|
 
 |
| CASE REPORT |
|
| Year : 2022 | Volume
: 9
| Issue : 2 | Page : 108-113 |
|
Homeopathic treatment of Nonbullous Impetigo: An evidence-based case report
P Dastagiri, Arun Krishnan
National Homoeopathy Research Institute in Mental Health, Under Central Council for Research in Homoeopathy, Ministry of AYUSH, Kottayam, Kerala, India
| Date of Submission | 02-Sep-2022 |
| Date of Decision | 02-Nov-2022 |
| Date of Acceptance | 03-Nov-2022 |
| Date of Web Publication | 20-Feb-2023 |
Correspondence Address:
P Dastagiri
National Homoeopathy Research Institute in Mental Health, Under Central Council for Research in Homoeopathy, Ministry of AYUSH, Kottayam - 686 532, Kerala
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/AYUHOM.AYUHOM_40_22
Impetigo is the most contagious skin infection affecting school-going children and is more prevalent during summer. Impetigo has two types, nonbullous Impetigo (NBI) and bullous Impetigo, of which NBI is the most typical variety caused by Staphylococcus aureus and Group A beta-haemolytic Streptococci or both. The diagnosis is mainly based on the clinical examination and the characteristic appearance of the honey crust formation. In addition, the culture of the pus or bullous fluid may be helpful for the identification of the pathogens. A 14-year-old girl presented with NBI even after taking 1-week conventional treatment for 1 week in vain. However, Mezereum was treated successfully without topicals, complications, or adverse effects. Further, changes in the Dermatology Life Quality of Life questionnaire score from 20 (at the beginning) to zero have been observed: the Modified Naranjo Criteria for Homoeopathy score was +9 out of +13, providing evidence attributed to the intervention. This case report reinforced that homeopathic intervention is beneficial in treating bacterial infections such as NBI, and future pragmatic research needs to strengthen the results.
Keywords: Homeopathy, impetigo, mezereum, nonbullous impetigo
How to cite this article:
Dastagiri P, Krishnan A. Homeopathic treatment of Nonbullous Impetigo: An evidence-based case report. AYUHOM 2022;9:108-13 |
| Introduction | |  |
Impetigo is a contagious, superficial pyogenic infection of the skin.[1] This infection commonly affects school-going children and is more prevalent during summer.[2] The global burden of this illness is 1.6 billion children, with a median prevalence of 12.3%. More than 10 million school-going children in India are affected, with an incidence of 5.96%.[3],[4] Impetigo has two types – nonbullous Impetigo (NBI) and bullous Impetigo. NBI is the most common form, also called Impetigo contagiosa. It accounts for 80% of impetigo cases caused by Staphylococcus aureus and 10% by Group A beta-haemolytic streptococci.[5]
NBI often starts as a vesicle or a pustule; it coalesces and ruptures after the purulent exudate with the characteristic honey-colored crust is formed. Then, an erythematous base will often appear with mild regional lymphadenopathy. Systemic symptoms such as fever are typically absent in NBI. Eruptions appear most commonly on the face and extremities, where skin disruption occurs frequently.[6] The diagnosis is mainly based on the clinical examination and the characteristic appearance of the honey crust formation. The treatment is primarily for antibiotics (oral and topical) and wound care.[6],[7] Although symptoms are mild, rare serious complications such as rheumatic heart disease or glomerulonephritis could occur if the treatment is not started promptly.[8]
Homeopathy treats the patients gently and effectively with minimum doses prepared with natural substances.[9] In the synthesis treasure edition 2009 v (Schroyens. F) repertory under the skin chapter, rubric eruptions-Impetigo, commends72 remedies have been indicated for Impetigo.[10] This case report will establish the strength of homeopathy medicine in treating NBI. Moreover, this case report was prepared in adherence to the CARE and Homoeopathic Clinical Case Reports (HOM-CASE) guidelines.[11]
| Case Report | | |
A 14-year-old girl was consulted on May 17, 2022, with eroded exudative lesions on the left hand with severe itching and pain for 1 month.
