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Atopic dermatitis successfully treatment by constitutional homoeopathic medicine graphites: A case report

Authors:
  • Metropolitan Homoeopathic medical College and Hospital
  • Bengal Homoeopathic Medical College and Hospital

Abstract and Figures

Abstract :- Atopic dermatitis (AD) is a commonly recurring inflammatory eczematous condition of the skin which affects up to 2.4% of the global population and among them, 15-20% of children and 1-3% of adults are affected globally. A 48 years old female patient diagnosed with AD, suffering from complaints of pruritic eczematous lesions with sticky pus collection on both arm and abdominal region for the last 36months. The patient was treated with modern medicine for a long time but there was no permanent relief. Therefore, the patient sought out homoeopathic treatment for a long-lasting cure. A constitutional medicine Graphites 0/1 was prescribed based on the totality of symptoms. All problems showed better, but after a while, they all came to a standstill. As per homoeopathic principles, this lento an increasing the potency of Graphites 0/2. Following four months of treatment, there was a considerable improvement in the eczematous lesions and all accompanying complaints, as well as a noticeable improvement in the SCORAD Index. This case shows that AD is cured by constitutional homoeopathic treatment.
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International Journal of Homoeopathic Sciences 2022; 6(4): 503-509
E-ISSN: 2616-4493
P-ISSN: 2616-4485
www.homoeopathicjournal.com
IJHS 2022; 6(4): 503-509
Received: 25-07-2022
Accepted: 28-09-2022
Dr. Tanmay Sarkar
Lecturer, Department of
Homoeopathic Pharmacy,
Metropolitan Homoeopathic
Medical College and Hospital,
Ramchandrapur, Sodepur,
Kolkata, West Bengal, India
Dr. Abhinandan Das
Lecturer, Department of
Physiology and Biochemistry,
Bengal Homoeopathic Medical
College and Hospital,
MXC8+7G2, Ismile, Shatabdi
Nagar, Asansol, West Bengal,
India
Corresponding Author:
Dr. Tanmay Sarkar
Lecturer, Department of
Homoeopathic Pharmacy,
Metropolitan Homoeopathic
Medical College and Hospital,
Ramchandrapur, Sodepur,
Kolkata, West Bengal, India
Atopic dermatitis successfully treatment by
constitutional homoeopathic medicine graphites: A
case report
Dr. Tanmay Sarkar and Dr. Abhinandan Das
DOI: https://doi.org/10.33545/26164485.2022.v6.i4h.703
Abstract
Atopic dermatitis (AD) is a commonly recurring inflammatory eczematous condition of the skin which
affects up to 2.4% of the global population and among them, 15-20% of children and 1-3% of adults
are affected globally. A 48 years old female patient diagnosed with AD, suffering from complaints of
pruritic eczematous lesions with sticky pus collection on both arm and abdominal region for the last 36
months. The patient was treated with modern medicine for a long time but there was no permanent
relief. Therefore, the patient sought out homoeopathic treatment for a long-lasting cure. A
constitutional medicine Graphites 0/1 was prescribed based on the totality of symptoms. All problems
showed better, but after a while, they all came to a standstill. As per homoeopathic principles, this led
to an increasing the potency of Graphites 0/2. Following four months of treatment, there was a
considerable improvement in the eczematous lesions and all accompanying complaints, as well as a
noticeable improvement in the SCORAD Index. This case shows that AD is cured by constitutional
homoeopathic treatment.
Keywords: Atopic dermatitis, homoeopathy, Graphites, constitutional treatment, SCORAD index
Introduction
Atopic dermatitis is a prevalent, chronic, recurrent, inflammatory skin condition. "derma"
and "itis" is Greek term it translates to "skin" and "inflammation," respectively [1, 2]. AD is
more frequent in developed countries than in agriculture-based countries [2]. The term
"atopy" refers to the genetic propensity to create immunoglobulin E (IgE) antibodies in
reaction to very small amounts of common environmental proteins such as pollen, house dust
mites, livestock, and food allergies [3]. Atopic eczema is a major public health problem
worldwide, affecting around 5% to 20% of children ages 6 to 7 and 13 to 14 years [4].
