SCOPE OF HOMOEOPATHIC MEDICINES IN ATOPIC DERMATITIS Dr.Smita Brahmachari Atopic dermatitis (AD), one of the most common skin disorders seen in infants and children, usually has its onset during the first 6 months of life. AD has a tremendously negative effect on the quality of life of patients as well as family, most commonly disturbing sleep. The condition also creates a great financial burden for both the family and society. The cutaneous manifestations of atopy often represent the beginning of the atopic march. On the basis of several longitudinal studies, approximately half of AD patients will develop asthma, particularly with severe AD, and two thirds will develop allergic rhinitis. Difficult to control atopic dermatitis (AD) presents a therapeutic challenge in today’s era. The present article discusses how homoeopathy can be used as a safe and alternative treatment for such cases at primary health care set up.

1. Dr. Smita Brahmachari,
M.D. (Repertory) from N.I.H., Kolkata.
M.O., Dept. of AYUSH,
Govt. of NCT Delhi.

2. 
The skin is the largest human organ. It fulfils a variety of
functions, of which the most important are as follows :

Separation and protection

Touch and contact

Expression and representation

Sexuality

Respiration

Excretion (sweat)

Temperature regulation

All these diverse skin functions nevertheless have a common
theme that hovers between the two poles of separation and
contact.

For us, the skin is our outermost physical boundary, and yet at the
same time it connects us to the outside world and brings us into
contact with our environment. It is via our skin that we presents
ourselves to the world.

3. 


For a start, skin serves as a reflective
surface for all our internal organs.
The experienced practitioner is capable of
seeing and feeling from the skin the
condition of the various organs, and
equally of treating these organs via their
particular projection sites on the skin.
If the skin is the outward expression of
what is going on inside us, then every
attempt artificially to alter that expression
is necessarily an act of dishonesty.

4. 

A male child of three years came with his father on 6 th December 2013
with complaint of severe pruritic painful eruptions all over the body
with thick scab formation along weeping and crusting of eruptions at
various places especially face and scalp and swelling of face. The
eruption on trunk and extremities were dry, scaly and thickened. The
complaint started at 6 months of age in month of May. The eruptions
were more aggravated since 15 days.
On observation the child was undernourished, dark complexioned,
yellowish discolorization of sclera, brownish discolorization of hair
and scalp full of eruptions. The child was very irritable, became
restless on close examination of his eruptions, but sat quietly in his
father’s lap. The 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.
His father reported that he cried when combing his hair and while
urinating complaining burning micturition. He liked solitude, played
with his own toys alone and closes the door if any neighbourhood
child comes to play with him.

5. 



He has a great liability to take cold and hence suffers from
recurrent attack of cough and cold and need multiple nebulization
for asthmatic episodes.
The child was admitted in RML Hospital on 14 th February 2013
with diagnosis of Atopic dermatitis, eosinophilia and UTI induced
hypertension. During the time of admission, ultrasonography was
done
which
revealed
intusseception
with
multiple
lymphadenopathy; haemogram revealed microcytic, hypochromic
anaemia with anisopoikilocytosis, leucocytosis, tear drop cells and
eosinophilia.
He had also recurrent attack of cystitis before being admitted and
taken treatment from different hospitals. 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.
Family history revealed asthma in maternal grandfather and
allergic rhinitis in father’s elder brother.

6. 





The child liked potatoes, salt, and pickles in his
diet and disliked vegetables.
He had a good appetite but as soon as he started
eating feels nauseated after few mouthfuls.
His bowel movements were regular and 3-4 stools
a day. He had urge for stool during eating and
passed after meals.
He perspired normally from scalp and face.
His stool and urine were offensive.
He disliked bathing and uncovering as it
increased pain and caused violent itching,
burning and scratching all over the body.

7. 





The case was started with Sulphur 30/1 dose as the child was under the
repeated and prolonged use of skin ointments as local application for
eruptions since the onset of complaint.
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.
The case was now prescribed Arnica 30 on the keynote symptom…fear of
being approached or being touched, in 9 doses, thrice daily for 3 days and later
followed by placebo for 7 days.
The rubric taken into consideration for prescribing Arnica from KENT’s
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,
sensitiveness of whole body and weeping skin eruptions with symmetrical
distribution”.
The patient responded very well to Arnica and fever subsided with
improvement in skin condition.

