Effect of Homoeopathy remedy Petroleum on skin disorders and chilblain

Dr Puneet Kumar Misra

Abstract
During the cold weather when the person come with the main complaint as the swollen finger of lower extremities or both extremities with or without ulcer, the new as well as experience clinicians first choice of the   drug are the dynamic   petroleum i.e. the petroleum in the potency and this prescription never dispirited the prescriber. But most of the physicians are unawares about the    major quality of this medicine which is highly   proved effective in the winter dryness of skin and other associated disorder of dry skin due to cold wind exposed specially kids and old age group.

Key words – Petroleum, skin, Chilblain, winter, dryness, eczema

Introduction

The skin is the largest organ in the human body. Forming a major interface between man and his environment, it covers an area of approximately 2 m and weighs about 4 kg. The structure of human skin is complex, consisting of four distinct layers and tissue components with many important functions. Reactions may occur in any of the components of human skin and their clinical manifestations reflect, among other factors, the skin level in which they occur, and sometimes they act as a ‘window’ of systemic changes elsewhere in the body, e.g. medical conditions , such as those associated with pruritus , systemic causes of erythema nodosum  or paraneoplastic skin conditions . The accurate diagnosis of most skin lesions requires an adequate history, careful examination of the patient and, occasionally, laboratory investigation, but dermatology is predominantly a visual specialty.1

Non-freezing cold injury (trench or immersion foot) – This results from prolonged exposure to cold, damp conditions. The limb (usually the foot) appears cold, ischaemic and numb, but there is no freezing of the tissue. On rewarming, the limb appears mottled and thereafter becomes hyperaemic, swollen and painful. Recovery may take many months, during which period there may be chronic pain and sensitivity to cold. The pathology remains uncertain but probably involves endothelial injury. Gradual rewarming is associated with less pain than rapid rewarming. The pain and associated paraesthesia are difficult to control with conventional analgesia . The patient is at risk of further damage on subsequent exposure to the cold.2

Chilblains –Chilblains are tender, red or purplish skin lesions that occur in the cold and wet. They are often seen in horse riders, cyclists and swimmers, and are more common in women than men. They are short-lived and, although painful, not usually serious.2

  PERNIO (CHILBLAINS) is a vasculitic disorder associated with exposure to cold; acute forms have been described. Raised erythematous lesions develop on the lower part of the legs and feet in cold weather . They are associated with pruritus and a burning sensation, and they may blister and ulcerate. Pathologic examination demonstrates angiitis characterized by intimal proliferation and perivascular infiltration of mononuclear and polymorphonuclear leukocytes. Giant cells may be present in the subcutaneous tissue. Patients should avoid exposure to cold, and ulcers should be kept clean and protected with sterile dressings.3

Chilblains, is a cold-induced vasospastic inflammatory process that affects the skin after exposure to nonfreezing temperatures or damp climates. Pernio is seen more commonly in the northern United States and northwestern Europe. It is most common in individuals with a low body mass and in young women between the ages of 15 to 30 years, although it also can occur in children and in the elderly. The cause is unknown but is likely a result of cold-induced vasoconstriction that induces inflammation and ischemia of vessels and surrounding tissue. The histopathologic findings include dermal edema, keratinocyte necrosis, and a deep dermal lymphocytic infiltrate. Pernio can be classified as acute or chronic. Acute pernio develops a few hours after exposure, whereas chronic pernio develops after repeated exposures to nonfreezing cold or damp conditions.4

