Efficacy of homoeopathic remedies in irritant contact dermatitis

Introduction

The skin is the organ that separates the human body from the external environment. This function exposes it to physical, chemical, and biological aggression that determines diseases such as eczema. Eczema is a form of dermatitis characterized by the presence of erythema, edema, vesicles and exudation (acute eczema); pink erythema and desquamation (subacute eczema) and lichenification (chronic eczema). Eczema caused by exogenous agents whether contactant or endotantes are called contact eczema or contact dermatitis (CD). Contact dermatitis can be caused by irritants, irritant contact dermatitis (ICD), or sensitizers, allergic contact dermatitis (ACD).

Irritant contact dermatitis is a form of contact dermatitis that can be divided into forms caused by chemical irritants and those caused by physical irritants.

Chemical irritant dermatitis: Chemical irritant contact dermatitis is either acute or chronic, which is usually associated with strong and weak irritants respectively. The mechanism of action varies. Detergents, surfactants, extremes of pH, and organic solvents all directly affecting the barrier properties of the epidermis. Chemical irritants are often strong alkalis as found in drain cleaners and soap with lye residues. Many other chemical compounds can also cause contact dermatitis.

Physical irritant dermatitis: Physical irritant contact dermatitis (PCID) is a less-researched form of ICD due to its various mechanisms of action and a lack of a test for its diagnosis.Low humidity from air conditioning was found to be the most common cause of PICD.

Plants: Many plants cause ICD through their spines or irritant hairs. Some plants such as the buttercup, spurge, and daisy act by chemical means. The sap of these plants contains a number of alkaloids, glycosides, saponins, anthraquinones, and (in the case of plant bulbs) irritant calcium oxalate crystals - all of which can cause CICD.

Butternut squash and Acorn squash have been known to cause an allergic reaction in many individuals, especially in food preparation where the squash skin is cut and exposed to the epidermis. Food handlers and kitchen workers often take precautions to wear rubber or latex gloves when peeling butternut and acorn squash to avoid temporary Butternut squash (Cucurbita moschata) dermatitis. A contact dermatitis reaction to butternut or acorn squash may result in orange and cracked skin, a sensation of "tightness", "roughness" or "rawness".1-4

SYMPTOMS AND SIGNS OF ICD: A detailed history is required because the diagnosis of irritant contact dermatitis (ICD) rests on the history of exposure of the affected body site to the cutaneous irritant. Patch testing also is used in severe or persistent cases to exclude allergic contact dermatitis as a component of the individual's cutaneous manifestations. Onset of symptoms occurs within minutes to hours of exposure in simple acute irritant contact dermatitis.

The onset of signs and symptoms may be delayed by weeks in cumulative chronic irritant contact dermatitis. Cumulative irritant contact dermatitis is a consequence of multiple incidents of subthreshold damage to the skin, with the time between exposures being too short for a full resolution of skin barrier function. Patients with sensitive skin (i.e., atopic individuals) have a decreased irritant threshold or a prolonged restoration time, making them more vulnerable to clinical irritant contact dermatitis.

Cumulative irritant contact dermatitis typically occurs with exposure to weak irritants rather than strong ones. Often, the exposure (eg, water) is not only at work but also at home.These patients report both itching and pain caused by fissuring of the hyperkeratotic skin (chapping). Pain, burning, stinging, or discomfort exceeding pruritus occur early in the clinical course.

Less important subjective criteria for irritant contact dermatitis include the onset of dermatitis within 2 weeks of exposure, and reports of many other coworkers or family members affected.

Occupational history: Irritant contact dermatitis is a major occupational disease; skin disorders comprise up to 40% of occupational illnesses. The physician needs to take an occupational history from adults with suspect irritant contact dermatitis.

Occupational irritant contact dermatitis typically affects workers who are new to a job, who are constitutionally more susceptible to irritant contact dermatitis, or who have not learned to protect their skin from cutaneous irritants. Individuals with history of atopic dermatitis (especially of the hands) are more susceptible to irritant contact dermatitis, particularly of the hands.

