ABSTRACT
Atopic eczema (dermatitis), a type of eczema, is a chronic inflammatory skin disease posing a significant burden on health care resources. It affects up to 3% of adults; recent data show that its prevalence is still increasing, especially in low socio economic countries. There is limited evidence to support the use of conventional treatment of this condition. With reference to the current scenario prevalence of atopic dermatitis in adults is increasing. Homoeopathy treats the individual in disease and not the disease alone and holistically helps the patient in need. Thus by striking at the root of the problem patient can be relieved from further remission of suffering.
INTRODUCTION
Atopic dermatitis (AD) is an itchy, inflammatory skin condition with an affinity for the skin flexures, characterized by poorly defined erythema with oedema, vesicles and with discharge in acute stage and skin thickening in chronic stage. It can be present for the first time in adult age with atypical morphology or may progress from childhood onset.
Dermatitis clinically manifests as pruritus, erythema, edema, papules, vesicles, scaling, and lichenification. The feature that predominates depends on stage-acute dermatitis is exudative, while chronic dermatitis is dry, scaly, and often lichenified.
Classification of Dermatitis
Endogenous Dermatitis: where constitutional factors predispose the patient to developing Dermatitis
· Atopic dermatitis, Seborrheic dermatitis, nummular dermatitis, statis dermatitis
Exogenous Dermatitis: where external stimuli trigger development of dermatitis.
· irritant dermatitis, allergic dermatitis, photo dermatitis, radiation dermatitis
ATOPIC DERMATITIS
The word atopy was first used for a group of hereditary disorders in people who had a tendency to develop an urticarial response to foods and inhaled substances. Atopic dermatitis is an endogenous dermatitis triggered by exogenous agents, Is an inflammatory skin condition which is characterised by increased itching, erythematous eruption, with crying tendency in acute onset and lichenification in chronic stage, excessive water loss from the skin which leads to dryness of skin (xerosis). Atopic dermatitis may present for the first time in adult age with atypical morphology or may progress from childhood with affection for skin flexures.
Atopic dermatitis usually affects up to 20% of children and up to 3% of adults, recent study shows that the prevalence of Atopic dermatitis is considerably increased in recent years especially in developing or under developing countries, patient who have been affected by Atopic dermatitis have genetically dysfunction in skin barrier or immune functions.
Around 50% of Atopic dermatitis patient develops symptoms within one year of age, around 95% of patients experience symptoms of Atopic dermatitis before 5 years of age and around 75% of patient develops symptoms of Atopic dermatitis during childhood, about 25% of patient continue to have dermatitis in adults or may experience relapse of symptoms after a symptom free years.
Usually about 50 % of patient with atopic dermatitis have family history of allergic rhinitis, bronchial asthma, and eczema
CLINICAL FEATURES OF ATOPIC DERMATITIS:
An atopic dermatitis consists of verity of features. The clinical features of atopic dermatitis classified into: atopic itch, atopic dry skin, atopic eczema and stigmata of atopic dermatitis.
The atopic itch is a constant feature and absence of it virtually excludes the diagnosis of the atopic dermatitis. Indirect evidence like scratching, excoriation and lichenification of skin. Dry atopic skin is an another clinical features of atopic dermatitis, dry atopic skin mainly occurs due to change in lipid content in the skin especially in the epidermis and fillagrin gene mutation which leads to increased trans epidermal water loss (TEWL) ultimately results in the dryness of skin.
Atopic dermatitis is classified into three phases-
· Infantile phase,
· Childhood phase and
· Adolescence phase or Adult.
INFANTILE PHASE: Begins after the age of three months, intensely itchy papules and vesicles, which soon become exudative. Begins on the face but can involve rest of the body sparing the diaper area.
Runs a chronic course: In 40% of infants, lesions clear by 18 months of age. In 60%, pattern, lesions changes into childhood phase pattern of lesion.
CHILDHOOD PHASE: Dry, leathery and extremely itchy plaques, mainly on elbow and knee flexures.
ADULT PHASE: Intensely itchy lichenified plaques. Cubital and popliteal fossae are commonly affected site in adult onset atopic dermatitis.
A low grade involvement may see on the rest of the body like lips, nipple, and hand.
Other atopic manifestations: about 50% of patients with atopic dermatitis (AD) have allergic rhinitis and about 30% have asthma. In patients with both asthma and dermatitis, there may be an inverse relationship between two.
Urticaria: atopics also develop food allergies and urticaria more frequently. Eye changes that were observed include isolated blepharitis, loss of the eyelashes, Eczema of the eyelids and conjunctival papillae. Anterior sub capsular cataract and keratoconus.
Features that may predispose a patient for eye involvement are family history of atopy, palmar hyper linearity, and dryness of the skin and Dennie Morgan folds.
Other clinical manifestation of Atopic dermatitis:
Pruritus is primary manifestation seen in atopic dermatitis which is triggered by stress, allergens, sweating, and change in humidity.
