Homoeopathic medicines in the management of Chickenpox

Dr Such Sushil 

ABSTRACT
Varicella (chickenpox) is an acute infectious disease. It is caused by the varicella-zoster virus (VZV), a DNA virus that is a member of the herpes virus group. After the primary infection, VZV remains in the body (in the sensory nerve ganglia) as a latent infection. Primary infection with VZV causes chickenpox. Reactivation of latent infection can lead to shingles (herpes zoster).

KEYWORDS: Varicella, varicella-zoster virus, macules, papules, a polymerase chain reaction

 INTRODUCTION

• Varicella or chickenpox is a highly contagious rash that most commonly occurs in childhood as a result of primary varicella-zoster virus (VZV) infection in susceptible individuals.
• The chickenpox rash forms small itchy blisters that crust over, usually starting from the face and scalp and quickly spreading to the trunk, leaving the extremities relatively intact.
• The Lesions are scattered, reflecting the spread of viremia in the skin, and they progress sequentially from rose-colored macules to papules, vesicles, pustules, and crusts.
• It follows by fever, fatigue, pharyngitis, and headache which usually last 5-7 days. Complications include pneumonia, encephalitis, and bacterial skin infections.
• This disease is more severe in adults than in children. Symptoms begin 10 to 21 days after exposure to the virus but the average incubation period is about 2 weeks.

ETIOLOGY
The primary route of transmission for chickenpox is through the respiratory tract by air droplets or aerosols, but it can also be transmitted through direct contact. The virus is highly contagious and can spread quickly. The initial infection is in the mucous membranes of the upper respiratory tract. The virus enters circulation within 10-12 days.  The chickenpox rash is not contagious and the droplets containing the virus can be infectious for a very limited time.

Although infectivity in varicella patients is thought to depend primarily on the shedding of the virus by the mucosa of the upper respiratory tract, VZV has rarely been cultured from pharyngeal secretions. However, using polymerase chain reaction (PCR) based test, VZV DNA can be detected in the oropharynx of most patients.

EPIDEMIOLOGY
Chickenpox occurs worldwide, but infection occurs at an earlier age in temperate regions than in tropical regions. Subclinical infection may occur. It is estimated that about 15 cases per 1000 people per year occur in nonimmune populations, resulting in about 95% of young people being HIV positive. The HIV positivity in the tropics and the rate of immigration from the tropics to the temperate regions are slightly lower.

Age: More than half of all primary infections occur before age 5 and 85% occur before puberty.

 CLINICAL FEATURES

1. PRODROME SYMPTOMS	In young children- uncommon. In older children and adults- the rash is usually preceded by 2 -3 days of mild fever, chills, malaise, headache, anorexia, backache, and, in some patients, sore throat and dry cough.
2. RASH	It usually begins on the face and scalp and spreads rapidly to the trunk and extremities.
3. FEVER	It usually persists as long as new lesions continue to appear, and its height is usually proportional to the severity of the rash. It may be absent in mild cases or rise to 40.5°C (105°F) in severe cases.
4. PRURITUS	Usually present until all lesions have crusted over.

COMPLICATIONS
In normal children, varicella (chickenpox) is rarely complicated. The most common complication is secondary bacterial infection of the skin lesions, usually caused by Staphylococci or Streptococci, which may produce impetigo, cellulitis, and erysipelas.

DIFFERENTIAL DIAGNOSIS 

• Impetigo
• Insect bites
• Disseminated herpes zoster
• Disseminated herpes simplex
• Drug eruptions
• Molluscum contagiosum
• Scabies

PROGNOSIS
In healthy children, the prognosis is excellent. However, the infection has a high incidence in immunocompromised individuals.

HOMOEOPATHIC THERAPEUTICS FOR VARICELLA (CHICKENPOX)

 ANTIMONIUM CRUDUM: Vesicles, and pustules. Sensitive to cold bath. Thick, hard, honey-colored crusts on the vesicles. Intense itching when warm in bed. Dry skin. Scaly, pustular rashes with burning and itching that get worse at night.

ANTIMONIUM TARTARICUM: Great rattling of mucus in the throat, but very little is expectorated. The pustular eruption leaves a bluish-reddish mark. Small-pox.

BELLADONNA: Dry and hot skin; swollen, tender; burns scarlet, smooth. Eruptions like scarlatina suddenly spread. Erythematous pustules on the face. Red Boils. Burning, pungent, steaming, heat during fever. Feet were icy cold. Fever without thirst.

DULCAMARA: Pruritus, always worse in cold and damp weather. Herpes zoster, pemphigus. Swelling and induration of glands from the cold. Vesicular eruption. Sensitive bleeding ulcers. Red Humid eruptions on face, genitals, and hands, etc. Warts, large, smooth, on face and palmar surface of hands. Thick, brown-yellow crusts, that bleeds on scratching. During fever dry burning heat all over the body. Chilliness towards evening, mainly on back. Icy coldness, with pains. Dry heat and burning of skin. Chilliness with thirst.

MERCURIUS SOLUBILIS: Vesicular and pustular eruptions. Ulcers are irregular in shape with ill-defined edges. Intense itching aggravates from the warmth of the bed. Yellow-brownish crusts over eruptions.

PULSATILLA: chickenpox-like rash, with intense and violent itching in bed. Children who need this remedy are usually tearful and want lots of attention and comfort when they are ill. Hot, stuffy, and warm rooms can aggravate itching which can be improved by cool fresh air. The person rarely feels thirsty, even during fever.

RHUS TOXICODENDRON: Skin is red, and swollen with intense itching. Vesicles, herpes; urticaria; pemphigus; erysipelas; suppurative vesicular forms are marked features of this remedy. The glands are swollen.  Burning eczematous eruptions with the tendency of scale formation.

SEPIA: Eruptions of vesicles with itching, stinging, pricking, and burning. Herpes in solitary patches. Itching is not relieved by scratching which is worse in the bends of elbows and knees.

SULPHUR: Dry, scaly, unhealthy skin with itching, and burning which get worse from scratching and washing. Pustules. In the evening pruritis, especially from warmth. During fever frequent flashes of heat. Dry skin with great thirst. Night sweats on the nape of the neck and on the occiput.

THUJA OCCIDENTALIS: Purulent papules, like smallpox. Eruptions only on covered parts. After being scratched, the eruptions will burn.

During fever chill starts from the thigh. Sweating during sleep only on uncovered parts or all over the body except the head. Sweat is profuse and smells like honey.

MANAGEMENT, PREVENTION, AND IMPROVEMENT OF HEALTHCARE 

• The key to reducing the incidence of chickenpox is education.
• Parents of infected children should be advised to cut their child’s fingernails to avoid or minimize skin damage and the associated bacterial infections.
• Parents should be told not to give aspirin to young children to control fever because of the risk of developing Reye’s syndrome.
• All clinicians should encourage parents to get their children vaccinated, as this can prevent infection-related morbidity.

REFERENCES 

1. Fitzpatrick’s Dermatology; 9^th
2. Rook’s Textbook of Dermatology; 9^th
3. Davidson’s Principles and Practice of Medicine; 24^th
4. Boericke OE. Boericke’s New Manual of Homoeopathic Material Medica with Repertory. New Delhi; B. Jain Publisher, Third Revised & Augmented Edition, 2008.
5. A Dictionnary of Practical Materia Medica by J.H. Clarke.

Dr. Such Sushil
Department of Homoeopathic Materia Medica
Bakson Homoeopathic Medical College and Hospital, Greater Noida, Uttar Pradesh, India