Treatment of Onychomycosis with Homoeopathic Medicine-An Evidence-Based Case Report

Introduction

Onychomycosis, commonly referred to as a nail fungal infection, is a prevalent fungal disorder that affects the nails, particularly the toenails. It is caused by various types of fungi, with the most common culprit being dermatophytes. Yeasts and molds can also cause fungal infections. Onychomycosis can affect one or multiple nails. It begins at the edge of the nail and then spreads to the nail plate, nail bed, and the skin surrounding the nail.¹

The condition can present in different forms, including:

Distal Subungual Onychomycosis (DSO): This is the most common form, characterized by the fungal infection starting at the nail's tip and spreading down towards the cuticle. The nail becomes discolored, thickened, and brittle.

White Superficial Onychomycosis (WSO): In this type, the infection appears as white spots or patches on the nail's surface. The affected area may become soft and brittle.

Proximal Subungual Onychomycosis (PSO): This typically begins at the cuticle and progresses towards the tip of the nail. It is more commonly seen in individuals with compromised immune systems.

Candida Onychomycosis: This is caused by yeast (Candida) and often occurs in people who frequently immerse their hands in water, leading to nail plate separation and white or yellow discoloration.

Onychomycosis leads to aesthetic concerns, discomfort, and functional impairment. It is common in older adults, individuals with weakened immune systems, those with a history of athlete's foot, and people who frequently visit warm, moist environments like swimming pools.²

Case Presentation

A 35-year-old office going female presented with a chief complaint of discolored and thickened right toe nail which had been bothering her for the past year (Figure 1). She reported that the condition started as a small white spot on the edge of her big toenail and had gradually spread to involve the entire nail. The nail was discolored, yellow-brown, and had become brittle and easy to break. She experienced occasional pain and discomfort when wearing closed-toe shoes. The patient was healthy with no significant medical history. She mentioned that she spends most of her time at work and often feels fatigued and irritable due to the demanding workload. No History of diabetes mellitus (DM), hypertension (HTN), rheumatoid arthritis, and gout was reported. No family history of DM/ HTN was reported.

Aggravation: Washing, Morning.

Amelioration: Hot application.

Mental

• Indifference

• She cannot narrate her symptoms without weeping.

• Great sadness and constant weeping.

• Always wanting to be alone.

• Absent-minded.

• Consolation aggravation.

Examination

Upon examination, the affected toenail appeared yellowbrown and thickened. There were signs of nail plate separation and crumbly texture. There was no evidence of inflammation or swelling in the surrounding skin. The remaining toenails appeared normal.

Diagnosis

Based on clinical presentation and examination, she was diagnosed with DSO, which is the most common type of nail fungal infection (Figure 2).

Treatment

1. SEPIA 200/ 1 dose(4-0-0)

2. SAC LAC 15 days

1st Follow-up: 31/07/2023 (after one month) (Figure 3)

1. Discoloration of the nail was reduced.

2. Mentally, she was involved in her daily activities.

3. Sleep was 5–6 hours.

4. Generally feeling better

R_X

1. SAC LAC 15 days

Discussion

The presented case describes the treatment of onychomycosis using Sepia 200 in homeopathic context. The patient exhibited classic symptoms of nail fungal infection, including nail discoloration, brittleness, and pain. In line with the holistic approach of homeopathy, Sepia 200 was chosen based on the patient's specific symptoms, which included fatigue, irritability, and characteristic nail changes.

The treatment response observed in this case was notable. Over one month, the patient experienced a gradual improvement in the appearance of her nail. The nail discoloration decreased, and the texture seemed to normalize. In addition, she reported a reduction in pain and discomfort associated with wearing closed-toe shoes.

The selection of Sepia 200 was based on its known indications in homeopathic literature. Sepia is often associated with a decrease in symptoms of fatigue, irritability, hormonal imbalances, and a sense of detachment from one's surroundings.^4,5 The presentation of these symptoms in this case aligned with the potential benefits of Sepia.

While this case report suggests a positive outcome, it is crucial to recognize the limitations of this study. The lack of a control group and the subjective nature of homeopathic assessment could introduce bias. 

Furthermore, the absence of double-blinding, common in personalized treatments like homeopathy, might influence the patients' and practitioners' expectations.

This case report aligns with a broader context of exploring homeopathic treatments for various conditions. While the findings indicate potential benefits, it is essential to emphasize that homeopathy's individualized approach and reliance on subjective assessment might not always align with the conventional research methodologies.

Conclusion

In conclusion, this case report provides an illustrative example of the potential role of Sepia 200 in treating onychomycosis within a homeopathic context. While the results are promising, they warrant further investigation through more robust research methodologies. The patient's improvement and the alignment with Sepia's indications underscore the need for individualized treatment approaches in homeopathy.

Conflict of Interest

None