Most affected workers have a degree of permanent injury that is lower than that of other occupational diseases; however, the compensation pay was higher for skin diseases than for diseases of the respiratory system or musculoskeletal disorders.

Physical Examination

Rietschel and Fowler proposed the following as primary diagnostic criteria for irritant contact dermatitis (ICD):

Macular erythema, hyperkeratosis, or fissuring predominating over vesiculation.

Glazed, parched, or scalded appearance of the epidermisHealing process beginning promptly on withdrawal of exposure to the offending agent

Negative results on patch testing that includes all possible allergens.

Minor objective criteria for irritant contact dermatitis include the following:

Sharp circumscription of the dermatitis

Evidence of gravitational influence such as a dripping effect

Lower tendency for the dermatitis to spread than in cases of allergic contact dermatitis

Morphologic changes suggesting small differences in concentration or contact time producing large differences in skin damage

Individuals may develop a habit of continuing to rub a site initially affected by irritant contact dermatitis and may develop secondary neurodermatitis or lichen simplex chronicus (lichenification). This may be accepted as a sequela of an occupational injury.

Complications

Skin lesions may become colonized secondarily and/or infected, particularly by Staphylococcus aureus. Secondary neurodermatitis (lichen simplex chronicus) may develop in individuals with irritant contact dermatitis (ICD), particularly in those with workplace exposures or under psychological stress.

Post-inflammatory hyperpigmentation or hypopigmentation may occur in areas affected by irritant contact dermatitis or persist after resolution of irritant contact dermatitis in individuals with more pigmented skin.

Scarring may occur after corrosive agent exposure, excoriation, or artifact, causing ulceration.

Irritant contact dermatitis increases the risk of sensitization to topical medications.

Diagnostic Considerations: Other causes of contact dermatitis must be excluded. Elements of the history and/or patch testing to relevant allergens can identify allergic contact dermatitis. Scabies may resemble fiberglass dermatitis. When localized to the hands, psoriasis or dyshidrotic eczema can be clinically mistaken for irritant contact dermatitis.

In strict homoeopathic prescribing it is usual to seek for the exact similimum and to administer this remedy, but in the treatment of allergic state this rule has been found not to be of universal application. It is frequently necessary to deal with the presenting symptoms due to antigen-antibody reaction first and then to proceed to the treatment of the case on the totality of the symptoms.

Management

Homeopathic approach

In strict homoeopathic prescribing it is usual to seek for the exact similimum and to administer this remedy, but in the treatment of allergic state this rule has been found not to be of universal application. It is frequently necessary to deal with the presenting symptoms due to antigen-antibody reaction first and then to proceed to the treatment of the case on the totality of the symptoms. Therefore, the treatment of the ICD can be divided into three main considerations and studied thus under these headings.

First, the treatment of the presenting symptoms complex. Second, the treatment of the chronic disease or systemic diseases evidenced by the genetic disorder which is the basis of the allergy, and thirdly, such adjuvant procedures as are necessary to permit to the treatment to progress successfully.5-6

In the treatment of ICD, the axiom that the mental are the most important features of any case illustrated with extreme clarity, because allergy is a condition which can undoubtedly be profoundly influenced by the person’s psychical make-up.

Almost all types of allergic responses are greatly affected by the individuals attitude to the life and to the disease from which they are suffering, but conversely it must not be lost sight of that the attitude of the patient to life is result of his disease process, thus we have a vicious circle which often has to be broken if the psychical component is not continuous to act as trigger to the allergy long after the antigen has gone. The chronic remedy chosen must therefore suit the person mentally if it ever to be successful.

In the careful selection and exhibition of our chronic remedies, with this in mind, we can do much help the psyche of our patient and to a more normal balance.

Finally, under this heading must also include the treatment of the psychological conditions which occasionally are the direct cause of an allergic response. Here, proper psychological investigation is required with probably the exhibition of some psychotropic drugs.

