Atopic dermatitis (AD) is one of the most common skin disorders seen in children. The cutaneous manifestations of atopy often represent the onset of the atopic journey gradually marching towards asthma and allergic rhinitis. Difficult to control AD presents a therapeutic challenge in today’s era. But constitutional homoeopathic medicines prescribed singly in its potentised form definitely benefit the patient. Two randomly diagnosed cases of AD have been discussed who opted for treatment after relapse and remission of skin lesions under prolonged allopathic treatment. Both cases complained of intense pruritic painful eruptions all over the body. The first case was of a male child aged 3yrs who also had hyperpyrexia which was controlled with Arnica followed by prescription of single dose of Nitric acid. The second case was a female child of 10yrs who was prescribed Hepar sulph in 30 potency initially followed by 200. Prescription was based on totality of symptoms. The assessment of outcome was judged on change in pruritus, AD extension and severity, general and psychological wellbeing. Comparison of affected skin area between first and last consultation showed significant improvement clinically. These cases suggest that homoeopathic treatment could be contemplated as an effective choice for patients with AD. It is important for all of us to work more meticulously, on modern scientific parameters, creating enough documentary proofs as per the need of the hour, without jeopardizing the tenets of Homoeopathy, so that our studies leave no gaps when such analyses are repeated.

1. Dr. Smita Brahmachari,
M.D. (Repertory) (N.I.H., Kolkata)
Senior Medical Officer,
Dept. of AYUSH,
Govt. of NCT Delhi.
SCOPE OF HOMOEOPATHIC MEDICINES
IN ATOPIC DERMATITIS

2. Atopic dermatitis (AD) is one of the
most common skin disorders seen in
children.
The cutaneous manifestations of atopy
often represent the onset of the atopic
journey gradually marching towards
asthma and allergic rhinitis.
Difficult to control AD presents a
therapeutic challenge in today’s era.

3. AD is a chronic, itchy and inflammatory
skin disease caused by the interaction
between susceptible genes, environment,
drug reactions, skin barrier defects, and
immunological factors.
Included under scaling lesions in
dermatological disorders (ICD-10…L20).
Onset in childhood in most patients. Onset
after age of 30 is very uncommon.

4. Pruritus.
Chronic relapsing character of
the disorder.
Age-specific morphology.
Distribution of lesions (flexural
lichenification, hand eczema,
nipple eczema and eyelid eczema
in adults).

5.  Also helpful are :
A personal or family history of
atopic disease (asthma, allergic
rhinitis, atopic dematitis),
Xerosis – ichthyosis
Facial pallor with infraorbital
darkening
Elevated serum IgE and
Eosinophilia.
Repeated skin infections.

6. CASE NO.1…….Presenting COMPlaints
A male child of three years.
Date of 1st visit: 6th December 2013
Severe pruritic painful eruptions all over the body with thick
scab formation.
Weeping and crusting of eruptions at various places especially
face and scalp with swelling of face.
Eruptions on trunk and extremities were dry, scaly and
thickened.
Father reported that he cried when combing his hair and while
urinating complaining burning micturition.
Complaint started at 6 months of age in month of May 2010.
Eruptions have aggravated since 15 days.

7. Initial visit…(06.12.13)

8. OBSERVATION
 Child was undernourished, dark complexioned,
yellowish discolorization of sclera, brownish
discolorization of hair and scalp full of eruptions.
 Child was very irritable, became restless on close
examination of his eruptions, but sat quietly in his
father’s lap.
 Child was totally covered up, could not bear being
slightly uncovered as his eruption become more
painful and cried on being exposed to open air. His
father had brought the child to dispensary by
keeping even his face being covered up with a
shawl.

9. PAST HISTORY AND MEDICAL HISTORY
 Great liability to take cold and suffers from recurrent attack of
cough and cold and need multiple nebulization for asthmatic
episodes.
 Admitted in RML Hospital on 14th February 2013 with diagnosis
of Atopic dermatitis, eosinophilia and UTI induced
hypertension.
 ULTRASONOGRAPHY report….intusseception with multiple
lymphadenopathy
 HAEMOGRAM….microcytic, hypochromic anaemia with
anisopoikilocytosis, leucocytosis, tear drop cells and
eosinophilia.
 H/o of recurrent cystitis.
 He was discharged from hospital in a stabilized condition with
prescription of ointment for local application and antihistamine
(cetrizine). Since then he is regularly taking the prescribed medicine.