International asthma and allergies in childhood (ISSAC) say that the manifestation of AD is
10% to 20% in children and 1% to 3% in adults globally [5]. On the cheeks, flexor surfaces of
the arms, chest, and forehead, in particular, the condition is characterised by the development
of dry, scaly patches of skin. Patients who frequently exhibit severe pruritis, xerosis,
erosions, excoriations, and ill-defined areas of erythema throughout acute flares might be
diagnosed with AD [5, 6]. The distribution of these symptoms varies with age [6]. In some
cases, the pathogenesis of AD begins with a genetically predetermined skin barrier defect
that manifests as dry skin. This innate skin barrier deficit results in the overexpression of
pro-inflammatory cytokines released, which leads to the activation of innate lymphocyte
subsets and antigen-presenting cells. Sometimes few cytokines are involved in the itch
sensation [7, 8]. Not only patients are affected by the social shame of an obvious skin
condition, but the characteristic of extreme itching of the disease usually results in skin
injury and significant rest disturbances [9]. AD disturbed the health-related quality of life
(HRQoL) of children and their families. Sleeplessness is caused by itching and pain in more
than 60% of people. Lose of Sleep leads to weariness, mood swings, and impaired
psychosocial functioning of school-going children and family members [10, 11, 12]. Overall
physical, psychological, and psycho-social life was hampered by AD [11]. Homoeopathy is
based on ‘like cures like. Clinical research and meta-analysis proved that homoeopathy has
its own actions [13]. Homoeopathy is a unique and classical therapeutics of science [14].
Positive effects of Homoeopathy suffering from AD and asthma in children and adult age [15].
International Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com
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Case report
A 48 year’s old Hindu female patient visited the OPD of Dr.
Tanmay Sarkar on 06/06/2022 and presented with
complaints of eczematous skin diseases in various parts of
the body but especially in the arm along with severe itching,
after scratching thick sticky discharge collection, mild
lichenification, dryness, cracked of skin from last 3 years
(Figure1). Itching aggravated in the evening & at night and
amelioration from wrapping up. Tenderness with pain in
both knee joints legs especially in open air & change
weather, Sensitive to cold. The patient was anxious,
melancholic, and depressed, forget her words when she
speaks or interact with others and forgetful & confused. She
has a weeping disposition and wants to be crying alone.
Before coming to my O.P.D she was treated with modern
medicine (antifungal and steroidal ointment) for 3 years
by a dermatologist for Atopic Eczema (Dermatitis), at that
time she complained was little ameliorated for 1 month and
after that, eczema became more violent than earlier. She
changed dermatologists every time when her complaints
aggravated but each time complaint not cure. Under these
circumstances, she was going to decide to take
homoeopathic treatment.
There was a past history of skin irruption, and dust allergy
treated with modern medication, Chickenpox was affected
in childhood. She had no addiction and was not on any
ongoing allopathic medicine. In the family history, father
and paternal grandfather had hypertension and skin disease.
Mother had osteoarthritis with uric acid.
The patient had short stature, dark complexion, and rough
skin. Her facial expression was always anxious & a panic
mood for her suffering complaint.
On examination of the skin, there were reddish-brown
patches with crusty scab formation after thick exudation,
dry, cracked, itching and mild lichenification over both
arms. Other systemic examinations like respiratory, CVA,
and Abdomen were normal but extremities gaits &
movement were changed.
Homoeopathic Generalities
Mental Generals: - Patient complains were Indiscretion++,
forgetfulness++, irritability++, anxiety++ and tensive++,
confusion of mind+++, depression+++ (sad, melancholic),
weeping disposition <alone+++, desire to company++,
Hesitating++, Restlessness in working++.
Physical Generals: - The physical generalities were
appetite good, bitter taste, hot things disagree, Stomach
heavy & ameliorated by lying+, Stool difficult to pass (hard,
stringy, tough), thermal reaction chilly++, desire salty things
+ and curd+, aversion in sweets+++, milk+++, aversion to
bathing & open air+, especially in winter+++, Great thirst in
the morning & after meal +++, Urine-Involuntary emission
of urine +++, perspirationhead but offensive++,
sleepdisturbed/ un-refreshing+++, Dreams- death & fire
+++. Her menstrual cycle was stopped at 43 years of age &
she has 2 children.
