ABSTRACT: Freckles is a condition characterized by anomalies in pigmentation which forms discrete, grouped or confluent pigmented macules caused by excessive localized formation of melanin. Topical application of sunscreen cream is the choice of treatment in most of the cases, but it can be managed and cured through individualized homoeopathic remedies. The case can be treated homeopathically focusing on the patient as a person, symptomatically, pathologically as evident by follow up investigation, proper case processing and repertorisation of case.
KEYWORDS: Freckles, physical constitution, predisposition, synthesis repertory, evaluation photographically
INTRODUCTION: 1,2,Freckles are small[>5mm in diameter], circumscribed,poorly marginated,labile,pale brown macules that appear exclusively on sun exposed skin of fair complexioned individual. It is also called as Ephelides. The term “epi”[upon] and “Helios”[sun], implying the definite role of sunlight in its causation.1,2, 3Freckles are produced by UV radiation. 4 The Ezzedine study showed that facial ephelides were associated with frequent sunburns.
5,11,12 Freckles are numerous pigmented macules on the face commonly occurring in the Caucasian and Chinese population. They are clusters of concentrated melanized cells which are most easily visible on people with a fair complexion. Other causes are hormonal imbalance and genetic factor. 4 Bliss et al.performed a meta‐analysis of 10 case–control studies and found that all seven studies that analyzed freckles reported an association with the formation of melanoma.4,5,6.A case-control study was done including patients with melanoma and non-melanoma skin cancer and subjects without a history of skin cancer..The coding sequence of the MC1R gene was analyzed by single-strand conformation polymorphism analysis followed by sequence analyses.7,8 ,9 Carriers of one or two MC1R gene variants had a 3- and 11-fold increased risk of developing ephelides indicates strong relationship of MC1R gene with ephelides.1,2, Freckles do not have an increased number of melanocytes, but instead have melanocytes that overproduce melanin granules changing the coloration of the outer skin cells (keratinocytes) developing ephelides. 7, 8 Freckling is a common pigmentation which is divided into ephelides and solar lentigines.Symptoms includes, it first appear in childhood around 3-5 years as multiple, symmetrical small discrete brown macules on the face, shoulders, and back.1 ,2 A sharp line of demarcation usually observed between freckled and unaffected skin.It increase in its number and pigmentation during summer. The pigment get immediately darker when exposed to sun. The color of freckles varies from light to dark brown. Diagnosis is usually done with family history ,age of onset, affection of individuals with fair complexion, characteristic involvement of sun exposed skin , hyperpigmentation, and accentuation of pigmentation on wood’s lamp examination allow one to clinically diagnose the freckles.8 They commonly stop spreading before adolescence and last for life, but it could be sometimes be subtle in adulthood. They are transmitted as an autosomal dominant . 5 Genome-wide scan for linkage analysis in a multigenerational Chinese family was conducted and found that freckles were found as chromosome 4q32-q34. 10 It was also found that a there is a positive relationship between the risk of endometriosis and freckles.
CASE PROFILE: A 23 year old Christian lady reported on 28-10-19 with multiple small brown round spots over the face across the cheeks and bridges of the nose since 2years.
HISTORY OF CHIEF COMPLAINT:
Patient was apparently well 2 years back. She gradually started developing small multiple brown spotting patches which appears first over the bridge of the nose which she noticed after prolonged exposure to the sun during her sports day. Within 2 days it started spreading over the cheeks under the eyes bilaterally which appears like butterfly rashes. It was initially slight reddish with itching occasionally. Itching is more when exposure to sun, during summer and bathing in hot water and is better when washing with cold water. It gradually turned into multiple small brownish spots with single line of demarcation. She had consulted an allopathic physician and lotion was prescribed for her and she was better with that. It was on and off attack which she felt better during winter. The complaint again reappeared when she stops applying the lotion.
- Appetite: Good, mixed.
- Thirst: Good, 2 L per day, thirst less.
- Craving: sweets2+, cold drinks2+.
- Aversion: Milk+
- Bladder habit: Good, 4-5 times per day.
- Bowel habit: 1 time per day, regular.
- Sleep: Good, 11 to 6 am, 7 hours per day refreshing.
- Dreams: Nil
- Thermally: chilly patient
- Menstrual history:
- FMP: 12 years of age.
- LMP: 11-10-19, regular
- Clots occasionally.
- No accompanying complaints.
Recurrent attack of UTI.
Taken allopathic medication for the same.
FAMILY HISTORY: Farther HTN since I year.
LIFE SPACE INVESTIGATION:
Patient belongs to middle socioeconomic background. She belongs to Shillong, Meghalaya and left her native place for 2 years due to her education. She has 2 siblings (1 elder sister and 1 younger brother). Her father is a government employer and mother is also working along with her father.
Disposition: She was talkative, Likes Company and like to share with others.
Mental state: Anxiety for little thing, always nervous without reason, doesn’t like company, Reserved, Anger easily shouts back, weep easily, regret about past, suppressed emotions, emotionally sensitive, fear of snake.
