EXPERIENCE WITH HOMOEOPATHY IN A CASE OF PITYRIASIS VERSICOLOR Dr Sapna Gupta BHMS Reader, Department of Pathology, Nehru Homoeopathic Medical College and Hospital, Directorate of AYUSH, Govt of NCT of Delhi. India. E-mail:
[email protected] Abstract Pityriasis Versicolor is a common fungal infection of the skin in which flaky, pale colored patches appear on the upper trunk area of the body. A 12 years old boy suffering wth pityriasis versicolor was treated with the homeopathic medicine Sepia, after repertorising the few available symptoms of the case with Boger Boenninghausen’s Repertory. Repertory. The lesions resolved rapidly and complete repigmentation occurred within 5-6 weeks. Keywords Pityriasis versicolor, Homoeopathy, Local maladies, Sepia
Introduction Pityriasis versicolor (Tinea versicolor) is a common fungal infection of the skin caused by the Malassezia furfur, seen in hot and humid climate. Clinically it presents as hypo-pigmented macules with delicate, fine scales, which are seen mainly in upper trunk extending to shoulders, upper arms, neck and lower trunk. Face and scalp are rarely involved. The diagnosis may be readily confirmed by demonstrating the organism in scrapings of the scales in a 10% KOH solution. The hypopigmentation may persist for weeks or months after the fungal disease is cured. The disease needs to be differentiated from seborrhoeic dermatitis, pityriasis rosea, pityriasis alba, vitiligo. The disease has a tendency to become chronic or to relapse.[1,2,3]
Allopathic treatment comprises of local application of 25% aqueous solution of sodium thiosulphate for several weeks or 2.5% of Selenium sulphide. Ketoconazole or Flucanazole are given orally in recommended dosage[2]. Pityriasis versicolor normally presents in individuals with very few symptoms and hence, according to homoeopathic philosophy, falls within the domain of ‘so-called ‘so-called local maladies’ maladies’ . Samuel Hahnemann has extensively discussed about the nature and homoeopathic treatment of such conditions in his Organon of Medicine from aphorism 185-203[4]. These few local manifestations should not be presumed to be a mere local disease as they always originate from a miasmatic disturbance deep within. They are true chronic diseases belonging to the class of one-sided diseases and require detailed case-taking and anti-miasmatic treatment. This fundamental homoeopathic philosophy propounded by Hahnemann nearly 200 years back stands verified today as nearly all (so called) local diseases are relapsing, remitting by nature viz. pityriasis versicolor, most of local fungal skin diseases, viral skin diseases etc.
Homoeopathy strongly condemns the use of any external medicinal application in these diseases and recommends judicious treatment of the internal morbid state. In accordance with the principles of homoeopathic philosophy, selection of homoeopathic medicine is solely based on the novel combination of signs and symptoms present in every individual case. Few therapeutic pointers however, may also be found in homoeopathic literature viz. the rubric Pityriasis (dermatitis exfoliativa) is mentioned under the chapter Skin of Boericke’s repertory enlisting 25 medicines like Colchicum, Fluoric Acid, Graphites, Kali Ars, Sepia, Sulphur etc.[5] Kent’s Repertory gives a cross-reference to Eruptions, scaly under the rubric Pityriasis in the Skin chapter.[6] Case Report Master K., 12 years old boy, fair complexioned, thin built with widely spaced teeth and reddish flabby lips presented with asymptomatic, slightly scaly, hypopigmented, macular lesions on his upper extremities. The lesions were noticed in the month of July (in Delhi), after he had joined a cricket academy and played for long hours in hot and humid afternoons. The spots first appeared on right upper limb and then spread to left side and were rapidly increasing in size and number. The spots were mainly centered on the flexor aspect of elbow joint. The lesions were observed to have a bilateral symmetry in distribution.
The child had suffered with dengue fever in 2013. He desired sweets (2+). A constant sweat was observed on his upper lip during case taking. There was family history of tuberculosis. Nothing further could be elicited during the case taking. Analysis of the Case: In the above case, very few symptoms were elicited in case taking. In the absence of strong Generals in the case, we referred to Boger Boenninghausen’s Repertory[7]. The following rubrics were selected:
LOCATION SENSATION/ COMPLAINT SENSATION/ COMPLAINT MODALITY CONCOMITANT CONCOMITANT
CHAPTER Upper Extremity Skin and exterior body
Skin and exterior body Aggravation Amelioration in general Appetite Sweat
The result of Repertorisation was: 1. Sepia : 14/6
RUBRIC Elbow joints, bend of Spots, white
Desquamation, exfoliation, white scales and Weather, sultry, agg Desires, sweets partial sweat of spotted
single
parts,
2. 3. 4. 5. 6.