Pernio occurs most frequently in late fall to early spring in wet or non-freezing cold environments. Acute pernio is characterized by intense itching, numbness, or a burning sensation that develops shortly after exposure to cold or damp conditions and disappears within a few weeks. Pernio is generally symmetrical. It usually involves the toes and fingers and less commonly the nose, ears, or cheeks. Pernio may also affect the thighs of horse riders, young women wearing tight slacks, motorcycle riders, or people who frequently apply ice packs. Pernio is associated with single or multiple erythematous, brownish or purple-blue skin lesions (macules, papules, or plaques) that may progress to blisters or ulcers. Chronic pernio develops after repeated cold exposure and results in cyanotic papules, macules, or nodules. Patients often report a history of similar episodes that develop each year during the cold months and typically resolve with warmer temperatures. The diagnosis is based on the history and physical examination. Patients generally have a normal arterial examination. Pulse volume recordings may reveal vasoconstriction, but capillaroscopy is usually normal. A skin biopsy may be necessary to differentiate pernio from other disorders, such as Raynaud phenomenon, frostbite, acrocyanosis, atheromatous embolization, erythema nodosum , erythema induratum , lupus erythematosus , sarcoidosis , or atherosclerosis . Laboratory testing is important to exclude an underlying collagen vascular disease. Up to 35 to 40% of patients may have cold agglutinins as a precipitating cause . Prevention Patients susceptible to pernio should be advised to avoid cold exposure. If they must go outside in cold or damp weather, they should dress appropriately with layered outdoor clothing, insulated footgear, gloves, scarf, and hat. Pernio is usually self-limiting in the acute state. Chronic pernio can lead to scarring, atrophy, and chronic occlusive vascular disease.4

PROPOSED DIAGNOSTIC CRITERIA OF PERNIO

MAJOR CRITERIA –Localized erythema and swelling involving acral sites and persisting for >24 hours 4

MINOR CRITERIA – Onset and/or worsening in cooler months (between November and March) Skin biopsy consistent with pernio (dermal edema with superficial and deep perivascular lymphocytic infiltrate) without findings of lupus erythematosus. Response to conservative treatments (warming and drying of affected areas). 4

FROSTBITE – Peripheral cold injuries include both freezing and nonfreezing injuries to tissue. Tissue freezes quickly when in contact with thermal conductors such as metal and volatile solutions. Other predisposing factors include constrictive clothing or boots, immobility, and vasoconstrictive medications. Frostbite occurs when the tissue temperature drops below 0°C (32°F). Ice-crystal formation subsequently distorts and destroys the cellular architecture. Once the vascular endothelium is damaged, stasis progresses rapidly to microvascular thrombosis. After the tissue thaws, there is progressive dermal ischemia. The microvasculature begins to collapse, arteriovenous shunting increases tissue pressures, and edema forms. Finally, thrombosis, ischemia, and superficial necrosis appear. The development of mummification and demarcation may take weeks to months. 3

CLINICAL PRESENTATION The initial presentation of frostbite can be deceptively benign. The symptoms always include a sensory deficiency affecting light touch, pain, or temperature perception. The acral areas and distal extremities are the most common insensate areas. Some patients describe a clumsy or “chunk of wood” sensation in the extremity. Deep frostbitten tissue can appear waxy, mottled, yellow, or violaceous-white. Favorable presenting signs include some warmth or sensation with normal color. The injury is often superficial if the subcutaneous tissue is pliable or if the dermis can be rolled over bony prominences. Frostnip may precede frostbite. Frostnip is a nonfreezing cold injury resulting from intense vasoconstriction of exposed acral skin. Clinically, frostbite is superficial or deep. Superficial frostbite does not entail tissue loss but rather causes only anesthesia and erythema. The appearance of vesiculation surrounded by edema and erythema implies deeper involvement . Hemorrhagic vesicles reflect a serious injury to the microvasculature and indicate severe frostbite. Damages in subcuticular, muscular, or osseous tissues may result in amputation. An alternative classification establishes grades based on the location of presenting cyanosis; that is

Grade 1, absence of cyanosis;

+Grade 2, cyanosis on the distal phalanx;

Grade 3, cyanosis up to the MP joint; and

Grade 4 cyanosis proximal to the MP joint.

