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Allergic Dermatitis and its Homoeopathic Perspective

Manchanda R.K.*, Arora S.C. **, Mehan Neena***
Sidhu P .K., Geetika, Kavita, Deepti, Hemant ****

Introduction

         The radical and effective treatment of skin disorders is one of the key areas where patients opt for Homoeopathy as the first line of treatment. Amongst skin disorders, allergic skin disorders particularly respond well to Homoeopathy and these constitute a major chunk of patients in the private practice of nearly every successful homoeopathic practitioner. Inspite of large number of allergic skin disorders patients being treated by homoeopaths, there are only very few well-documented studies /case reports to evaluate effectiveness of our system in such cases. Moreover, these studies and case reports use old and poorly explained terminologies like eczema, lichen, herpetic, tettery eruptions whose use has been already discarded by current dermatologists. Use of these terms creates confusion as term eczema without any proper definition is used in homeopathic literature to cover almost any type of skin disease presenting as a patch. Therefore it is necessary that homoeopaths should adopt a uniform use of appropriate terms for the type of lesion/eruption and try to bring out proper or probable diagnosis. This will not only improve the quality of homoeopathic practice in skin disorders but also the documentation, which is vital to the progress of our system. Proper diagnosis in allergic skin cases also helps in understanding, exciting and maintaining causes, the natural history, course, complications, and prognosis i. e curability or incurability of a case. It also helps in differentiating homoeopathic aggravation from disease or medicinal aggravation.

       Allergic skin disorders occur when the body starts reacting in an abnormal manner by forming antibodies or allergised lymphocytes to the common harmless agents in the environment namely food, physical agents like heat, cold, sunlight, drugs prescribed by the doctor for different diseases, clothes, jewellery, cosmetics, a variety of inhalants which are breathed in unknowingly, a large number of micro-organisms, parasites, plants and animals. Certain observations about allergy are :

1. Allergy or sensitivity is more frequent to substances that are more commonly used

2. Some substances produce more frequent allergic reactions than the others and thus are more potent antigens

3
. Some individuals are more prone to develop allergic reactions

4. Once an individual develops allergy to a particular substance, every subsequent exposure to that substance would result in recurrence of the allergic reaction unless the exposure is inadequate, and

5. If further exposure to causative or it's chemically related substances prevented, the allergic reaction would improve even without any treatment, unless secondary infection or changes have complicated it.

Allergic skin disorders are broadly classified into exogenous and endogenous types depending upon the source of causative factors

ExogenousEndogenous
UrticariaAtopic dermatitis
Contact dermatitisNummular dermatitis
Drug allergyInfectious eczematous dermatitis
PhotodermatitisPompholyx

The aims and objectives of the present study were to find out the most effective homoeopathic drugs and prescribing indications in different types of allergic skin disorders except urticaria.

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The clinical features used for the diagnosis of different types of dermatitis are as under:

1. Contact Dermatitis

The dermatitis to locally applied allergic substances is called contact dermatitis. It is mediated by delayed hypersensitivity reaction through T cells and the substance that produces the dermatitis is called contact antigen or concatenate.

Various types of the substances responsible for producing contact dermatitis are:

  1. Wearing apparel like clothes, shoes, caps, hats, socks, spectacles, and various items of jewellery.
  2. Cosmetics like hair oils, hair dyes, shaving creams, tooth pastes, lipsticks etc.
  3. Different drugs of local applications like antibacterials, antifungals etc used on the skin, eyes, ears or other body orifices
  4. Different substances coming in contact during professional activities, hobbies, pastimes, social responsibilities. Such substances include vegetables and fruits, chemicals, tools employed in the factories, industries, inks, pens, chalks, plants, weeds, & fertilizers and insecticides used by the farmers etc. Sometimes an individual unknowingly gets exposed to agents like plant components and pollutants present in air.