History of presenting illness
Initially, a group of pustules developed on the left arm; after scratching, it led to bloody, purulent, offensive discharges and further spread the lesions to the adjacent area, extending the same lesions to form the crust. She took the conventional medicine for 1 week from May 1, 2022, to May 07, 2022, topical and oral, but it was futile.
The itching was aggravated at night. She has constant burning pain in the lesions, more at night.
Discharges were purulent, bloody, and offensive.
Past history
She has been suffering from atopic eczema for 6 years, has been taking conventional medicine, and occasionally relapsed in the winter season.
Family history
The patient's father has allergic rhinitis; mother is healthy. And her paternal grandfather had bronchial asthma under conventional medicine.
Mental generals
After developing this illness, she became dull due to the illness and always needed company (mother informed).
Physical generals
She lost her appetite, had no specific desire and aversions, had increased thirst for a smaller amount of cold water, her bowel movements and urine voiding were regular and satisfactory, and she had disturbed sleep due to itching and pain. And also, she had intolerance to cold air and weather.
Particulars
Eruptions – erosions of the skin on the arm with itching aggravated at night. Pain – burning in nature more at night. Skin – discharges, bloody, purulent, offensive, and crust formation.
General examination
Afebrile, ill-looking, pulse rate-98/min, respiratory rate-22/min, mild left axillary lymphadenopathy, no other abnormality detected.
Local examination
Skin-on inspection – erosions with crust, reddish color, ill-defined margins, purulent, bloody discharges, multiple lesions, coalescing in arrangement, localized asymmetrical distribution on a left arm extending to the elbow region. Firm inconsistency, warm on touch, with severe tenderness on palpation.
Diagnostic assessment
Based on this clinical examination and history, this case was diagnosed as NBI.
Analysis and evaluation of the case
After analysis and evaluation of the case, the repertorial totality was constructed and repertorization details are shown in [Figure 1].[10] The miasmatic analysis was done by Dr. R. P. Patel's Chronic Miasms in Homoeopathy and their cure, and the predominant miasms were psora and syphilitic[12] [Table 1].
Therapeutic intervention
After repertorization and referring to Materia Medica,[13] Mezereum was selected, covering the maximum rubrics, including the characteristic features of the condition. Afterward, assessing the patient susceptibility based on age, seat of the disease, pathology, and nature of the disease, higher potency was indicated, and[14] hence the prescribed 200C potency was administered orally. The treatment details including dose and duration are given in [Table 2].
Follow-up and outcomes
Self-explanatory Dermatology Life Quality of Life (DLQI)[15] questionnaires were handed to the patient to know the severity of her illness; ranges are 0–1 (no effect at all patient's life), 2–5 (small effect), 6–10 (moderate effect), 11–20 (very large effect), and 21–30 (extremely large effect); at the first visit, her score was 20 which means “very large effect” to her quality of life. The treatment timeline, including follow-up details of the patient, is given in [Table 3]. | Table 3: Monarch inventory (improved version of the Modified Naranjo criteria for homoeopathy)
Click here to view |
| Discussion | | |
NBI mainly affects children, where the skin is easily disrupted on the face and extremities with intolerable itching, pain with serous exudation, and the characteristic golden-yellow crust formation, and needs prompt medication. Under conventional treatment, topical and oral antibiotics were treated to relieve and prevent complications. The present case also represented the same complaints and was treated successfully with Mezereum 200c potency orally, repeated in frequent doses, and the lesions were cleaned with normal saline only. As a result, all the complaints were alleviated in 2 weeks without any complications or adverse events.
In homeopathy, there are no specific antibiotics or antivirals for particular organisms. However, as S. Close[14] emphasized, the correctly chosen remedy is based on anamnesis and administered in infinitesimal doses; per orum satisfies the morbid susceptibility, supplies the need of the organism, and confers true immunity by promoting health, which is the actual object to be gained.
Dr. H. A. Robert's denoted that if there is any syphilitic taint in combination with psoric base, these patients are susceptible to Impetigo.[16] With this continuation, Dr. J. H. Allen, in his Chronic Miasm, explained that Mezereum had an affinity toward the anti-syphilitic and pseudo-psoric.[17] Hence, we selected this remedy which covers the totality of symptoms, including the underlying miasm.