Most cases of ICD however, do not require drastic treatment, but it has been my experience that then allergic patient has to make a conscious effort to overcome his dependence on the allergic state as a method of escape.

Dr. Hahnemann has postulated the idea of acute disease with the chronic lying behind allergic conditions and ICD. In no other field in medicine is Hahnemann’s theory more clearly illustrated than in the field of allergy., nor has it to be kept in mind more constantly if any success is to be obtained in the relief and cure of the allergic subject.

The allergic subject is born so and therefore our treatment has to deal with the very nature of the person. We confronted with the disorder of gene substance itself, and in Homoeopathy we have a possible method of acting upon gene structure, so that when it is disordered, we can by the homoeopathic potencies change these disorders unto order and bring relief to our patients.

Objectives of study

1. To know the effects of Homoeopathic remedies in cases of Irritant Contact dermatitis.

2. To avoid the risk of sensitization to topical medications.

Materials and Methods:

Source of data

The subject for this study is taken from OPD’S and satellite clinic of A.M.Shaikh Homeopathic Medical College, Hospital and P.G Research center, Belgaum and from the Village camps, Government and Private schools of Belgaum.The project was started on 01-01-17 continued till the month of 31- 12-2018. The study was conducted on 30 patients of ICD. Patients were randomly selected on the basis of inclusive and exclusive criteria from the Hospital OPD and village camps.

Methods

The above 30 patients were identified on clinical presentation.

A detail case history was taken according to the schema of model case Performa with special emphasis on the history of present skin disease.

Diagnosis was done on the basis of clinical presentation and thorough examinations of skin lesions.

Remedy was selected after analyzing, evaluation and repertorisation of the case.

Observations and Results

The patients of Irritant Contact dermatitis between the age group 10 to 60 years irrespective of sex were selected.

Following were the observations noted.

Each patient was given a well selected constitutional homoeopathic remedy after taking detail case history with respect to mental general, physical generals, particulars and PQRS symptoms. Each case was repertorised by using classical method. The final selection of the remedy was done after confirming with Materia Medica.

Out of 30 patients 16 were females and 14 were males. Since ICD is more common with detergents, many house wives suffer from ICD.

Treatment

All 30 patients were given constitutional remedies. But it was observed that acute exacerbation of itching was better managed with Graphites. Graphites was given for 11 patient with very good improvement with relief in itching as well as eruptions. Patients with ICD due to Hair dye improved excellently with Graphites, 4 of the patients responded well to Sepia particularly in house mades and washer women. 9 of the patients were given Sulphur, in which 5 of the patients were given Sulphur as an intercurrent remedy to enhance the action of previous remedy. Natrum Mur was given in two patients with good result, whereas three patients in whom cause of the ICD was not known did not respond to the treatment, not improved.

All the 30 patients were followed for almost 1 year with every fifteen days follow-up. Even with restarting using the allergen. It was observed that there was significant reduction in sensitivity. 

Results

Result with the Homoeopathic treatment of ICD was quite satisfactory, out of 30 patients, 20 patients improved i.e. (66.66%), 3 patients partially improved i.e. (10%), 2 patients did not report after first prescription (6.66 %), 5 patients did not show any change i.e. (16.6%)

Discussion and Conclusion

Irritant contact dermatitis is one of the common skin allergy disorder. In homoeopathy these disorders are included under morbid susceptibility, or hypersensitivity or idiosyncrasy.

30 patients with manifestation of ICD were taken up for study and the result discussed below.

Majority of the patients were house wives or washer women, probably they more exposed to detergents and soaps and cosmetics. Males have shown sensitivity to chemicals and paints. The common sites affected in many patients was palms of hands, dorsum of hands. Most cases presented with peeling of skin and rashes, cracks and fissures, some presented with eruptions. Many were unable to do their day today work because of location of lesions on the hands.

During treatment though constitutional remedies helped the patients in general improvement of their health, but the remedy Graphite’s has helped the patients to get their skin complaints completely recover.