Clinically the lesion represents a dermatitis reaction that may be acute, sub-acute or chronic depending upon the degree of individual's hypersensitivity and nature of the substance. Liquids and volatile substances produce acute reaction in the form of severe itching, oedema, erythema, papules or papulo-vesicles while solid agents cause subacute reactions consisting of itching and erythematous scaly lesions. On Palms and soles the lesions are usually erythematous with fissuring. Once the individual gets sensitized, his whole skin is capable of reacting to the antigen. However dermatitis occurs only in those areas which get exposed to the antigen. During natural exposure each agent gets applied only on the specified areas of the body, thus the clinical presentations are localized to those areas of the body coming in contact with antigen produce a specific pattern of distribution of the lesions that are characteristic and diagnostic for different causative antigens. Sometimes the antigens get applied on the neck or face unintentionally while individual is sitting in a thoughtful mood.

       The most important step in the management is prevention of the further exposure of patient to the causative antigens. The dermatitis continues to worsen as long as contact with antigen continues. However, once the exposure to the antigen is stopped, the dermatitis tends to subside even without any treatment. Washing of the affected area with soap and water further reduces or even clears the remnants of the antigen that could be present on the skin. After the subsiding of the dermatitis the treatment can be withdrawn, the cause of contact dermatitis should be confirmed by patch test with the suspected substances responsible for the dermatitis. While performing the patch test with the suspected substances those substances which are likely to be recommended as substitute should also be tested to ensure their safety. Patient should be advised to avoid contact with the causative substances and use the substitute-tested safe, and if there is any recurrence of dermatitis, the possibility of inadvertent exposure to causative agents or exposure to some related chemicals should be considered.

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2. Photo- Dermatitis

       A most common variety of dermatitis seen due to sunlight. A large number of chemicals found in plants or a synthetic compounds when present in the system can make a human more sensitive to sunlight. Such substances include drugs like demethylechloretetracycline, sulphonamides, griseofulvin, and chlorpromazine, dyes like eosins present in some cosmetics and perfumes, tar products, compounds like psoralens and others present in the plants. If an individual gets exposed to sunlight when such substances are present in his system, he is likely to develop dermatitis on his exposed parts of the body. However, if the substance is eliminated from the body, further exposure will not produce any dermatitis. It presents clinically as erythema, scaling, and vesiculation along-with itching in the areas exposed to sunlight. Sometimes the lesion may present only as hyperpigmentation with or without itching. When the photosensitiser is a local applicant on the skin, the pattern of the lesion will correspond to the areas coming in contact with the photosensitisers sparing the area not exposed to sunlight or to the photosensitiser. In the management of photo dermatitis it is important to pinpoint the substance responsible for the reaction and advise the patient to avoid further exposure to it. The skin should be protected from sunlight through measures like covering the body by full sleeves high-neck clothes and cap till the photosensitizing substance is completely eliminated from the body.

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3. Drug Allergy

       Reactions due to systemic administration of drugs are usually sudden, generalized and bilaterally symmetrical with some exceptions. The lesions vary from drug to drug and patient to patient. Any drug can produce any type of lesion in an individual, a few drugs are known to produce specific types of reactions. The diagnosis in this case can be confirmed by provocation test with suspected drugs after recovery from acute symptoms.

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4. Atopic Dermatitis

       This is inherited as a polygenic recessive character. The patient inherits an increased tendency for irritable skin and of getting sensitized to various antigens present in the atmosphere. It may also be associated with other components of atopy like asthma, urticaria, hay fever or allergic dermatitis. The clinical manifestations vary with age but itching is the persistent symptom. Atopic dermatitis during the period of infancy is called infantile eczema. The lesions in this type may appear at any time between 2-6 months of age and continue to appear during the first two years of life. These consist of severely itchy, erythematous papules that become exudative and crusted especially on the cheeks and subsequently spread to the other parts of the body. Secondary infections with pyogenic organisms and lymphadenopathy are common. Some cases may clear up immediately and remain free for the rest of their lives, while the others develop changes of childhood stage. In childhood stage, which starts from two years of age onwards, the lesions tend to involve the cubital and popliteal fossae predominantly. The lesions consist of severely itchy, mildly erythematous papules with mild to moderate lichenification. The skin is dry with no exudation. As the age advances, the lesions tend to become more dry and lichenified and may involve the face, neck and trunk. This is called the adulthood stage of atopic dermatitis. In severe cases the whole body may get involved with lichenification.