Calcarea Carb: 8/5 Sulphur: 12/4 Lycopodium: 10/4 Kali carb: 9/3 Phos: 9/3
Since the eruptions had a bilateral symmetrical appearance and this rubric was not found in Boger Boenninghausen’s Repertory, we referred to the Synthesis Repertory wherein we found the rubric Eruptions, symmetrical , under the section on skin, with following remedies[8]: Arn, crot-t, lac-d, nat-m, nept-m, sep, sil, thyr It was therefore decided to prescribe Sepia in the case. Prescription and Follow up:
Date 23-8-14
30-8-14
20-9-14
5-11-14
Condition
Prescription Sepia 30/2 pills/tds for 08 days
The progression of lesions stopped. No new Sepia 30/TDS/ 21 spot appeared. The old lesions regressed in days. size and their color improved. Placebo for one month.
Placebo for one month. The case is still being followed.
Discussion: Boennighausen was an able student of Hahnemann and homoeopathy since the early years. His commitment and contribution to the system were acknowledged by the esteemed founder in his own writings.
In the above case, we could not elicit many symptoms. Generalities were also not strongly described. Working out a suitable remedy would have been difficult proposition if Boeninghausen hadn’t spelt out the importance of completing a symptom. The complete symptom, according to him, had location, sensation/ complaints and modality. Since the human being functions as a unit and all parts are in a harmonious correlation with each other, he further added to doctrine of concomitants. When we combine them together, we get the complete totality of symptoms. Totality, according to Boenninghausen, is itself a GRAND symptom of the patient, which a homoeopathic remedy should correspond to. Though the Boger Boenninghausen’s repertory is undervalued today for fewer number of remedies mentioned, it must be borne in mind that the book contains all the known polychrest remedies, which correspond to most of the common clinical conditions encountered in daily practice. Conclusion The case of pityriasis versicolor responded rapidly to the indicated homoeopathic remedy, Sepia, which was prescribed in 30th potency and the skin returned to normal color in 5-6 weeks of treatment. It is further stated that the case above needs long follow up to rule out any relapse especially in the hot and humid weather, which I intend to do.
My experience in this one sided (chronic) diseased condition has strengthened my belief in the logic of Boennighausen’s philosophy and applicability of his repertory in such cases. It also brings clarity as to why Hahnemann labeled such diseases as ‘so called local maladies’ and advocated their cure with internal medicines alone! References 1. Gupta R, Manchanda RK. Dermatology for Homoeopaths. Galgotia Publishing Company, India; 1997; pp 70 2. Arnold HL, Odom RB, James WD. Andrew’s DISEASES OF THE SKIN Clinical Dermatology. W.B Saunders, USA. 8th edition; 1990; pp 198-213 3. Framil VM, Melhem MS, Szeszs MW, Zaitz C. New aspects in the clinical course of pityriasis versicolor. Accessed online on 09/11/2014 at the link http://www.ncbi.nlm.nih.gov/pubmed/22281901 4. Hahnemann S. Organon of Medicine, 6 th edition. B.Jain Publishers (P) Ltd, India. Reprint edition 2004; pp 171-175 5. Boericke W. Pocket Manual of Homoeopathic Materia Medica. Pratap Medical Publishers Pvt Ltd, India; Reprint edition, 1998; pp 912 6. Kent JT. Repertory of the Homoeopathic Materia Medica. B. Jain Publishers (P) Ltd, India. Enriched Indian Edition 11 th impression, 2013; pp 1318-19 7. Boger CM. Boenninghausen’s Characteristics Materia Medica and Repertory with word index . B.Jain Publishers (P) Ltd, India. Reprint edition, 2003; pp 808, 966,949,1152,477,1079 8. Schroyens F. SYNTHESIS Repertorium Homeopathicum Syntheticum. Homeopathic Book Publishers, London. Edition 7.1; 1997; pp 1537