Analysis of the case and repertorization: - A detailed
analysis and evaluation of the characteristics and symptoms
were converted to totality & further converted to the rubrics.
Totality of Symptoms & Rubrics
Indiscretion++
forgetfulness++
confusion of mind+++
depression+++ (sad, melancholic)
weeping disposition <alone+++
desire to company++
Hesitating++
Restlessness in working++
Thermal reaction chilly++,
Desire salty things + and curd++
Aversion in sweets+++
sleepdisturbed/ un-refreshing+++
Dreams- death & fire +++
Involuntary emission of urine +++
Stomach heavy & ameliorated by lying+
Stool difficult to pass (hard, stringy, tough)
Eruption: Discharging, scratching after
Eruption: Discharging: Moist
Eruption: Discharging glutinous+++
Skin: Cracks painful
Excoriated: denuded, raw
Skin: dry/ dryness
Itching aggravated in the evening & at night and
amelioration from wrapping up
Clinical diagnosis: Atopic Dermatitis (Hanifin and Rajka-
developed criteria for diagnosis in 1980)
Fig 1: Before Homoeopathic Treatment
International Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com
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Fig 2: SCORAD Index before Homoeopathic Treatment
Table 1: Repertorial analysis of the characteristic Symptoms
International Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com
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Bases of Selection Individualized Homoeopathic
Medicine (IHM): - Graphites is chosen based on the
Totality of Symptoms. Repertorial analysis done by J.T.
Kent & Symptoms Cross cheeked by Clark materia medica
[16, 17, 18, 19]. We selected Graphites as a constitutional
remedy.
Table 2: Patient Follow-up
Date
Symptoms
Remedy
06/06/2022
Baseline presentation [Figure 1] severe itching (Pruritus), serous exudates like thick
honey fluid, lichenification, dryness, and cracked skin. Itching aggravated in the
evening & at night, complaints amelioration from wrapping up.
Graphites 0/1
OD˟ 16 doses
24/06/2022
Eczema discharges less, itching persists & Involuntary emission of urine
complaints ameliorated
Graphites 0/2
OD˟ 16 doses
11/07/2022
No new symptoms arise, Skin and mental symptoms were ameliorated.
Graphites 0/3 OD˟ 16 doses
30/07/2022
No itching, no discharges.
Graphites 0/4 OD˟ 16 doses
18/08/2022
No itching, no discharges.
Placebo-30 4 globs˟ TDS˟ 15 days
05/09/2022
No itching, no discharges.
Placebo-30 4 globs˟ TDS˟ 15 days
Table 3: Assessment by Modified Naranjo Criteria Score [20, 21, 22, 23]
S.N.
Item/Question
Yes
No
Not sure
or N/A
Was there an improvement in the main symptom or condition for which the homoeopathic medicine was prescribed?
+2
0
0
Did the clinical improvement occur within a plausible time frame relative to the drug intake?
+1
-2
0
Was there an initial aggravation of the symptom? (need to define in a glossary)
+1
0
0
Did the effect encompass more than the main symptom or condition, i.e., were other symptoms ultimately improved or
changed?
+1
0
0
05
Did overall well-being improve? (suggest using a validated scale)
+1
0
0
06
(a)
The direction of cure: did some symptoms improve in the opposite order of the development of symptoms of the
disease?
+1
0
0
The direction of cure: did at least two of the following aspects apply to the order of improvement of symptoms -from
organs of more importance to those of less importance - from deeper to more superficial aspects of the individual -
from the top downwards.
+1
0
0
Did old symptoms” (defined as non-seasonal and non-cyclical that were previously thought to have resolved) reappear
temporarily during the course of improvement?
+1
0
0
Are there alternate causes (other than the medicine) that-with a high probability- could have caused the improvement?
(consider the known course of the disease, other forms of treatment and other clinically relevant intervention
-2
+1
0
Was the health improvement confirmed by any objective evidence? (e.g. lab test, clinical observation, etc.)
+1
0
0
Did repeat dosing, if conducted, create similar clinical improvement?