The patient's susceptibility, seat, nature, intensity, stage, and duration of the disease will determine the potency and how often we repeat the medicine. Here, we selected the 200c potency with frequent repetition and advised the patient that if the pain and itching intensity were reduced, the remedy should be stopped as soon as signs of improvement appeared.[14]
The complaints gradually decreased without aggravation during the intervention. Therefore, it represents J. T. Kent's 4th observation means “no aggravation whatever.” With less depth in pathology or diseases in the functional aspect, the cure is possible without any aggravation by the accurate remedy and potency, which will annihilate the complaints and restore or cure the disease. Furthermore, it is the highest order of cure, especially in acute conditions. This fourth observation conveys cases in which there is no aggravation with the recovery of the patient. The patient continued the treatment and did not observe any recurrence of the complaints.[18]
The total outcome score per the modified Naranjo criteria for Homoeopathy (MONARCH).[19] Inventory (An improved version of the MONARCH) was +9, close to the maximum score of +13 [Table 3]. This score shows the causal attribution of the homoeopathic intervention Mezereum toward reducing the complaints of NBI. This clinical condition may affect the patient's quality of life very highly, as reflected in this patient's DLQI score of 20 initially; after 2 weeks of intervention, she improved both subjectively and objectively, and the score became zero without any adverse reactions.
Few publications[20],[21],[22],[23] have emphasized that Impetigo can be treated successfully with homeopathic intervention. This evidence-based case report also reinforces homeopathy in treating Impetigo without topicals and adverse effects.
Recent studies emphasize that the mezereum has daphnetoxin, a major bioactive principle made from its bark. This essential active principle has anticancer, anti-inflammatory, anti-HIV, antifertility, neurotrophic, and cholesterol-lowering effects.[23],[24] Perhaps based on this bioactive anti-inflammatory principle, this case was cured and needed more pragmatic research to know the efficacy of Mezereum in treating inflammatory disorders such as NBI.
| Conclusion | | |
This case report demonstrated the role of homeopathy in treating bacterial infections such as NBI, where Mezereum was prescribed and administered orally without topical and showed evident positive results. However, further pragmatic research trials are needed to confirm the results.
Highlights
- NBI is the most typical infection in school-going children; it starts as a vesicle or a pustule; it coalesces and ruptures after the purulent exudate with the characteristic honey-coloured crust. Most commonly seen on the face and extremities
- The pathognomic symptoms of the NBI are similar to the Mezereum characteristic features, and the bioactive principles had anti-inflammatory properties in reducing the complaints. During the treatment, the validated scales were used to assess the severity of the disease, prognosis, causal relationship, and photographic evidence.
Declaration of patient consent
The authors certify that they have obtained patient consent and that the patient has given her consent for her photographs and other clinical information to be reported in the journal. In addition, the patient was made to understand that her name and initials would not be published, and efforts would be made to conceal his identity.