       In the management, it is very important to keep the skin and hair clean by advising daily bath with ordinary toilet soap and shampoo the hair daily to reduce the antigenic challenge. Oil application even on dry skin should be stopped because oil traps more dirt on the skin interfering with the cleaning process.

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5. Nummular Dermatitis

       It manifests as recurrent itchy papulo-vesicles grouped into coin shaped patches mostly situated on the extensor aspects of the lower and upper extremities. It is common in children and young adults. Secondary infection with pyogenic organisms is also common. The lesions exude profusely resulting into heavy crust formation. The course of the disease is punctuated into remissions and relapses. It is diagnosed on clinical history and aggravating factors include infection, low protein diet and winter season.

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6. Pompholyx

       It manifests as recurrent severely itchy vesicles on both palms and/or soles. The lesions are seen all over the palms and soles. The sides of the fingers are frequently seen having the lesions. Occasionally the lesions may be present on the dorsum of the hands and feet. The lesions heal spontaneously in a few days leaving behind scaling. The exact cause of this disease is still unknown. It is believed to be an allergic manifestation to a septic focus in the body, tinea interdigitable, a food article, an inhalant or even a drug. However, in several cases the cause remains untraced. Besides the treatment an attempt should also be made to trace the cause of allergy in the patient and remove it.

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7. Infectious Eczematous Dermatitis or Infective eczema

        It is due to hypersensitivity to the infecting pyogenic organism or its antigenic products. The patients develop eczematisation around the original lesions of pyoderma as itchy, diffuse, papulo-vesicular or scaly lesions. In the management of Infectious eczematoid dermatitis cases, it is necessary to frequently clean active pyodermic lesions with ordinary soap, Calendula or Echenicea 10% in water as it reduces the bacterial load causing sensitization and helps in speedy recovery from indicated drug.

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8. Non- Specific Dermatitis

Allergic skin cases defying specific presentations were grouped under this heading in the present study.

Material & Methods

        A total number of 265 cases 154(Males) and 111(Female) of different types of Allergic Dermatitis 94 cases of Infective Eczematoid Dermatitis, 65 cases of Pompholyx, 48 cases of Nummular Dermatitis, 30 cases of Contact Dermatitis, 7 cases of Atopic Dermatitis, 5 cases of Drug induced dermatitis, 3 cases of Photo-Dermatitis and 13 cases of non-specific dermatitis were included in the study (Table-I). The study was conducted at Nehru Homoeopathic Medical College & Hospital, New Delhi during last five years from 1993-1998. The age group of the patients varied from six months to above 60 years (Table-II). The duration of complaints varied from few months to more than five years (Table-III). Cases were recorded on a pre-designed case recording Performa and diagnosed on the basis of clinical signs and symptoms. Cases of Contact dermatitis were also differentiated & evaluated on the basis of patch test. The medicines were prescribed on the basis of presenting complaints, totality of symptoms and in some cases exclusively on mental symptoms (Table-IV). About 29 Homoeopathic drugs were used in different potencies from 30 to 1M. (Table-V) .The prescribing indications of each drug used in this study have been mentioned separately. The average duration of treatment varied from few months to more than three years. (Table-VI). The response to treatment was evaluated in terms of asymptomatic (cured) cases, mild, moderate & marked improvement, no change, worse, drop out and recurrence if any (Table-VII). In addition the cases were also managed individually according to clinical types of patient.