Erythematous eruption: erythematous eruption with papulovesicular exudation of skin and lichenification of skin with dryness of surrounding skin is the commonest manifestation in atopic dermatitis. Xerosis
Cutaneous infections (Staphylococcus aureus, group A streptococcus, herpes simplex,
Coxsackie virus, vaccinia, molluscum, warts). Nonspecific dermatitis of the hands or feet
Ichthyosis, palmar hyper linearity, keratosis pilaris. Nipple eczema, Elevated serum immunoglobulin E levels. Positive results of immediate-type allergy skin tests.
DIAGNOSIS
AD diagnosis is based on clinical presentation rather than laboratory test like-
1) Essential features of atopic dermatitis that is itchy skin
2) Typical lesions distribution
3) Strong family history of atopy
4) Known associated features like infraorbital thickening.
Diagnosis of atopic dermatitis is mainly based on clinical presentation, investigation plays a very little importance, some of primary investigation for atopic dermatitis are serum IgE levels (Immuno CAPR; radio allergosorbent tests technique), and skin prick test and AEC count.
MANAGEMENT OF ATOPIC DERMATITIS:
A multiple approach is required in patients suffering from atopic dermatitis.
The aim in the management of atopic dermatitis is to
1. Maintain the skin barrier function
2. Lowering the inflammatory response
3. Identification and removing the triggering factors
4. Avoidance of allergens
GENERAL MANAGEMENT
Natural Oils - Coconut oil is an excellent moisturizer, because it is rich in triglycerides, one of its main constituents is lauric acid, which imparts antibacterial and antifungal properties. Coconut oil also has antioxidant properties. Sunflower seed oil, which helps stimulate the body’s natural ceramide production internally, ultimately improving the skin barrier and heading off eczema.
Oatmeal - Oatmeal has been used for centuries as a soothing agent to relieve itch and irritation associated with various dry skin conditions
Honey has antibacterial, antifungal, antiviral, and anti-inflammatory properties that can be effective when applied to the skin, Honey’s organic acid content provides gentle exfoliation
Atopic dermatitis, the skin’s pH the balance in levels of acidity and alkalinity, is elevated, causing irritation and dryness. Apple cider vinegar’s acidity may help restore the skin’s natural pH balance and ultimately improve atopic dermatitis symptoms when added to a bath or applied to the skin using a wet wrap.
Potential benefits of aloe vera in atopic dermatitis, some research suggests that its antibacterial, antifungal, and anti-inflammatory properties could help alleviate symptoms
Calendula cream is an herbal remedy. Calendula has been used for centuries as a folk remedy to heal skin inflammation, burns, and cuts.
HOMOEOPATHIC MANAGEMENT:
The human body when forms, functions, react in whole and dies as whole. When it is affected by a disease also, it reacts as a whole against the disease, in the form of signs and symptoms. The symptoms are also formed in the patient’s mental state. In homoeopathy, to get a true and absolute picture of the sickness, the chief complaint, symptoms of all parts of the body and the mind are considered to impose a remedy. No two persons are alike in health and sickness. Another striking thing about homoeopathy is that it has no side effects. People on multiple medications can safely take homoeopathic medicines. Homoeopathic drugs are non-habit forming and have no addictive characteristics. Homeopathic remedies stimulate the body's own immune system and offer a long lasting cure rather than giving temporary relief.
Homoeopathy offers good prognosis to cases of atopic dermatitis. Medicines like Antimonium crudum, Arsenicum album, Arum triphyllum, Calcarea carbonica, Psorinum, Sepia officinalis, Natrum Mur, Phosphorous, Croton tiglium, Mercurius, Silicea, Cantharis, Lycopodium, Graphites, Hepar sulphuris calcareum, Mezereum, Petroleum, Rhustoxicodendron, Sulphur etc are often found indicated in cases of atopic dermatitis
Indicated Remedies | Indications |
Antimonium crudum: | This remedy has eczema with thick, cracked skin and is also prone to indigestion. Yellow crusted eruptions on cheeks and chin. Cracks in the corners of the mouth. Eczema, with gastric derangement. Eruptive tendency of pimples, vesicles and pustules. These patients are usually sensitive and very sentimental, they love to eat (craves pickles, vinegar, and other sour things), and may be overweight. Children are shy and irritable, insisting that they don’t want to be touched or looked at. Itching is worse from warmth and sun exposure. |
Arsenicum album:
| Persons who need this remedy are anxious, restless, and compulsively neat and orderly. The skin is dry, itches, and burns intensely. Dry, rough, scaly, dirty, shriveled skin. Looks seared Eczema. Scratching can make the itching worse, and applying heat will give relief. Indigestion with burning pain and a general feeling of chilliness are often seen when Arsenicum is indicated. Skin symptoms alternate with internal affections. |
Arum triphyllum:
| This remedy is indicated when allergic skin eruptions are more on the lower part of the face, especially around the mouth. The chin may look chapped and feel hot and irritated. The lips are cracked (raw due to the person picking them) and the nostrils may be sore. People who need this remedy are often indicated in throat irritation and hoarseness. |
Calcarea carbonica: | This remedy is indicated in person who is chilly with clammy hands and feet, and tends to develop eczema and cracking skin that is worse in the wintertime. Who are easily fatigued by exertion, and feel anxious and overwhelmed if sick or have overworked. Desire for sweets and eggs, they have a sluggish metabolism, and also tendency toward putting weight are other indications for Calcarea. |
