Verruca vulgaris treated with lycopodium clavatum – a case report

Authors: Dr. Virendra chauhan, Professor, Dept. Of Practice of Medicine (Hom.) Dr. M.P.K. Homoeopathic Medical College, Hospital and Research Center. Homoeopathy University, Jaipur.

Dr. Yogita Kumari, MD Scholar, Department of Practice of Medicine (Hom.), Dr. M.P.K Homoeopathic Medical College, a constituent college of Homoeopathy University, Jaipur.

Dr. Kanika Agarwal, MD Scholar, Department of Practice of Medicine (Hom.), Dr. M.P.K Homoeopathic Medical College, a constituent college of Homoeopathy University, Jaipur.

Dr. Manish Singh, MD Scholar, Department of Repertory, Dr. M.P.K Homoeopathic Medical College, a constituent college of Homoeopathy University, Jaipur.

ABSTRACT
Warts or verruca vulgaris is a viral infection caused by Human Papiloma Virus (HPV). It causes frustration to both clinician and patient due to its recurrence after cauterization . In such cases homoeopathic medicines are always beneficial when given after individualization of the patient and prescribed medicine must be similimum in order to cure the patient.

Here in opd ,a 24 year old female patient was complaining of wart on chin since last 1 month. After getting his totality he was prescribed Lycopodium Clavatum 200 single dose and on rubrum for 15 days . In follow up large warts are vanished and no new warts are observed in a subsequent visit. So it is a classical example of homoeopathic medicine in the treatment of warts with photographical evidence.

KEYWORDS 1.Verruca vulgaris     2. Homoeopathy    3. Lycopodium Clavatum     4.  Similimum     5. Cauterization

INTRODUCTION
Wart is a viral infection caused by Human Papiloma Virus (HPV). It appears in various forms on different sites of the body and include common warts , plane or flat warts, myrmecia, plantar warts, coalesced mosaic warts, filiform warts, periungual warts, anogenital warts (venereal or condyloma acuminata), oral warts and respiratory papillomas.. 

Common warts have been a frustration for both patients and practitioners.[1] They can greatly affect a patient’s quality of life by causing embarrassment, ear of negative appraisal by others and frustration caused by persistence and/or recurrence. Moderate to extreme discomfort is reported in 51.7% of patients, and social or leisure activities are affected to a moderate to an extreme degree in 38.8%.[2]

Etiology
HPV is a double-stranded DNA virus that causes cutaneous viral warts, most commonly located on the skin and genitalia. . The most common warts on the hands and feet are caused by HPV types 1, 2, 4, 27 and 57.Transmission of warts occur by direct contact or indirectly by fomites.                                                                                                     

Types: 

Verruca vulgaris (common warts) are hyperkeratotic, exophytic and dome-shaped papules or nodules especially located on fingers, hands, knees, elbows or any other sites of trauma

Plane or flat warts are flat topped papules with minimal scaling and only slight elevation and are 2–4 mm in diameter.

Intermediate warts can show features of both common warts and flat warts. 

Myrmecia are large, deep, burrowing warts.

Plantar warts can be painful due to their callused, endophytic papules that have deeply penetrating sloping sides and a central depression.

Mosaic warts: Numerous coalesced warts on the plantar surface will form a tile-like pattern known as mosaic warts.

Filiform warts are most often seen on the face with characteristic frond- finger like projections that exhibit quick proliferation.

CASE PROFILE: A 24  years female came in our OPD with the complaints of warts on chin on 26 May 2019. The wart  is large, fleshy, horny, and painful to touch. Bleeds sometimes whenever rubbed with  rawness.

History of present complaints & treatment history:
Patient was apparently well 40 days back when she gradually developed a small wart on her chin.  Initially, it was a small wart which later increased in size becoming very large and fleshy. She  went for cauterization and external applications with very little relief. But after sometime, it reappeared on affected part which now was larger than before fleshy, and it bled on scratching.

Associated symptoms: Headache since 2 months, on and off generalized heaviness which aggravates by mid day, on being empty stomach, sun exposure, damp- cloudy weather, stress / anger.There is relief in headache by sleeping.

Physical generals: The patient has normal appetite has meals twice daily with no specific desire and thirst of the patient is of 4-5 litres of water per day where she takes 2-3 glasses at a time.

Mental generals: The patient suppresses her anger which leads to headache.

She desires for company and she has fear of darkness.

Clinical findings: Appearance –Ectomorphic, Height – 5’2”; Weight – 55kgs. Other general and systematic examination findings suggest no abnormal sign.

Provisional Diagnosis: Filiform Warts

Totality of case: Suppressed anger, does not express her anger which leads to headache.

  • Desires company.
  • Fear of darkness.
  • Thirst for 4-5 liters of water in a day 2-3 glasses at a time. 
  • Eruption on chin, wart like since 1 month
  • Wart bleeds on scratching 
  • Wart single, large fleshy.
  • Headache since 2 months, on and off generalized heaviness, aggravates by midday on exposure to sun, damp cloudy weather, while empty stomach .
  • Ameliorates by sleeping.

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Figure 1: Repertorization of case from Synthesis Repertory using RADAR software.

On reportorial analysis, both  Lycopodium and phosphorus have scored highest marks 14 covering 7 out of 11 and 5 out of 11 symptoms.

First prescription with justification: Lycopodium Clavatum  200 one dose was prescribed after repertorization on  the basis of totality of symptoms and 200 potencies prescribed according to susceptibility of patient and  nature of  medicine & disease. 200CH potency was selected  and single dose  was  given  to  avoid   any unwanted  aggravation. After that patient was given placebo for 15 days.

Date Symptoms Prescription
26.05.2019  Wart large painful and sensitive to touch on chin.

Recurrent headache

Lycopodium clavatum 200/1 dose

Placebo /TDS for 15 days.

10..06.2019 The wart has darkened in color 

Frequency of headache reduced

Rubrum 200/1 dose

Placebo /TDS for 1month.

08.07.2019 Few tencles of the large wart shedded few remaing 

Headache on and off more during fasting

Lycopodium Clavatum1M/1 dose

Placebo /TDS for 1month.

12.08.2019 No warts like eruptions are seen 

There is significant relief in the frequency of episodes of headache.

 Rubrum 30/TDS for 28 days.

Table 1: Follow ups with prescription and justification

CONCLUSION AND JUSTIFICATION:
Physical appearance-related issues have become almost important for young individuals in this modern era and competitive world. This was a case of facial warts in a 24 years old female who has previously undergone cauterization and under the external application. This  might have affected her on physical as well as emotional level .This case confirms the significance of single dose and repertorial approach on the basis of totality of symptoms. Homoeopathy is a specialized system of medicine which treats the patient and not the disease. Homoeopathy believes in holistic individualized approach, and corrects disturbances in the vital force.

References:
1. Leman JA, Benton EC. Verrucas. Guidelines for management. Am J Clin Dermatol 2000;1:143–149.[PubMed]

2. Ciconte A, Campbell J, Tabrizi S, Garland S, Marks R. Warts are not merely blemishes on the skin: A study on the morbidity associated with having viral cutaneous warts. Australas J Dermatol 2003;44:169–173. [PubMed] 

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