+2
0
0
Total score =Maximum score=13
Minimum score=02
Score=09
The interpretation of the total Naranjo Score predicting drug
action is as follows: Total scores range from -4 to +13; the
reaction is considered definite if the score is 9 or higher,
probable if 5 to 8, and possible if 1 to 4, and doubtful if 0 or
less [20, 21, 22, 23].
International Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com
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Fig 3: After Homoeopathic Treatment
Fig 4: SCORAD Index after Homoeopathic Treatment
Discussion
Homoeopathy is the world’s 2nd largest system of treatment
& it treats the patient not the disease [24, 25, 26]. If we selected
a proper individualised Homoeopathic Medicine (IHM) for
the treatment then it works not only symptomatically but
also works holistically. In this case report, there was also a
selected IHM that was Graphitis 0/1 & it’s also followed
constitutionally. After the prescription, no new symptoms
came & patient had 50% relief on the 3rd follow-up. In the
5th & 6th, follow-ups mentioned the complaints were gone.
The Case report Figures 01 & 03 was a clear picture that
Graphites work beautifully & SCORAD index was before
62.75 & after treatment 4.5. Assessment by Modified
Naranjo Criteria Score (Table 3) 09 out of 13, which means
IHM works tremendously well [22, 26].
Conclusion
Homoeopathy is a remarkable alternative system of
medicine in the modern era (13, 26) . Homoeopathic medicines
are effective in the treatment of AD, which has been proven
once again under this case report. If we selected remedies on
the bases of the totality of characteristic symptoms and
through individualization which covers the patient’s
miasmatic background. These types of remedy selection
procedures can cure the patient at a deeper level & patient
relief permanent. If we choose symptomatic treatment, a
mixture of various medicines or use any suppressive
external application, which affects badly to the patient.
Individualized Homoeopathic Medicine (IHM) is also
capable to cure the mental symptoms of the comorbidity AD
patient. Graphites proved that it can cure the characteristic
symptoms of AD, along with mental symptoms. Meanwhile
good homoeopathic case-taking & prescription is important
for every acute & chronic case. Further research study
needed on this topic for the betterment of Homoeopathy.
International Journal of Homoeopathic Sciences https://www.homoeopathicjournal.com
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Acknowledgement: The author wishes special thanks to Dr.
Joydev Sarkar and Dr. Prof. Asok Kumar Das.
Conflict of Interest: None
Source of Funding: None
Author’s Contribution: Not available
Declaration of patient consent
The authors attest to having obtained the required patient
consent form. The patient has granted her permission in the
form for her photos and other clinical data to be published in
the publication. The patient is aware that her name and
initials won't be published, and that appropriate measures
will be taken to keep her identity a secret.
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How to Cite This Article
S Tanmay, D Abhinandan. Atopic dermatitis successfully treatment
by constitutional homoeopathic medicine Graphites: A case report.
International Journal of Homoeopathic Sciences. 2022;6(4):503-509.
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The Continuum theory and the Levels of Health theory propound the idea that return of efficient acute inflammation (high fever) heralds true improvement in chronic inflammatory states. We present 6 cases of atopic dermatitis (AD), which had stability in their improvement for 1 year or more, under classical homeopathy. The cases were retrospectively assessed with selected based on the Hanifin Rajka atopic dermatitis diagnostic criteria and the follow ups evaluated according to changes on SCORing Atopic Dermatitis scale (SCORAD) scale. The pictures are presented as evidence. Modified Naranjo Criteria for assessing causal attribution of clinical outcome to homeopathic intervention was used to assess the effect of homeopathy in these cases. All the cases improved and stabilised with complete skin clearance (those that relapsed within 1 year were not included). These patients had not suffered high fevers/acute inflammatory diseases since onset/aggravation of AD. Five of the 6 cases developed acute inflammatory diseases as the chronic condition improved. The last case showed return of an old, lesser pathology. The control cases – which were selected for non-improvement under classical homeopathy also showed remarkable skin clearance when there was appearance of acute inflammatory states. In this study, there is a mutually exclusive relationship between efficient acute inflammation and chronic inflammation, which is in accordance with the 2 theories considered here. Further scientific studies are necessary to establish the phenomenon at tissue level.
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