Psorinum:
| Dry lusterless skin with intolerable itching, eruption especially on scalp, bends of joints with itching. Worse from warmth of bed. Crusty eruption all over the body, slow to heal. Eczema behind ears. Pustular near fingernail. Erythematous eruption after severe exertion. |
Sepia officinalis:
| Itching not relieved by scratching, worse in bends elbow and knees. Eruption every spring. Ringworm like eruption. Herpetic eruption about mouth, lips and nose. Wine coloured skin, spots on skin. Itching vesicles. Boils in axilla. Thick crust over elbow and knee. |
Natrum Mur: | Dry eruption especially over scalp and bends of joints. Skin is greasy and oily especially over hairy surface, eczema raw red inflamed worse by eating, general dry scaliness of skin, urticaria from eating too much of salt. Superficial ulcer surrounded by vesicles but not suppurated. Sweat is profuse and gradually reduces all the symptoms |
Phosphorous: | Eczema, pustular eruption surrounded by small boils or ulcers, inflammation and excoriation of skin. Desquamation of skin. Burning in skin. Excoriation of skin with cracks and shooting pain, tingling in skin and nettle rash, cracked in middle of lips and ulcers at the corner of mouth |
Croton tiglium: | Pure idiopathic eczema in children, eczema over genitals and face. Pustular eruption especially over face and genitals with fearful itching followed by painful burning, vesicles: confluent oozing. Redness, itching, warmth, stinging here and there with pustules and grey crusting of skin |
Mercurius: | Offensive forms of eczema: scufy eczema, vesicular eruption, eruption with pus discharge. Vesicles burn and smart with excoriation of skin especially on head. Most eruption are moist with much itching. Excoriating wherever two parts comes together, fissure at the corner at the mouth and lips. One of important remedy for moist eczema |
Silicea: | Painful pustular eruption at last forming a suppurating ulcers over forehead and occiput. Itching over whole body. Eczema, eruption itch only during day time. Rhagades over eyelids and mouth. Itching, burning eruption behind ears. Skin is sensitive to cold, patient wants to wrap up warmly |
Cantharis: | Eczema about scrotum and genitals following excessive perspiration, eruption with mealy scales. Vesicular eruption with burning and itching with great restlessness at night. Eruption beings in small spots and spreads to larger parts with watery discharge underneath the scalp. Eczema after insect bite |
Lycopodium: | Eczema with gastric, hepatic and urinary complaints. Boils which is not matured but remains blue. Vesicular eruption, with offensive sweat, violent itch with fissured eruptions. Skin becomes thick and indurated. Skin thick and shrunken especially over palms. Offensive perspiration especially over feet and axilla |
Graphites: | Persons who are likely to respond to this remedy have thick skin with cracks and soreness, and often have a long-term history of other skin disorders. The areas behind the ears, around the mouth, or on the hands are often cracked, with an oozing discharge that forms into crusts. Itching is worse from getting warm in bed, and the person will often scratch the irritated places till they bleed. Difficulty in concentrating, especially in morning, and is often seen in a person who needs Graphites. |
Hepar sulphuris calcareum: | This remedy may be indicated in very sensitive individuals, chilly people whose eczema is extremely sore and becomes infected easily. The skin, especially on the feet and hand, looks chapped and with deep cracks which is very slow to heal. The person usually feels vulnerable and irritable, with a low resistance to illness and infection. |
Mezereum: | An individual who requires this remedy often has strong anxiety, which is felt physically in the stomach. An intense itching eruption which starts as blisters, then ooze and form thick crusts, and scratching can lead to thickened skin. A cold application often gives relief to the itch (although the person is chilly in general). A craving for fat and a tendency to feel better in open air are other indications for Mezereum. |
Petroleum: | This remedy is indicated for a person whose skin is very dry and which tends to crack, more on the fingertips and palms. Eczema is worse in winter, with deep, sore cracks that which often bleed. The person feels a cold sensation after scratching. Itching is worse at night and from getting warm in bed. The skin is easily infected, and may get tough and leathery from chronic irritation. |
Rhustoxicodendron: | A person whose eczema has blister like eruptions that look red and swollen, itch intensely, and are soothed by hot applications may respond to this remedy. The person is restless from discomfort and often is very irritable and anxious. Muscle stiffness, relieved by warmth and motion, is also likely. A person who needs Rhustox often craves cold milk. |
Sulphur: | Intensely burning, itching, inflamed eruptions that are worse from warmth and worse from bathing suggest a need for this remedy. Affected areas may be red, with scaling or crusted skin. Eruptions can be either dry or moist. This remedy is sometimes helpful to people who have repeatedly used medications and ointments on their eczema without success. |
Conclusion
With reference to the current scenario prevalence of atopic dermatitis in adults is increasing. Homoeopathy treats the individual in disease and not the disease alone and holistically helps the patient in need. Thus by striking at the root of the problem patient can be relieved from further remission of suffering.
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