8. 



After continuing Arnica for few days, there was again appearance of old
symptom….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 prescription was now changed to NITRIC ACID, the trimiasmatic
polycrest medicine. He was prescribed Nitric acid 200, single dose on
23rd December and till today (29th january) on placebo.
The basis for prescription were…symptom like Arsenic (the
complementary chronic remedy was Acid nit); chilly patient, disposed to
gastroenteritis, discharges being offensive (urine and faeces), craving
for salty food, equally worse in hot and cold weather and excessive
irritableness of mind and physical complaints.
There was 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.

9. At this juncture it’s too early to give any
comment about the case. But the beautiful
action of our medicines instills conviction
in me to push up our boundaries and take
up more cases of AD to nullify the unfair
words written in various articles published
in reputed peer reviewed homoeopathic
journals that homoeopathic medicines
have no action in dermatological skin
disorders especially AD and hence should
be never prescribed in such cases in
paediatric population.

10. Case No.1…Initial visit

11. Case No.1….under Arnica 30

12. Case No.1….under Arnica 30

13. Case No.1….under Nitric acid 200

14. Case No.1….under Nitric acid 200

15. 


Name : Miss S., 10yrs, Female child. Date of
1st visit : 4.2.11.
A diagnosed case of Atopic dermatitis from
Safdarjung hospital, New delhi.
P/C : 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 from the
mentioned hospital with relapse and
remission of complaint.

16. 




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
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 is lean
and emaciated, wheatish complexioned.

17. 


Medicine selected: HEPAR SULPH.
Reason for selection : With 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.)
For photographs see the attached word
file.

18. Follow – ups :
 4.2.11. – Hepar sulph 30, 4 globules, tds, 5 days. Advice to use Petroleum jelly on
affected parts and coconut oil after bathing when skin is wet and cotton clothes;
report after 7 days.
 12.2.11 – Pt. was better, complaints worse after bathing – placebo 30, 7 DAYS.
 22.2.11 – skin eruptions persists – Repetition of the medicine in 30 th potency, 5
days.
 The pt. made visits on 27.2.11, 5.3.11 and 15.3.11. where only placebo prescribed.
 21.3.11 – Sulph 30 / 2 doses – 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 : Generals, History, medicine; of abuse of
allopathic : Lach., Nux-v., Puls., Sulph., Thuja., and Zinc.)
 26.3.11 – Hepar sulph 200 / 2 doses, OD, followed by placebo 30 , 10 days.
 9.4.11 – Pt. was much better – Skin is regaining its normal colour and tone.
 For photographs see the attached word file reflecting both photos of initial and
last consultation.

19. 
These two cases of AD elaborated in this article 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.

Cases of AD require a long term follow-up as the lesions
have tendency to recur.

20. 



The term ‘atopy’ was coined in 1923 by Edward D. Perry,
comes from the Greek word
atopia which means –
‘unusualness’, ‘strangeness’, ‘a being out of the way’. 2
Atopy originally involved only asthma and allergic rhinitis,
but in 1933 atopic dermatitis (AD) was also included in the
group of atopic disorders, in recognition of the close link of
this form of eczema with asthma and allergic rhinitis. AD is
often the first manifestation of atopic diseases. 3
Allergies generally start with AD, and develop towards
food allergies in the form of gastro-intestinal, followed by
respiratory conditions (rhinitis and asthma).
AD is a chronic, itchy and inflammatory skin disease
caused by the interaction between susceptibility genes,
environment, drug reactions, skin barrier defects, and
immunological factors.4

21. 



Recently there has been a constant spurt in the
number of cases of allergy, particularly in both
developed and developing countries, to such an extent
that expressions like “disease of the third millennium”
and “allergic epidemic” have been used to describe the
phenomenon.5 The upward trend is also true in Indian
context.
Included under scaling lesions in dermatological
disorders. 6
Looks different at different ages and in people of
different races.
Pattern of appearance of lesions…acute weeping
lesions, sub acute or scaly lesion or chronic, dry,
lichenified lesions.