The two most common nonfreezing peripheral cold injuries are chilblain (pernio) and immersion (trench) foot. Chilblain results from neuronal and endothelial damage induced by repetitive exposure to damp cold above the freezing point. Young females, particularly those with a history of Raynaud’s phenomenon, are at greatest risk. Persistent vasospasticity and vasculitis can cause erythema, mild edema, and pruritus. Eventually plaques, blue nodules, and ulcerations develop. These lesions typically involve the dorsa of the hands and feet. In contrast, immersion foot results from repetitive exposure to wet cold above the freezing point. The feet initially appear cyanotic, cold, and edematous.  Frostbite with vesiculation, surrounded by edema and erythema. The subsequent development of bullae is often indistinguishable from frostbite. This vesiculation rapidly progresses to ulceration and liquefaction gangrene. Patients with milder cases report hyperhidrosis, cold sensitivity, and painful ambulation for many years. Treatment of peripheral cold injury – Management of the chilblain syndrome is usually supportive.

 Asteatotic eczema This occurs in dry skin and is common in older adults. Low humidity caused by central heating, over-washing, diuretics and cholesterol lowering drugs predispose. The most common site is the lower legs, and a ‘crazy paving’ pattern of fine fissuring on an erythematous background is seen. Emollients are a mainstay, in combination with topical glucocorticoids. Patients must be advised to use caution with flammable emollients and to avoid bathroom slippages related to emollients on floor and feet, and this is particularly relevant for older individuals.2

Asteatotic eczema, also known as xerotic eczema or “winter itch,” is a mildly inflammatory dermatitis that develops in areas of extremely dry skin, especially during the dry winter months. Clinically, there may be considerable overlap with nummular eczema. This form of eczema accounts for many physician visits because of the associated pruritus. Fine cracks and scale, with or without erythema, characteristically develop in areas of dry skin, especially on the anterior surfaces of the lower extremities in elderly patients. Asteatotic eczema responds well to topical moisturizers and the avoidance of cutaneous irritants. Overbathing and the use of harsh soaps exacerbate asteatotic eczema.3

