Dr Aleena Roy
INTRODUCTION
Milia (singular: milium) are benign and transient dermal cysts of keratine that present as small firm white papules in various numbers most commonly distributed on the face, but they can also be present on other anatomical areas such as the upper trunk, extremities, and genital area (prepuce).
Physical Examination
Typically, congenital milia lesions occur spontaneously, they consist of small white to yellow papules, less than 3 mm in diameter, and have a smooth dome shape. They could be associated with a faint blue hue in darkly pigmented skin. Milia vary from solitary to multiple grouped lesions. Usually found on the face, characteristically with the nose being involved most of the time.
Evaluation
Milia lesions are diagnosed on clinical findings. Although seldom required, incision and drainage of the keratinous content of milia can corroborate the diagnosis. Additionally, persistent and widely distributed milia may require investigation for other causes of primary and secondary milia, such as an underlying genodermatosis, especially when other clinical findings are present.
Differential Diagnosis
The principal differential diagnosis is sebaceous hyperplasia, which manifests as white to yellow grouped papules around the upper lip and nose. Similarly to congenital milia, sebaceous hyperplasia is less frequent in premature newborns. Other differential diagnoses could include comedonal acne, flat warts, milia-like idiopathic calcinosis cutie.
Homoepathic Therapeutics
Rubrics
Synergy software-reliable repertory(9)
R.R. – skin;ERUPTIONS;miliary(47) : 3acon., 3agar., ail., am-c., anan., ant-c., 3ars., bar-m., 3bell., 3bry., bufo, 2carb-v., caust., 3cham., cocc., coff., cop., 3corn., 3cupr-ar., 2dulc., hell., hep., hyos., 3ip., jab., kali-i., 3kali-m., kreos., lach., 2led., 2manc., 2merc., mez., 3nat-m., nux-v., 2op., 2par., phos., phyt., psor., puls., 3rhus-t., 2stram., 2sulph., tab., valer., viol-t.
Kent – Face;ERUPTIONS.;miliary(15) : ail., anan., ars., bell., cham., euphr., hep., hura, ip., manc., par., sarr., tab., tarent., verat.
Kent – Skin;ERUPTIONS;tubercles;miliary(1) : nat-m.
Phatak – PHATAK REPERTORY;ERUPTIONS;miliary(9) : acon., ars., bry., coff., 2dulc., 2ip., merc., phyt., 2sulph.
Boenn.Inn – Sensations and complaints;Skin and external parts;EXANTHEMA, MILIARY ERUPTION(56) : 4acon., alum., 2am-c., 2am-m., 3ant-c., 3ant-t., 2arn., 3ars., asaf., 3bell., 2bov., 4bry., 3calad., 2calc., 2canth., 3carb-v., 3caust., 3cham., chin., 2clem., 2coff., cupr., dig., 2dulc., 3euphr., 2graph., 2hell., 2hyos., 4ip., 3lach., 3led., 4merc., 3mez., nat-m., 2nux-v., op., 3ph-ac., 2phos., 3puls., rheum, 3rhus-t., ruta, 2sars., sec., 3sel., sep., 2sil., 2spong., 3staph., 2stram., 3sulph., valer., 3verat., 3viol-t., 2zinc., marr.
Boenn – Skin;Eruptions;miliary(23) : 3acon., 3agar., am-c., ars., 3bell., 3bry., bufo, 2carb-v., cocc., hep., 2ip., kreos., 2led., 2manc., 2merc., nux-v., 2op., 2par., psor., puls., 3rhus-t., 2stram., valer.
Knerr – Skin;ERUPTION;miliary(29) : 3acon., am-c., anan., ant-c., 3ars., bar-m., 3bell., 3bry., caust., 3cham., coff., cop., 3corn., hell., hep., hyos., 3ip., jab., 3kali-m., lach., merc., mez., 3nat-m., phos., puls., sulph., tab., viol-t., 3cupr-acet.