22. 


Onset in childhood in most patients.
Onset after age of 30 is very
uncommon.
Tendency to recur.
Also helpful are : 1. A personal or
family history of atopic disease
(asthma, allergic rhinitis, atopic
dematitis), 2. Xerosis – ichthyosis, 3.
Facial
pallor
with
infraorbital
darkening, 4. Elevated serum IgE and
5. Repeated skin infections.

23. 



Diagnostic criteria for atopic dermatitis must include
pruritus, typical morphology, distribution (flexural
lichenification, hand eczema, nipple eczema and
eyelid eczema in adults) and chronicity.6
The association of pruritus and the chronic relapsing
character of the disorder, along with age-specific
morphology and distribution of lesions are the most
important features of AD.
The extent of involvement may range from mild and
limited, to generalized and severe.
Sleep disturbance is a common occurrence in both the
child and his family.

24. 



Severe and chronic pruritic, exudative or
lichenified eruption on face, neck, upper trunk,
wrists and hands and in the antecubital and
popliteal folds.
Pigmented persons may have poorly demarcated
hypopigmented patches (pityriasis alba) on cheeks
and extremities.
During acute flares, widespread redness with
weeping, either diffusely or discrete plaques is
common.
Lab findings include…eosinophilia and increased
serum IgE levels are present.

25. Must be distinguished from
• Seborrhoeic dermatitis (less pruritic, frequent
scalp and face involvement, greasy and scaly
lesions, and quick response to therapy).
• Secondary
staphylococcal
infections
may
exacerbate AD and should be considered during
hyperacute, weepy flares of AD. Fissuring where
the earlobe connects to the neck is a cardinal sign
of secondary infection.

26. •
•

Since virtually all pt.s with AD have skin disease
before the age of 5, a new diagnosis of AD in an
adult over the age of 30 should be made
cautiously.
Atopic like dermatitis associated with marked
elevation of IgE; recurrent staphylococcal
abscesses;
recurrent
pneumonia
with
pneumatocele formation; and retained primary
dentition may indicate hyper-IgE syndrome.
Other conditions that must be excluded are
scabies, allergic contact dermatitis, cutaneous
lymphoma, psoriasis and ichthyosis.

27. 






Topical corticosteroids (TC)
Topical calcineurin inhibitors
Wet-wrap therapy (a damp cotton
dressing+emollients or TC)
Antibotics ( for staphylococcus aureus
colonization complicating AD).
Antihistamines (sedative effect)
Leukotriene antagonists (when with atopic
triad).
Systemic immunosuppressants

28. 







Patient education…gentle skin care.
Use of homoeopathic medicines.
General measures:
AD have hyperirritable skin. Anything that dries or irritates the skin will
potentially trigger dermatitis.
Atopic individuals are sensitive to low humidity and often get worse in
the winter.
Adults with atopic disorders should not bathe more than once daily,
washcloths and brushes should not be used, after rinsing, the skin should
be patted dry (not rubbed) and then immediately covered with an
emollient or coconut oil.
Atopic pt.s are irritated by scratchy fabrics including wools and acrylics.
Cottons are preferable. Other triggers of eczema in some pt.s include
sweating, hot baths and animal danders.
Once symptoms have improved, constant application of effective
moisturizers is recommended to prevent flares.

29. 



AD runs a chronic or intermittent course.
Poor prognostic factors for persistence into
adulthood in AD include onset in early
childhood, early generalized disease and
asthma.
Only 40 – 60% of these patients have
lasting remissions.
The physician should monitor for skin
atrophy. AD may be superimposed with
eczema herpeticum.

30. According to Homoeopathic guidelines, the patient is to
be treated not his organs or parts or systems or tissues.
 So also in a case of AD our objective of treatment is
patient himself not the skin lesions [‘no real cure can
take place without a strict particular treatment,
individualization of a case of disease’….Aph.82,
Organon of Medicine].7
 The constitutional treatment is the only way for radical
cure of AD.
 Our aim is not merely to reduce the hypersensitivity of
skin along with skin lesions, but to have improvement in
both subjective and objective sphere of the patient as a
whole.