Acknowledgment
The authors acknowledged Dr. K. C. Muraleedharan, Assistant Director (H) and Officer In-charge, National Homoeopathy Research Institute in Mental Health, Kottayam, who encourages writing and publishing evidence-based case reports.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Christopher G, Barker J, Bleiker T, Chalmers R, Creamer D. Infections and Infestations. In: Rooks Textbook of Dermatology. 9 th ed., Ch. 26.13. UK: Blackwell Publishing, Ltd, Part 3; 2016.  |
| 2. | Mohan M, Abdul Latheef EN, Sarada Devi KL, Riyaz N. Clinico-bacteriological study of pyodermas in a tertiary care centre in South India. Indian J Dermatol Venereol Leprol 2016;82:532-4. [ PUBMED] [Full text] |
| 3. | Bowen AC, Mahé A, Hay RJ, Andrews RM, Steer AC, Tong SY, et al. The global epidemiology of impetigo: A systematic review of the population prevalence of impetigo and pyoderma. PLoS One 2015;10:e0136789. |
| 4. | Jawade SA, Chugh VS, Gohil SK, Mistry AS, Umrigar DD. Clinico-etiological study of dermatoses in pediatric age group in tertiary health care center in South Gujarat region. Indian J Dermatol 2015;60:635. Available from: https://www.e-ijd.org/text.asp?2015/60/6/635/169147. [Last accessed on 2022 Aug 20]. |
| 5. | Sharma D, Murki S, Pratap T. Impetigo contagiosa: An interesting and a very rare finding in a newborn. BMJ Case Rep 2014;2014:bcr2014204639. |
| 6. | |
| 7. | Pereira LB. Impetigo – Review. An Bras Dermatol 2014;89:293-9. |
| 8. | Barbieri E, Porcu G, Dona' D, Falsetto N, Biava M, Scamarcia A, et al. Non-bullous impetigo: Incidence, prevalence, and treatment in the pediatric primary care setting in Italy. Front Pediatr 2022;10:753694. |
| 9. | Dastagiri P, Kaushal KS. Clinical description of a rare dermatological disease, acne Keloidalis Nuchae, and successful homoeopathic management: A case report. Int J Homeost Sci 2021;5:217-23. |
| 10. | Schroyens F. Radaropus. Belgium: Zeus Soft; 2009. (Synthesis Treasure edition2009v). |
| 11. | van Haselen RA. Homeopathic clinical case reports: Development of a supplement (HOM-CASE) to the CARE clinical case reporting guideline. Complement Ther Med 2016;25:78-85. |
| 12. | Patel RP. Chronic Miasms in Homoeopathy and Their Cure With Classification of Their Rubric/Symptoms in the Dr. Kent's Repertory. Indian edition. New Delhi: Indian Books and Periodic publishers; 1996. |
| 13. | Boericke W. Boerike's New Manual of Homoeopathic Treatment with Repertory, 3 rd Revised & Augmented Edition Based on Ninth edition. New Delhi: B.Jain Publishers (P) Ltd; 2010. p. 392-3. |
| 14. | Close S. Chapter VII- Susceptibility, Reaction and Immunity. In: The Genius of Homoeopathy, Lecture and Essays on Homoeopathic Philosophy, Reprint edition. New Delhi: B. Jain Publishers, Pvt.Ltd.; 2001. p. 82,183-212. |
| 15. | Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) – A simple practical measure for routine clinical use. Clin Exp Dermatol 1994;19:210-6. |
| 16. | Roberts HA. Chapter XXIII, Disease Classification (Psora continued). In: The Principles and Art of Cure by Homoeopathy. New Delhi: B. Jain Publishers Pvt. Ltd; 1999. p 193. |
| 17. | Allen JH. Allen's The Chronic miasms Psora & Sycosis. Vol. II. New Delhi: B. Jain Publishers Pvt. Ltd; 2002. p. 337. |
| 18. | Kent JT. Lectures on Homoeopathic Philosophy, Reprint edition: Lecture XXXV Prognosis after Observing the Action of the Remedy. New Delhi: B. Jain Publishers Pvt. Ltd; 1999. p. 229. |
| 19. | Lamba CD, Gupta VK, van Haselen R, Rutten L, Mahajan N, Molla AM, et al. Evaluation of the modified naranjo criteria for assessing causal attribution of clinical outcome to homeopathic intervention as presented in case reports. Homeopathy 2020;109:191-7. |
| 20. | Deep KA, Shalini T. A case of impetigo cured with homoeopathic similimum. Int J Homeost Sci 2020;4:28-30. |
| 21. | |
| 22. | Mahesh S, Kozymenko T, Kolomiiets N, Vithoulkas G. Antimonium crudum in pediatric skin conditions: A classical homeopathic case series. Clin Case Rep 2021;9:818-24. |
| 23. | Bhaumik H. Evidence – Based homoeopathy: A case of contagious impetigo. AYUHOM 2017;4:155-9. |
| 24. | Nie YW, Li Y, Luo L, Zhang CY, Fan W, Gu WY, et al. Phytochemistry and pharmacological activities of the diterpenoids from the genus daphne. Molecules 2021;26:6598. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]
|
Search Pubmed for