Table I : Clinical Types of Allergic Dermatitis

S.NoClinical TypesTotalMaleFemale%
1.Nummular Dermatitis(N.D.)48282018
2.Pompholyx(pump)653431

24.5

3.Infectious Eczematous Dermatitis(I.E.D)94603434.5
4.Atopic Dermatitis(At.D.)7612.6
5.Contact Dermatitis (C.D.)30102011.3
6.Drug Allergy(D.A.)5411.8
7.Photo Dermatitis(P.D.)3121.1
8.Non-specific Dermatitis(N.S.D.)131124.9
9.Total256154111 
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Table II Age Incidence

AgeTotalN.DPompIEDAt.DCDPDDANSD%
6m to 10yrs2411136--129
10yrs-20yrs 5010111714-1618.8
20yrs-30yrs81222122-14-1130.5
30yrs-40yrs4861319-52-318.1
40yrs-50yrs293910-411110.5
50yrs & above3361013-3-1-12.4
Total2654865947303513 
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Table III: Duration of complaint

DurationTotalN.DPompIEDAt.DCDDAPDNSD%
1m to 1yrs80152226173--30.5
1-2yrs526718114---19.2
2-5yrs671517222523325.3
5yrs & above6612192834---24.9
Total2654865947305313 
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Table IV Basis of Prescription

S.NoClinical Types MentalTotality of
Symptoms
Presenting
complaints
  GiveEffectiveGivenEffectiveGiven Effective
1.Nummular
Dermatitis
17153227118
2.Pompholyx
(Pomp)
211939352521
3.Infectious
Eczematous
Dermatitis(I.E.D.)
231871552517
4.Atopic Dermatitis
(At.D.)
--5321
5.Contact Dermatitis
(C.D.)
311512129
6.Drug Allergy
(D.A)
--1143
7.Photo Dermatitis
(P.D)
----32
8.Non-specific
Dermatitis (N.S.D)
217442
 Total6654
88.8%
170137
80.6%
8663
73.25%
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Table V Drug Therapy

S.NoDrugsTotal
Patients
Found
Effective
N.DPomIEDAt.DCDPDDANSD
1.Sulphur7255(76%)11161128124
2.Natrum Mur6857(83%)141610282-5
3.Merc Sol3428(82%)72154----
4.Mezerium3327(82%)541125---
5.Nux Vom2718(67%)126-3-51
6.Sepia2216(73%)16414---
7.Rhus Tox1513(87%)-12--1---
8.Calc. Carb1514(93%)455-----
9.Ignatia1411(79%)452-----
10.Ars.Alb146(43%)-14-1---
11.Graphites138(62%)115---1-
12.Hepar Sulph128(67%)125-----
13.Psorinum128(67%)215-----
14.Sarsaparilla119(82%)27------
15.Achyranthes114(36%)2-2-----
16.Azadiractha Ind86(75%)5-1-----
17.Hydrogenoidle74(57%)-------4
18.Lycopodium74(57%)112-----
19.Antm Card65(83%)--2-3---
20.Gun Powder53(60%)--3-----
21.Petroleum33(100%)-21-3---
22.Ran.Bulb33(100%)-3------
23.Opium33(100%)-21-----
24.Thuja32(67%)--2-----
25.Bacillinum22(100%)2-------
26.Alumina22(100%)1(50%)-11-----
27.Calc.Sulph21(50%)--1-----
28.Phosphorus11(100%)-1------
29.Lachesis11(100%)-1------
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Table VI Duration of Treatment

DurationTotal%N.DPompIEDAt.
D
CDPDDANSD
1-3m11448.3%2015413182510
3-6m6126.7%142316241-1
6-9m2912.2%3714-5---
9m-1 yr135.5%265-----
1-2 yr93.8%234-----
2-3 yr8l3.4%125-----
Total234 4256855273511
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Table VII Response of the treatment