Materia  Medica Chronicle

• Painful sensitiveness of skin of whole body; all clothing is painful; slight injury suppurates [Hep.].  Skin  of  hands rough, cracked; tips of fingers  rough,  cracked,  fissured,   every   winter; 5
• There is one very marked characteristic symptom that guides  to  this   remedy out of a large list having similar  eruptions,  and   that  is   that the eruption is worse during the  winter   season   (ALOE.,  , PSOR.,) There is no other remedy that  has   this   so prominently.  The  hands chap, crack and  bleed, and  are  all   covered  with ECZEMA DURING THE WINTER and  GET WELL IN SUMMER.  6
• #General Very marked skin symptoms, acting on sweat and oil glands.   Ailments  are  worse  during the winter  7
• #Extremities Chronic sprains. Fetid sweat in axillae.  Knees stiff.  TIPS OF  FINGERS ROUGH,  CRACKED,  FISSURED  EVERY   Scalding  sensation in knee.  Cracking in joints. 7
• #Skin Itching at night. Chilblains, moist, itch and burn.  Bed-sores.   SKIN  DRY,  CONSTRICTED,  VERY  SENSITIVE,  ROUGH  AND   CRACKED,     Herpes. Slightest scratch makes skin suppurate.   [HEPAR.]   Intertrigo; psoriasis  of  hands.   THICK, GREENISH  CRUSTS,  BURNING AND ITCHING; REDNESS, RAW; CRACKS BLEED  EASILY.   Eczema.  Rhagades WORSE IN WINTER. 7
• #Upper limbs Fetid sweat of axillae, Drawing pains in arms and fingers. Great  weakness  of arms. Stiffness of arms and fingers.  Erysipelatous inflammation in arms. Brown or yellow spots on arms. Furunculi on   Tearings in hands. Burning sensation in palms of  hands. Sweating  of  hands. Pain in wrist-joint as  if  sprained. Brown  spots   on  wrist. Bleeding  fissures  in  hands  and   fingers,  especially  in  winter. Salt-rheum, red, raw, burning, moist  or  covered  with  thick  crusts. Chilblains and  warts  on  fingers.  Pricking and pain in warts on fingers, evening in bed.  Arthritic  stiffness in joints of fingers. Finger-nails painful when touched  as   if  bruised.  Finger tips  rough,  cracked,  fissured,   with  sticking, cutting pain. 8
• #Lower limbs Cracking  in joints of legs. Cramps in thighs, calves, and  feet  (all  day,  in soles at night). Furunculi in thighs  and    Tension  in  the  ham. Lancinations in knee.  Weakness  of  knee.  Herpes  on  knee. Tuberous, itching eruption on calves  of  legs.  Herpes  on  ankle  bones. Burning  sensation  in  soles.  Profuse  perspiration   on   feet.  Foetid  perspiration  of   feet   with  tenderness.  Coldness of feet. Swelling of feet. Hot swelling of  soles.  Swelling  and  redness  of heel  with  burning  pain  and  shootings.  Worse  by  walking.  Heels  blistered.  Sensation  of  splinter  in heel. Chilblains on toes, especially when they itch and are moist, itch and burn, inflamed in cold weather. Ulcers on  the  toes,  originating in blisters on the toes. Corns  on  feet.  Burning  and stitching in corns. Obstinate superficial ulcers on toes, with elevated margins and red based, with oozings. Eruption  between toes 8
• #Skin Swelling  and indurations of the glands, also  after    Great  sensibility  of the surface of  skin.  Miliary  urticaria.  Itching tetters. Itching, excoriated, and running spots on  skin.  Brown  and yellow spots on skin. Eruption of itching and  burning  pustules.  Pruritus  of the aged. Dreadful  irritation  all  over body, very intense in vagina, anus and perineum, preventing sleep  (cured  ***R.T.C.).  Papular eruptions, especially  on  face  and  lips.  Skin sore, crawling sensation. Rhagades. The skin is  hard  to  heal.  Skin  unhealthy, every  injury  tends  to  ulceration.  Furunculi.  Ulcers with shooting pains, often deep  ulcers,  with  raised  edges. Proud flesh in ulcers. When a person complains  of  eruption  or itching at night (affecting  scrotum  particularly),  the  eruption being either dry or moist. Chilblains  particularly  where  they itch a good deal and are moist.  Exanthema  corroding  and spreading, very difficult to heal. Sensibility of the skin in  general.  Sores produced by lying in bed. Warts. Corns  on  feet.  Chilblains, sometimes painful. 8
• #Temperature and Weather Many ailments are agg. before and during a thunderstorm. Amelioration from warmth, warm air. After getting into bed: itching of hemorrhoids intolerable. Open air: toothache; inflammation in chilblains sets in: aversion  to;  causes  chilliness; after a walk flushes of  heat;  ecthyma,  Exposure to draft: causes catching pain in back. Cold  air:  causes  oppressed  feeling  in  chest;  ulcers  agg.;  chilblains agg. Winter:   deep  blood  rhagades  on  hands  agg.;  ulcers   agg.;  chilblains. Bathing: causes tenderness of feet. 9
• Heat and burning. Skin hot in places; with sensation of coldness in spots. Burning and itching of palms and soles; face and  scalp  The itching and burning often go together; parts that  burn  itch  much. Feet  burn  and  have  a  sensation  as  if  frozen.  Chilblains which itch, burn and become purple. Parts frozen will, years after,  itch,  burn, sting and become  red  and  hot.  The  patient can tell when it will thaw because of the itching in  the  chilblains.  Petroleum  cures the itching and burning  in  frozen  parts,  but  not  as prominently as (Agaricus)  leads  all  other  remedies,  especially when the condition affects parts where  the  tissues are thin over the bones, as over the back of  toes.10

The study are focused on  mentioned disorder in the table 01   and  Continues observation of drug action on more than four years  on the  265 case  details are given in table 02  .

