened at night, and warmth.

Physical generalities include being chilly and thirsty, desires sweets and lemons, and having dreams about robbers and animals. Mental generals: Hurry, craves company, dislikes being alone, is careless, angry at contradictions, and finds it difficult to concentrate while calculating.

The totality of case was formed, and repertorization was carried out using CARA software ⁵ and Materia medica was reviewed to confirm the final selection of the remedy.

EVALUATION OF SYMPTOMS: (Table 1)

Mental generals	Physical generals	Particulars
Hurry Concentration difficult while calculating Anger contradiction from. Dislikes to be alone. Careless.	Dreams of animals. Dreams of robbers. Desires lemons and sweets. Thermally: Chilly.	itching with scaly eruptions on both the foot. Itching < evening, night. < warm water application. Offensive discharge.

SELECTION OF MEDICINE:

• Repertorial Approach.

Symptoms taken for repertorization:

• SKIN- Eruptions discharging moist scratching after
• SKIN- Eruptions itching warmth agg
• SKIN- Eruptions itching night
• SKIN- Eruptions scaly
• GENERALITIES- Food and drinks lemons desires
• GENERALITIES- Food and drinks sweets desires
• MIND- Dreams animals of
• MIND- Dreams robbers of
• MIND- Hurry
• MIND- Heedless, careless
• MIND- Company desires for, along agg. While
• MIND- Concentration difficult calculating while
• MIND- Anger contradiction from.

PRESCRIPTION:
Individualized Homeopathic Medicine Mercurius solubulis 200 was selected and prescribed based on the totality of the case and review of Materia medica.

Rx Merc sol 200 1 dose

MANAGEMENT:

• After bathing, dry the feet and toes attentively.
• Apply desiccating foot powder once or twice daily and avoid wearing occlusive footwear for long durations.
• Dry your shoes and boots thoroughly.
• Use a bleach-based cleaning solution to clean the shower and bathroom flooring.

FOLLOW UP:
Follow up was based on the requirement of the case and assessment was done according to Hering’s law of cure and Kent’s 12 observation.

DATE	COMPLAINTS	ADVICE
20/11/2023	Eruptions are little better. Offensive discharge is better. Itching is better by 50%	PL 15 DAYS
15/12/2023	Eruptions are better. Offensive discharge is reduced. Itching is better by 80%	PL 15 DAYS
5/1/2024	Eruptions almost reduced. Offensive discharge- not noticed Itching is better completely.	PL 15 DAYS

Conclusion AND Discussion:
This case report was done in the term of fulfilling the aim and objectives of the study which was conducted to ascertain the effectiveness of Individualized Homoeopathic medicines in the treatment of tinea pedis.

The case study was from the OPD of the Government Homoeopathic Medical College and Hospital, Bengaluru and the medicine and potency was selected based on the Homoeopathic principles. Follow ups were recorded and analysed as per the requirement of the case. After detailed case taking the patient was given Individualized Homoeopathic medicines.

Mercurius solubilis was selected on the basis of individualization using totality of symptoms. The predominant symptoms observed in this case are a hurried nature, anger when contradicted, difficulty concentrating while calculating, heedless and careless attitude, dreams of robbers and animals, and desires for sweets and lemons, which are similar to the symptoms of Mercurius solubilis. The patient exhibited remarkable improvement during subsequent follow-ups. Homoeopathic medicine takes a holistic approach to understand the patient as a whole. In the Organon of Medicine, Dr. Samuel Hahnemann discusses the drawbacks of local application for local maladies. ⁶ The condition improved significantly as a result of the Individualized Homoeopathic Medicine, and the tinea pedis was successfully treated. This case report demonstrates the effectiveness of Homoeopathy to tinea pedis and thus, other fungal illnesses.

ACKNOWLEDGEMENT:
I am grateful to my PG Guide and Professor, Dr. Shobha B. Mali Patil ma’am, Department of Organon of Medicine with Homoeopathic Philosophy and also grateful to the patient and her family for her cooperation.

DECLARATION OF PATIENT CONSENT:
Due written informed consent and assent were obtained from the patient and patients’ family for the publication of this study, ensuring anonymity.

CONFLICT OF INTEREST: None declared.

REFERENCE:

1. Sahoo AK, Mahajan R. Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian dermatology online journal. 2016 Mar;7(2):77.
2. Ilkit M, Durdu M. Tinea pedis: the etiology and global epidemiology of a common fungal infection. Critical reviews in microbiology. 2015 Jul 3;41(3):374-88.
3. Priya BT. Tinea Pedis-A Clinico-Mycological Study (Doctoral dissertation, Madras Medical College, Chennai).
4. Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G. Dermatology for the practicing allergist: Tinea pedis and its complications. Clinical and Molecular Allergy. 2004 Dec;2:1-1.
5. Complete Repertory by Roger van Zandvoort (CARA software)
6. Hahnemann S. Organon of medicine. 6^th New Delhi: B Jain Publishers; 2012.

Dr. D. Keerthana
PG Scholar, Department of Organon of Medicine with Homoeopathic Philosophy
Government Homeopathic College and Hospital, Bengaluru.

UGO: Dr. Shoba B. Mali Patil
Professor, Department of Organon of Medicine with Homoeopathic Philosophy
Government Homeopathic College and Hospital, Bengaluru.

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