10. FAMILY HISTORY
Maternal grandfather……… asthma
Father’s elder brother........allergic rhinitis

11. PHYSICAL GENERALS
 Desire…potatoes, salt, and pickles
 Aversion….vegetables.
 Appetite… good but as soon as he started eating feels
nauseated after few mouthfuls.
 Bowel habits….regular and 3-4 stools a day. He had urge
for stool during eating and passed after meals.
 Perspiration ….normally from scalp and face.
 Offensive stool and urine .
 Disliked bathing and uncovering as it increased pain and
caused violent itching, burning and scratching all over
the body.

12. MENTAL GENERALS
He liked solitude, played with his own
toys alone and closes the door if any
neighbourhood child comes to play with
him.
Very irritable.
Dislikes to speak or to be spoken. Sits
quietly in father’s lap.
Fear when being touched or approached.

13. EVALUATION OF SYMPTOMS
The case presents with strong
generals and characteristic
particulars and hence Kent’s
method of evaluation of
symptoms was followed in this
case. Synthesis Repertory (9.1)
version was used for
repertorization.

14. RUBRIC SELECTION
 MIND - IRRITABILITY - spoken to, when
 GENERALS - HEAT - lack of vital heat
 GENERALS - DISCHARGES - offensive, fetid
 GENERALS - IRRITABILITY, physical - excessive
 GENERALS - FOOD and DRINKS - salt - desire
 GENERALS - FOOD and DRINKS - potatoes - desire
 GENERALS - FOOD and DRINKS - vegetables -
aversion
 SKIN - INFLAMMATION
 STOMACH - NAUSEA - eating - while
 BLADDER - URINATION - dysuria - painful

15. REPERTORIZATION
Sulphur – 15/10
Nitric acid – 14/10
Silicea – 13/10
Pulsatilla – 13/10
Calcarea carb – 11/10

16. PRESCRIPTION…06.12.13
 Medicine selected: Sulphur 30/1 dose.
 Justification: the child was under the repeated
and prolonged use of skin ointments as local
application for eruptions since the onset of
complaint.
 Remedy reaction: On the very second day after
taking Sulphur 30, there was onset of fever with
chilliness < night esp. at 12 – 1 am, thirsty
during fever, waked up 4 times to drink water,
was very irritable, shivering all over the body, at
the same time heat of the head and cool hands
and feet.

17. PRESCRIPTION….08.12.13
 Medicine selected: Arnica 30 in 9 doses, thrice daily for 3 days and
later followed by placebo for 7 days.
 Reason for selection: The rubric taken into consideration for
prescribing from SYNTHESIS REPERTORY was…‘FEAR,
approaching him, of others, lest he be touched’ (single
medicine…ARNICA in highest grade).
 Not to be forgotten other valuable guiding symptoms further
confirming Arnica were :
 Difference of temperature in various parts of body (heat of the
head and cool hands and feet)
 Sensitiveness of whole body and
 Weeping skin eruptions with symmetrical distribution.
 Remedy reaction: Responded very well to Arnica and fever subsided
with improvement in skin condition.

18. under Arnica 30

19. Under arnica 30

20. PRESCRIPTION…NITRIC ACID
 After continuing Arnica for few days, the patient reverted back to its
original state with complaints of….nausea while eating, irritableness
increased, relapse and remission of febrile condition with mid night
aggravation and skin symptoms reverting back to original condition,
anorexia, frequency of stool increased to 4 – 5 times, defecating
immediately and during meals.
 The basis for prescription were :
 Chilly patient,
 Disposed to gastroenteritis,
 Discharges being offensive (urine and feces),
 Craving for salty food
 Equally worse in hot and cold weather
 Excessive irritableness of mind and physical complaints.
 2nd medicine in repertorization. (highest marks)

21. PRESCRIPTION…(23.12.13)
 Medicine selected: NITRIC ACID, the trimiasmatic polycrest
medicine, single dose.
 Remedy reaction: no appearance of fever after taking Acid
nit and patient as a whole is very much better. At initial
visit he never responded at any question I asked him, sat
quietly and but later after taking Nitric acid he has started
answering by nodding his head and his parents say also that
his mental irritableness has decreased.
 Change of potency: After continuing Nit acid 200 till 1st
February, the patient showed a stand still condition. So now
the prescription was changed to Nitric acid 1M, single dose
(01.02.14) and the patient till date is on placebo showing
improvement.

22. Under Nitric acid 200

23. Under nitric acid 200

24. Case No.2
 A female child of 10 yrs.
 Date of 1st visit : 4.2.11.
 A diagnosed case of Atopic dermatitis from Safdarjung
hospital, New delhi.
 Painful, violent itching, burning eruptions all over the body
since 2 yrs.
 < winter and summer especially hot humid weather; <
bathing after.
 Eruptions were bilateral symmetrical.
 H/o of use of lutica lotion on affected parts, steroid
ointments and antihistamines for 2 yrs with relapse and
remission of complaint.