Clinical
Types
CuredMarkedModerateMildNo
change
WorseDroppedTotal
ND113131231648
Pomp22105109-965
IED251220199-994
At.D.-113--27
C.D.3711231330
P.D.---21--3
D.A.3-11---5
NSD31223-213
 67
(25.2%)
34
(12.8%)
53
(20%)
51
(19.2%)
28
(10.5%)
2
(0.7%)
31
(11.7%)
 
 67
(25.2%)
39.2% 
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Discussion

1. In the present study, a total number of 265 cases of different types of allergic dermatitis have been evaluated after homoeopathic treatment for a period varying from few months to five years. Outs of these 31 (11.7%) cases are dropped out of study for various reasons of not complying with the study design. Out of 234 reporting cases, 67(25.2%) were completely cured, 34 cases (12.8%) had marked improvement and 104 (39.2%) cases had improvement ranging from mild to moderate degree. Only 28 (10.5%) cases got no relief and only one case became worse after treatment. The results clearly show that Homoeopathy is effective in the management of allergic dermatitis.

2. The drugs found effective in the study are grouped as under:

Dermatitis allergic: Alum, Achyr -asp, ANTIM.-CR, Azad Ind, Bac, CALC-CARB, Calc - sulph, GRAPH, Gun Powder, HEP-SULPH, Hydrc, Ign, Lach, LYCO, MERC-SOL, MEZ, NAT-MUR, NUX-VOM, Op, PETR, Phos, PSOR, Ran-b, SARS, SEP, SULPH, Thuja

Nummular dermatitis (N.D.) : Achy -asp, Azad Ind, Ars-alb, Bac, CALC-CARB, GRAPH, HEP-SULPH, Ign, LYCO, MERC-SOL, MEZ, NAT-MUR, NUX-VOM, PSOR, Rhus-t, SARS, SEP, SULPH

Pompholyx (Pomp) : Alum, ARS-ALB, CALC-CARB, GRAPH, HEP-SULPH, Ign, Lach, LYCO, MERC-SOL, MEZ, NAT-MUR, NUX-VOM, Op, PETR, Phos, PSOR, Ran-b, Rhus-t, SARS, SEP, SULPH

Infectious Eczematoid Dermatitis (I.E.D.): Alum, Achyr -asp, ANTIM. -CR, ARS-ALB, Azad Ind, CALC-CARB, Calc - sulph, GRAPH, Gun Powder, HEP-SULPH, Ign, LYCO, MERC-SOL, MEZ, NAT-MUR, NUX-VOM, Op, PETR, PSOR, SEP, SULPH, Thuja

Atopic Dermatitis: (At. D ): MERC-SOL, MEZ, NAT-MUR, SEP, SULPH,

Contact Dermatitis (C.D.): ANTIM. -CR, ARS-ALB, Azad Ind, Bac, Calc - sulph, MEZ, NAT-MUR, NUX-VOM, PETR, Rhus-t, SEP, SULPH.

Drug Allergy (D.A.) : SULPH , NUX-VOM, GRAPH

Photo dermatitis (P.D.): SULPH, NAT-MUR

3. In Homoeopathic repertory the general terms like eruptions vesicular, pustular, eczema, crusty etc are being used for allergic dermatitis. The above stated clinically efficacious drugs can be incorporated in the repertory for the benefit of profession in respect of each clinical types.

The drugs in respect of Nummular Dermatitis, Pompholyx, Infectious eczematoid, Contact Dermatitis have been found effective repeatedly but the number of cases in respect of Photo dermatitis, Drug Allergy is to not enough to establish the efficacy hence more study is required.

4. The pattern of aggravation during treatment was according to the clinical types, treatment taken and natural history of the different types of allergic dermatitis.

No aggravation was observed in the new and acute cases of dermatitis

Chronic cases that were improving partially with the local steroids reported reappearance of the old symptoms.>

5. As all the cases had been only clinically evaluated, there is a need to undertake further studies supported by other assessment parameters of immunological tests or double blind placebo controlled studies to arrive at a conclusion.