Calcareaiodatum: Best remedy for milium(2) Itching in various parts of the body, disappearing and reappearing in other parts, only relieved after much scratching (after one hour).Persistent itching on the right elbow, followed by the same on the left knee.(3)
Thuja occidental Purulent pimples, like variola.Warts on any part of the body, with little necks, called fig-warts, tubular warts, same size all the way out, “mother’s marks.” Warts, hard, cleft, and seedy. (4)Polypi, tubercles, WARTS epithelioma, Neva, carbuncles; ulcers, especially in ano-genital region. Freckles and blotches. Perspiration sweetish, and strong. Dry skin, with brown spots. Zona; herpetic eruptions. Tearing pains in glands. Glandular enlargement. Nails crippled; brittle and soft. ERUPTIONS ONLY ON COVERED PARTS; worse after scratching. Very sensitive to touch. Coldness of one side. Sarcoma; polyp(5)
Antimonium crudum Eruptive tendency of pimples, vesicles and pustules. Urticaria; white; with red areola, itching fearfully. Measly eruptions. Warts horny. Dry gangrene. Itching when warm in bed. Callositis from slight pressure.(6) Miliary eruptions and nettle-rash.(4)
Causticum Miliary eruptions and nettle-rash. Injuries of the skin, which had been healed, become sore again.Itch suppressed by mercury or sulphur, burning itch.Tingling (or stinging) swelling (sometimes called “buzzing” swelling) (Guernsey).Eruptions resembling scabies.(4)
Staphysagria: Itching in various parts of the body, disappearing and reappearing in other parts, only relieved after much scratching (after one hour).Persistent itching on the right elbow, followed by the same on the left knee.(4)
CASE REPORT
A 35 year old female came to outpatient department of government homoeopathic medical college and hospital Bhopal on 15/11/21 with complaint of multiple eruptions since 5months on face ,right side between chin and cheek around lateral commissure of lips.
History of presenting complaint: Patient was apparently well till last 5 month.Then she had fall from scooter while driving and got injury on face. Her face got multiple abrasions around eye and the exact location of the eruptions formed ie, around lateral commissure of lips on right side of face and chin too which were healed soon.Later that she got the multiple small pearly white colored eruptions on the same location.
Negative history: There is no itching, burning, discharge from eruption, pain while touch
Treatment history: She has taken allopathic medications including tablets and external application and needling on the eruption. But eruptions were stagnant.
- Past history: Recurrent headaches and giddiness on exposure to sun
- Family history: mother-hypertension for 10 years
- Physical general:
- Appetite-increased
- Thirst-more 9-11 glasses of water
- Bowel habits-regular but hard stool, unsatisfactory
- Bladder habbits:4-5times per day
- Sleep- good
- Thermals -Hot, need fan always, like open air, drink cold water, cant bear summer season
- Perspiration-Profuse on arm pits with offensive discharge. without staining
- Craving-salt++ puts more salt in her dishes ,likes chips
- Aversion -nill
- Mental generals-Angry fast and react fast ,doesn’t like to share her sadness and [cries alone only (it was a leading question)]
On examination-patient moderately built and poorly nourished ,face greasy,dry back hair.
Face-around right lateral commissure of lips and chin eruptions-pearly white multiple eruptions of 0.5 mm of 15-18 in number.
Totality of symtoms
Mental generals
- Irritable
- Introvert
- Cries alone
Physical general
- Cr-salt++
- Thirsty with dryness mouth
- Thermal hot
- Offensive profuse persipation
Charctrestic particular
- Face Eruptions white pearly
- painless hard
- Skin oily
DISCUSION
Homoeopathy is a system of medicine where we consider the patient as a whole. So here we considered not only the skin complaint but also his mental characters, physical makeup as well as the family history including Miasm- (Sycosis is dominant and fundamental miasm in the patient). In this case Natrum muriaticum was chosen based on individualisation and started with Thuja as Anti-miasmatic and as well as complimentary to Natrum mur for a fast cure in a gentle way.(7)
CONCLUSION:
A milium is a 1- to 2-mm, superficial, white to yellow, keratin-containing epidermal cyst, occur- ring multiply, located on the eyelids, cheeks, and forehead in pilosebaceous follicles. (8)
Homoeopathic medicines are gentle and acts in most effective way. It does not cause any long term side effects and rapidly reduces the discomfort, and other complaints associated with this condition.
There is wide range of medicines are available but for cure always individualised medicine with removal of underline miasm is required.
This case report is accompanied by photographic evidence along with improvement in patient symptoms.
Declaration of patient consent: parent of the patient was explained about the study and consent was obtained.
ACKOWLEDGEMENT: I am thankful to Dr. Ajay Singh Parihar Proffeser& HOD Department of Paediatrics ,GHMC Bhpoal, Madhya Pradesh, for his constant support and guidance.
REFFERENCES:
- Gallardo Avila PP, Mendez MD. Milia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Jul 29]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560481/
- A Text-book of Materia Medica and Therapeutics of Rare Homoeopathic Remedies …
- By Oscar Hansen, Allen Corson Cowperthwaite
- The encyclopedia of pure materia medica: a record of the positive effects of drugs upon the healthy human organism, Allen, Timothy Field,
- Dictionary of Practical Materia Medica – John Henry Clarke
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- Fitzpatricks colour atlas and synopsis of clinical dermatology-6th edition.
- Synergy homeopathy software-https://www.synergyhomeopathic.com
Dr Aleena Roy
MD -Scholar
Government Homeopathic Medical College and Hospital,Bhopal
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