25. Initial visit..(04.02.11)

26. Case No.2 (contd.)
Past H/O : Measles. Recurrent tendency to cough,
coryza and A.S.O.M. from change of weather
Family H/o : Mother – Asthma and Brother –
Crigler – Najjar syndrome (unconjugated
hyperbilirubinemia)
P/Gs : Desire for sour foods, craving for pickles
(steals money for the same). Bowel habits and
urine : Normal. Sweat from face, palms and soles
Physical appearance : the child was lean and
emaciated, wheatish complexioned.

27. Evaluation of symptoms
The case presents with strong
generals and characteristic
particulars and hence Kent’s
method of evaluation of
symptoms was followed in this
case. Synthesis Repertory (9.1)
version was used for
repertorization.

28. Rubric selection
Generals – Weather – change of
weather – agg.
Generals – food and drinks – sour
food, acids – desire.
Skin - Inflammation
Skin – Eruptions – painful
Skin – Eruptions – symmetrical

29. Repertorization
Hepar sulph – 10/5
Pulsatilla – 9/5
Rhus tox – 9/5
Sulphur – 9/5
Sepia – 7/5

30. PRESCRIPTION
The basis of prescription :
 The highest grade medicine in repertorization.
 Recurrent tendency to various illness from change of
weather.
 Unhealthy skin with painful eruptions.
 The guiding factor being strong craving for sour food.
(SYNTHESIS REPERTORY : Generals, Food and
Drinks, sour foods, acids, desire : 3 remedies in 1st grade
: Cor-r., Hepar s., and Verat.).
 Medicine selected : Hepar sulph.

31. Selection of medicine and
dosage
 The case was prescribed Hepar sulph initially in 30
(few doses) potency followed by 200 (single dose)
interspersed with 2 doses of Sulphur 30.
 Sulph 30 / 2 doses – justification –
 to clear up the ground for proper action of selected
medicine, remove the miasmatic taint with H/o of
long contd. use of allopathic medications (in spite of
giving well selected medicine skin unable to regain
normal colour)
 SYNTHESIS REPERTORY : Generalities, History,
medicine; of abuse of allopathic : Lach., Nux-v.,
Puls., Sulph., Thuja., and Zinc.)

32. Initial visit ..(04.02.11)

33. Last visit…(09.04.11)

34. OBSERVATION
These two cases of AD elaborated here opted for
homoeopathic treatment ( as 2nd choice) after relapse and
remission of skin lesions under prolonged modern
medicine treatment.
The assessment of outcome was based on :
Change in AD extension and severity,
Change in pruritus,
General and psychological wellbeing,
Improvement in quality of sleep.
Comparison of affected skin area between first and last
consultation showed significant improvement clinically.

35. Change of medicine…2nd prescription
‘In non-venereal chronic diseases those, therefore,
that arise from psora, we often require, in order to
effect a cure, to give several antipsoric remedies
in succession, every successive one being
homoeopathically chosen in consonance with the
group of symptoms remaining after the expiry of
the action of previous remedy (which may have
been employed in a single dose or in several
successive doses)’…..Aph. 171, Organon of
Medicine

36. Clinical studies on AD
1. Homoeopathic medical practice: long term results of a cohort study
with 3981 patients. (BMC Public Health | 2005 | Vol 5 | No 115 )
2. How healthy are chronically ill patients after 8 years of homoeopathic
treatment: results from a long observational study. (BMC Public Health |
2008 | Vol 8 | 413 )
3. Homoeopathy in pediatric atopic diseases: long term results in
children with AD. (Homeopathy | 2012 | Volume 101 | Issue 1 | Pages 13–20 )
4. Prospective observational study of 42 patients with AD treated with
homoeopathic medicines. (Homeopathy | 2012 | Volume 101 | Issue 1 |
Pages 21–27 )
Conclusion:
1. Disease severity and quality of life demonstrated marked and
sustained improvements following homoeopathic treatment.
2. Children showed a reduced tendency to maintain AD and develop
asthma and allergic rhinitis in adult age.

37. CURRENT RESEARCH ON AD
Conclusive research defining real efficacy and
best homoeopathic therapeutic strategies are still
insufficient.
Although the lack of sufficient research assessing
homoeopathic treatment of AD might lead to a
negative view of its possible effectiveness, the
fact that about half of patients with this disorder
resort to this alternative treatment is an indirect
indicator of their dissatisfaction with
conventional approaches.

38. CONCLUSION
 These cases suggests that constitutional
homoeopathic medicines prescribed singly in
its potentised form definitely benefit the
patient.
 Hence homoeopathic treatment could be
contemplated as an effective choice for patients
with AD.
 But cases of AD require a long term follow-up
as the lesions have tendency to recur.

39. THANK YOU