* Deputy Director (Homeopathy) , Govt. of Delhi, Nehru Homoeopathic Medical College and hospital, B_Block, Defence colony, New Delhi
** Medical Officer Homoeopathic Dispensary, N.D.M.C., Delhi
*** Assistant Professor, Dr. B.R.Sur Homoeopathic Medical College & Hospital
**** Homoeopathic Physicians.

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Annexure

Indications of the drugs used in the trial in respect of each drug are as under:

1. Sulphur (sulph)

It was given to dirty, filthy, lean, stoop-shouldered and scrofulous persons. Nervous temperament, very selfish nature, relapsing complaints, cannot stand for longtime, excessive burning everywhere, hungry at 11 A.M., constipated large painful stools, desires sweets, marked aversion to bathing were the leading indications. The mental symptoms used were embarrassed ailments after, delusion getting thin, longing refuse for tranquility. It was used in all types of allergic dermatitis with marked itching, want to scratch, burning after scratching worse by heat of bed, recurrent papulo vesicles, erythematous eruptions dry, cracks.

2. Natrum muriaticum (Nat-mur)

It was given in anaemic, cachectic, emaciated subjects, resulting from loss of fluids, or mental stress, emaciation marked around neck. Awkwardness, abruptness, irritable, weeping disposition that is aggravated by consolation, complaints precipitated after grief's, absorbed as to what would become of him and anxiety alternating with indifference were the characteristic mental symptoms. Desire for excessive salt, dry, geographical tongue, sweats while eating and aggravation at the seashore and sunlight, better in open air were leading symptoms. Skin symptoms include graying nails, vesicular eruptions around lips, dermatitis which is raw, red, inflamed, crusty, over scalp around hair follicles, over margins of hair, bends of limbs and behind ears.

3. Mercurius solubilis ( Merc-sol.)

It was used for suppurations with lesions varying from erythematous papules, vesicles, pustules, thickening, glandular swellings and ulceration. Itching or burning pains were worse at night. Profuse sweating without any relief, thick, very offensive acrid discharges, large, flabby, thickly coated tongue, internal chilliness, tendency for diarrhoea with slimy stools and offensive breath were the general indications.

4. Mezereum (Mez)

It was suitable to irresolute persons of phlegmatic temperament having eczematous dermatitis. Sensitive to cold air, chilliness and skin lesions with intolerable itching, thick leather like crusts under which thick yellow pus collects, hair glued and matted, offensive pus with maggots, vesicular lesions with burning, surrounded by shining fiery redness are characteristics.

5. Nux-Vomica ( Nux-Vom)

It was given to thin, sensitive, irritable, careful, zealous, ardent person with dark hair and bilious and sanguine temperaments having disposition to quarrel, spiteful, malicious, nervous and melancholic. Frequent dyspepsia, constipation with ineffectual desire and hypersensitive to cold were the leading indications. It was used for acute dermatitis after drugs, red papular lesions over face with itching.

6. Sepia (sep)

It was suitable to persons of dark hair with mild and easy disposition. The leading indications includes great sadness and weeping, indifferent to even loved one, yellow saddle across upper part of the cheeks and nose, sensation of emptiness, all types of uterine affections, intolerable offensive and profuse sweat, worse after, associated exposure to cold air and better after warmth of bed, hot applications and violent exercise. It is used in ring shaped lesions especially over upper parts of body appear every spring, itching not improving from scratching, worse on bends of elbow and knee, worse in open air and better in warm room.

7. Rhus Toxicodendron (Rhus-Tox.)

It was given for rheumatic diathesis, ill effects of getting wet after being heated. Restlessness, triangular red tip of tongue, better by warm, dry weather and pains that are better by continued motion are the leading indications. It is used for dermatitis with erythema, oedema, cellulitis, vesicular, bullous lesions, pustules with yellow pus, burning, itching or stinging pain better by warmth. It is also indicated for hardness and induration of skin.