On observation, as per the patient, she had a bad experience in her life for which she regrets now. Doesn’t like to share about that. She got annoyed when asked about the same.
PROVISIONAL DIAGNOSIS: FRECKLES.
TOTALITY OF SYMPTOMS:
After anlysing the symptom of the case, the characteristic mental and physical generals, physical make up, diagnosis, predisposition were considered for framing the totality.
Considering the Butterfly rashes on face, Anxiety and nervous, weep easily, fear of snake, emotionally sensitive, reserved, doesn’t like sharing, suppressed emotions, history of recurrent UTI, chilly patient, desire for cold drinks, sweets. Aversion for milk, thirst less, blackish discoloration in spots, aggravation in heat.
REPERTORISATION “Synthesis repertory was selected as there is much generals.
JUSTIFICATION OF REMEDY SELECTION.
According to DR Hahnemann, aph: 5, In the case of chronic disease, to enable him to discover its fundamental cause which is generally due to chronic miasm. In these investigation, the ascertainable physical constitution, his moral, intellectual character, occupation, mode of living etc. to be collected for complete cure of the disease.
In this case remedy Sepia was prescribed, giving importance to physical make up, as weak person with discoloration and desquamation, moth spot on the face and Tendency for recurrent UTI together with mental and physical generals.
28-10-2019 Rx 1) Sepia 1M (1P) HS today
|11-11-19||Blackish discoloration 10% better
Itching of face +occasionally <sun exposure
All other generals good
|Rx) 1)Sep (0),1P HS
2)no 4 pills 3-0-3 For 2 weeks
|25-11-19||Blackish discoloration 70% better
Itching of face: Completely better
Burning micturition occasionally.
All generals good
1)Sep 1M,1P HS
2)no 4 pills 3-0-3 For 2 weeks
|9-12-19||Blackish discoloration of face –Completely better
Itching of face _better
| Rx)1)Sep (0),1P HS
2)no 4 pills 3-0-3
DISCUSSION AND CONCLUSION.
Freckles are pigmentation disorders characterized by small brown multiple patches which become more pronounced when expose to sun. Today, Freckles are considered as sign of individuality and beauty asset. But there are exceptions. Totality of the symptoms includes physical generals and predisposing factors, that specially mark and helps distinguish the case of Disease. This picture of the disease, painted by its collected symptoms is the individuality of a portrait. The prescription should be purely based on this fact which help the physician to bring complete cure in the patient.
- The practice of dermatology P.N Behl 8th edition
- Indian Association of Dermatologists, Venereologists and Nephrologists. Vol 1 ,3rd edition
- Seddon JM, Gragoudas ES, Glynn RJ, Egan KM, Albert DM, Blitzer PH. Host factors, UV radiation, and risk of uveal melanoma: a case-control study. Archives of ophthalmology. 1990 Sep 1;108(9):1274-80.
- Praetorius C, Sturm RA, Steingrimsson E. Sun‐induced freckling: ephelides and solar lentigines.
- hang XJ, He PP, Liang YH, Yang S, Yuan WT, Xu SJ, Huang W. A gene for freckles maps to chromosome 4q32–q34. Journal of investigative dermatology. 2004 Feb 1;122(2):286-90.
- Viková M, Vik M. Some problems in the measurement of UV protective textiles. InThe 3-rd China International Wool Textile Conference, Xian 2002 Sep 26 (pp. 26-28).9
- Yamaguchi K, Watanabe C, Kawaguchi A, Sato T, Naka I, Shindo M, Moromizato K, Aoki K, Ishida H, Kimura R. Association of melanocortin 1 receptor gene (MC1R) polymorphisms with skin reflectance and freckles in Japanese. Journal of human genetics. 2012 Nov;57(11):700-8
- Bastiaens M, ter Huurne J, Gruis N, Bergman W, Westendorp R, Vermeer BJ, Bavinck JN. The melanocortin-1-receptor gene is the major freckle gene. Human Molecular Genetics. 2001 Aug 1;10(16):1701-8
- Araki Y, Okamura K, Munkhbat B, Tamiya G, Erdene-Ochir B, Nemekhbaatar L, Hozumi Y, Suzuki T. Whole-exome sequencing confirmation of multiple MC1R variants associated with extensive freckles and red hair: Analysis of a Mongolian family. Journal of dermatological science. 2016 Nov 1;84(2):216-9
- Kvaskoff M, Mesrine S, Clavel-Chapelon F, Boutron-Ruault MC. Endometriosis risk in relation to naevi, freckles and skin sensitivity to sun exposure: French E3N cohort. International journal of epidemiology. 2009 Aug 1;38(4):1143-53.
- Samuel Hahnemann Organon of Medicine,6th edition
- Stanley Davidson, 1971, Principles and practice of medicine, Churchill Livingstone.
Father Muller Homoeopathic Medical CollegeMangalore, Deralakatte