Table 01

S.No	Disorder	Observation
01	Whole body itch with dryness in winter	Good response
02	Itching & Burning  of lower extremities finger  in winter	Marked response
03	Swelling of lower extremities finger	Moderate effect
04	Itching & Burning  Both extremities finger are effected	Marked effect
05	Crack in the finger hand or heel or both	Mild to moderate
06	Vertigo with   finger Swelling in winter	Moderate
07	Vertigo without   finger Swelling  and  dry skin	No effect
08	Gastric disorder with   finger and skin are effected	Mild to moderate
09	Gastric disorder without dry skin and finger are effected	No effect
10	Facial eruption with dryness in winter	Moderate effect

Table 02

TOTEL CASE

263

MALE

189

FEMALE

74

Table 03

Age group distribution in Years
Up to 10	11-20	21-30	31-40	41-50	51-60	61-70	71 Above
20	67	45	38	36	22	23	13

Discussion

1. The petroleum are mentioned in the different materia medica is marked affinity in the winter associated disorder markedly on the end part of the extremities mainly fingers.
2. It is common trend in clinical practice the most of the clinician only focus on the crake skin of finger and unawareness about the dryness of entire skin of body with low water intake in routine habit and low perspiration history in the summer weather. This is the most common clinical totality for prescribing of homoeopathy remedy petroleum   .
3. When the gastric disorder i.e. heartburn ,distension  and nervous disorder i.e. vertigo is associated with dry skin and low intake of water as habit especially in the winter season the petroleum is good indicated medicine but its therapeutics the adequate dose with rehydration ,if the hydration of body is deficient the result of remedy is not satisfactory,
4. Therapeutics use of this medicine in winter are starts  from the itching  of fingers with mild inflammation till formation of non freeze ulcer , for better illation of this medicine mild hot water plunge three to four time daily till  complete recovery of disorder
5. The facial eruption in the winter is the common problem of all age group but teenage are more effected due to poor hydration state and unawares about skin care ,when petroleum given with adequate intake of fluid    the recovery occur rapid and gentle manner
6. The facial eruption include acne in the summer with the low perspiration along the suppurations this medicine facilitate   the action of other medicine i.e. calendula off, myristica seb etc
7. Particularly in the geriatric skin itching and dryness disorder this medicine are more  usefully  in Therapeutics purpose as well preventive(when use of this medicine start from beginning of winter once in a day preferably in night after meal with good intake of fluids   )
8. Above mentions condition the petroleum 30c in BD to TDS is more effective instead 200 or higher potency, for prevention of recurrence the 3-4 week or more  continues administration  is needed .

Conclusion  – the potentized petroleum are having excellent  effect on the skin disorder specially winter when intake of fluids is inadequate and exposure of cold environments are marked, with     whole body skin dry( Asteatotic eczema) and finger are swollen(peripheral cold injuries are chilblain (pernio) and immersion (trench) foot.)  . skin dryness with or without  itching  during summer season under continua use of cooling appliances  also controls by this remedy . for better results of this medicine is essential need of good hydration .

Reference

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6. E B Nash .leaders in homoeopathic therapeutics. reprint edition 1994. Delhi: B Jain publishers (p) Ltd;  page  590-591
7. Dr W Boericke. New manual of homoeopathic materia medica with repertory.  41^st   Delhi: B Jain publishers (p) Ltd; 2018. Page no 445-447
8. Dr John Henry Clarke. A Dictionary of Practical materia medica volII^. Export quality reprint 2006. New Delhi. B Jain publishers Pvt.Ltd; 2006. Page 749-750
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10. DR James Tyler Kent. Lectures on homeopathic materia medica . 47^th impression    Delhi: B Jain publishers (p) Ltd;  2020.  Page 819

Dr Puneet Kumar Misra
Lecturer(Practice of Medicine)
Govt L B S H M C  Prayagraj