8. Calcerea carbonica (Calc-carb)

It was suitable to leucophlegmatic constitutions, blond hair, fair complexion, and tendency to obesity. The persons with great apprehension and fear that people will observe their confusion and sensitive to hearing about accident, cruelties, riots, etc. Profuse sweating from head while sleeping, desire for eggs, feeling better when constipated were the leading indications. Skin is unhealthy, has tendency to ulcerate, small wounds do not heal quickly, glands swollen, petechial eruptions, abscesses in deep muscles.

9. Ignatia

It was used for person with profound sadness, silent, and grief, irritable due to pain and discontinued disposition. The eruptions was having itching and burning

10. Arsenicum album (Ars-alb)

It was indicated for dispositions that include depression, melancholia, despair, indifference, anxiety, fear, restlessnes, anguish or irritability, sensitiveness and peevishness. Marked prostration with fainting, mental restlessness, burning pains better by heat, nightly aggravations and offensive discharge were the leading indications. It was used for various types of lesions including papules, vesicles, pustules, ulcers, and dryness. The lesions also had itching or burning, oedema , redness, excoriations or crusting.

11 Graphites

It was suitable for stout, fair complexioned, constipated, and fatty and chilly individual. Children impudent, teasing, laugh at reprimands. Sad, despondent, music makes them weep. It was used in various types of skin lesions. Unhealthy skin, every injury suppurates, old cicatrices break open again, eruptions upon ears, between fingers, toes and on other skin folds of the body. The discharge had characteristics of being watery, transparent, sticky and thick. Swelling, induration of glands. Cracks, fissures at tips of fingers, nipples, labial commissures, anus and between toes.

12. Hepar Sulphuricum ( Hep-Sulph)

It was used in irritable, quick and hasty persons. Patient was peevish, angry at even least trifle, hypochondrical and unreasonably anxious, extremely sensitive to cold air and touch. It was used for various types of skin lesions, slightest injury causes suppuration abscess, suppurating glands, papulo-pustular lesions and deep cracks on hands and feet, Ulcers with pus discharge mixed with blood, smelling like old cheese, surrounded by little pimples, very painful, splinter like pain and better by warmth.

13. Psorinum (Psor)

It was given to psoric constitutions when well-selected remedies or Sulphur fail to relieve or permanently improve. Filthy smell of body, great sensitiveness to cold air or changes of weather, carion like odor, despair from itching were the leading indications.

14. Sarsaparilla (Sars.)

It was given to dark-haired persons having lithic or sycotic diathesis. Emaciation, white coated tongue, aphthae, increase salivation, foetid breath and pain at the end of urination were the leading indications. It was used for dry, itchy, crusty eruptions, cracked skin of hands and feet's particularly on the side of fingers and toes with hardness and induration, eczema of breast with cracked and inverted nipples and eruptions every spring and worse in summer.

15. Achyranthese aspera(Achy)

It was given to dull, indolent, irritable and sulky person. The lesions were erythematous, vesicular, papular , pustular and ulcers with pain or burning, especially over hands, feet. The discharge from the lesion was yellowish, bloody, sticky and foul smelling.

16. Hydrocotyle asiatica (Hydrc.)

Inflammation, cellular proliferation, induration and lichenification of the skin were important symptoms. It was used for circumscribed red scaly lesions with severe itching or pricking which is worse at night and after scratching.

17. Lycopodium clavatum ( Lyco.)

It was suitable to person intellectually keen but physically weak, upper parts of the body emaciated lower parts semi dropsical, having deep-seated progressive chronic diseases. It affects right side of the body or the complaint goes from right to left side. The person is predisposed to gastric and hepatic affections, all the symptoms were worse in the evening between 4 to 8 PM. The complexion was pale, dirty, unhealthy, and sallow with deep furrows and senile look. The temperament is irritable, peevish loves power, cannot endure opposition, avaricious, greedy, miserly and malicious. Skin symptoms include ulcers, fissures, abscesses, and wheals, violent itching worse on warm applications, eczematisation, chronic dermatitis, thickening, indurations, brown spots on face, premature graying of hair.