31. 
‘An older, more chronic disease will
yield somewhat later together with
all traces of discomfort by the use of
several doses of the same more
highly potentized remedy or after
careful selection of one or another
more
similar
homoeopathic
medicine’….Aph.148, Organon of
Medicine7

32. ‘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
Medicine7

33. 
T.P.Paschero
writes,
“Every
experienced
homoeopath
knows
positively that unless he reaches the
dynamic, constitutional background
of the patient, unless he had
penetrated
and
understood
the
psychological personality and the
vicissitudes of adaptation of life
which give the earlier symptoms of
neurovegetative dystoria determining
the nature of his character and its

34. 
Conventional medical treatment of childhood eczema is again a sad example of
symptom suppression.

Homoeopaths understand that skin diseases are not simply skin problems but are
the result of an underlying internal disorder.

Using steroid medicines suppresses the natural defensive effort of the body.
Although they are highly effective in suppressing symptoms, they do not treat
the internal disease. Parents often note that the eczema returns, sometimes
worse than before, when conventional medical treatment is stopped.

Most commonly homoeopaths see the suppression of skin symptoms later
resulting in a lung condition, usually asthma. The skin does much breathing for
the body and acts as a “third lung”, it is predictable that disease would attack
the superficial lung first. Then, as the condition is either ineffectively treated or
suppressed, it attacks the two primary sources of life’s breath.

Conventional physicians commonly note that eczema and asthma are linked,
although they, unlike homoeopaths, generally treat them as separate illnesses
and prescribe different medications for them. These physicians do not recognize
this internalizing of the disease as suppression or as a worsening of the child’s
illness.

Homoeopaths assume that whenever treatment simply controls or suppresses
symptoms, true cure will remain elusive, and disease is likely to penetrate
deeper into the person.

35. Homoeopaths understand eczema
as a internal disorder, so they
need to choose a medicine
individually based on a full
evaluation
of
the
infant’s
physical, emotional and mental
characteristics as well as his or
her
genetic
endowment.
An
infant’s body is still in a
delicate stage of development and

36. AD is frequently seen in homoeopathic practice.
Homoeopathic treatment is believed to be
effective in this disorder as in eczema in general,
including severe cases. But conclusive research
defining its real efficacy and best homoeopathic
therapeutic strategies is 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 may be an
indirect indicator of their dissatisfaction with
conventional approaches.


37. 

These cases suggests that homoeopathic
treatment could be regarded 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.

38. References
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2.
3.
4.
5.
6.
7.
8.
9.
10.
Dethlefsen T. The skin. The healing power of illness. Brisbane: Element Books Limited, Reprinted
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Spergel JM, Paller AS. Atopic dermatitis and the atopic march. J Allergy Clin Immunol 2003; 112:
118 – 127.
Leung DY, Bieber T. Atopic dermatitis. Lancet 2003; 361(9352): 151 – 160.
Holgate ST. The epidemic of allergy and asthma. Nature 1999; 402: B2 - B4.
Mcphee J.Stephen and Papadakis A.Maxine. Dermatological disorders. Atopic dermatitis. Current
Medical Diagnosis and Treatment 2012, 51st ed. McGraw Hill Publication, 2012. p. 102 – 104.
Hahnemann S. Organon of Medicine, 5th ed. New Delhi: Pratap Medical Publishers (P) Ltd, Indian
edition; 1994.
Paschero T.P. Homoeopathy. New Delhi: Elsevier, A division of Reed Elsevier India (P) Ltd,
South Asian edition; 2007.
Ullman Dana. Paediatrics. Discovering Homoeopathy: Medicine for the 21 st century. Berkeley,
California: North Atlantic Books, 1988. p. 99.
Sankaran P. Pathology in Homoeopathy. The Elements of Homoeopathy, Vol.II. Bombay:
Homoeopathic Medical Publishers. p. 539