18 Antimonium crudum (Antin. -cr.)

This drug was used in dull, lethargic, phlegmatic persons having extraordinary craving for apples. Drowsiness, debility, thick white coated tongue with red edges, profuse sweating. The symptoms got worse in damp and cold climate and in spring weather. The drug is useful for vesicular, pustular and crusty eruptions with itching over various parts of body especially face and head.

19. Petroleum

It was given to person with irritable, quarrelsome disposition, easily offended at trifles, vexed at everything. Skin symptoms were worse in winter. Itching is worse at night, painful sensitiveness of whole body, slightest injury suppurates, rough, cracked, fissured, painful lesions especially on hands, finger tips, soles. Heat and burning of palms and soles with foul sweat.

20. Ranunculus bulbosus

It was given for muscular pains, intercostal rheumatism, chest sore, bruised sensation, worse from touch, stormy weather, motion or turning the body.

21.Thuja occidentale (Thuja.)

It is given to hydrgenoid obese constitutions, dark complexioned, black hair and unhealthy skin. Fixed ideas of various types, rapid exhaustion, emaciation and strong smelling perspiration more to covered parts are the leading indications. It is used for every type of warty growths, polyps, tubercles, ulcers around ano-genital area, dry skin with brown spots on hands and arms, painful glandular swellings, nails crippled brittle and soft, burning after scratching and eruptions are more marked on covered parts.

22. Bacillinum (Bac.)

It was used for fair complexion, blue eyed, blond, tall, flat and narrow chested person who is active, precious, and weak and is having tubercular diathesis. It was given as intercurrent medicine when best indicated remedy fails to act with the tubercular background. Excessively chilly, rapid and pronounced emaciation, changing symptoms from one part to another were the leading indications. Skin symptoms include recurrent small boils which were intensely painful and were appearing especially in nose with green foetid pus, chronic eczematous lesions over skin folds, behind ears, hairy areas, fiery red skin with soreness and rawness, psoriasis with immense quantities of white bran like scales and itching worse by undressing, bathing.

23. Alumina (alum)

It was used in thin, dark complexioned having hypochondriac and chilly constitution, suffering from chronic diseases and constipation with great straining while defaecation. The lesions were dry, itchy and scaly which were worse in winter and better in warm and wet weather.

24 Calcarea sulphurica (Calc - sulph)

It was used for dermatitis, glandular swellings, cyctic tumours and suppurative processes when the pus has yellow, thick and lumpy character. The skin is unhealthy like in other calcarea salts. Itching and pain in lesions were better by cold.

25. Phosphorus (Phos)

It was suited to tall, slender, stoop shouldered persons of sanguine temperament. The skin was fair, and delicate. Their nature was very sensitive, sympathetic, nervous and weepy with depressed spirits and palpitation. Haemorrhagic diatheses, burning weak, empty all gone sensation in various parts of body, desire for juicy refreshing, cold food and drinks. The skin symptoms included dandruff, hair fall in bunches and in patches, loss of sensation, fornication, itching, burning, ecchymosis, scaly lesions over various parts of body including eyebrows, bleeding ulcers and brown spots on face.

26. Lachesis

It was used for dark eyed melancholic persons with disposition to low spirit and indolence. It was better suitable to thin and emaciated having haemorrhagic diatheses than too obese. Great loquacity, suspicious, left sided complaints extending to right, great sensitiveness, worse after sleep, passive bleeding, and hot flushes with hot sweating and ailments during and after menopausal period were the special indications for its use. Skin lesions are of dark, bluish, purplish appearance with dark haemorragic discharge.

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