Tuesday, March 26, 2013

Eczema And Its Homoeopathic Approach - Dr. D. Kumaresan



Eczema And Its Homoeopathic Approach










ECZEMA


SKIN

The human skin is the outer covering of the body. In humans, it is the largest organ of the integumentary system. The skin has multiple layers of ectodermal tissue and guards the underlying muscles, bones, ligaments and internal organs.

ANATOMY OF THE SKIN:

LAYERS OF THE SKIN:
The 3 layers of skin - the epidermis, dermis, and subcutaneous tissue.
Epidermis
The epidermis is the outer layer of skin. The thickness of the epidermis varies in different types of skin. It is the thinnest on the eyelids at .05 mm and the thickest on the palms and soles at 1.5 mm.
The epidermis contains 5 layers. From bottom to top the layers are named:
·         stratum basale
·         stratum spinosum
·         stratum granulosum
·         stratum licidum
·         stratum corneum
The bottom layer, the stratum basale, has cells that are shaped like columns. In this layer the cells divide and push already formed cells into higher layers. As the cells move into the higher layers, they flatten and eventually die.
The top layer of the epidermis, the stratum corneum, is made of dead, flat skin cells that shed about every 2 weeks.
Dermis
The dermis also varies in thickness depending on the location of the skin. It is .3 mm on the eyelid and 3.0 mm on the back. The dermis is composed of three types of tissue that are present throughout - not in layers. The types of tissue are:
·         collagen
·         elastic tissue
·         reticular fibers
Layers of the Dermis
The two layers of the dermis are the papillary and reticular layers.
·         The upper, papillary layer, contains a thin arrangement of collagen fibers.
·         The lower, reticular layer, is thicker and made of thick collagen fibers that are arranged parallel to the surface of the skin.

Subcutaneous Tissue
The subcutaneous tissue is a layer of fat and connective tissue that houses larger blood vessels and nerves. This layer is important is the regulation of temperature of the skin itself and the body. The size of this layer varies throughout the body and from person to person.
`The skin is a complicated structure with many functions. If any of the structures in the skin are not working properly, a rash or abnormal sensation is the result. The whole specialty of dermatology is devoted to understanding the skin, what can go wrong, and what to do if something does go wrong.

SKIN COMPONENTS:
Skin has mesodermal cells, pigmentation, or melanin provided by melanocytes, which absorb some of the potentially dangerous ultraviolet radiation (UV) in sunlight. It also contains DNA-repair enzymes that help reverse UV damage, and people who lack the genes for these enzymes suffer high rates of skin cancer. One form predominantly produced by UV light, malignant melanoma, is particularly invasive, causing it to spread quickly, and can often be deadly. Human skin pigmentation varies among populations in a striking manner. This has led to the classification of people(s) on the basis of skin color.
FUNCTIONS OF THE SKIN:
Skin performs the following functions:
1.     Protection: an anatomical barrier from pathogens and damage between the internal and external environment in bodily defense; Langerhans cells in the skin are part of the adaptive immune system.
2.     Sensation: contains a variety of nerve endings that react to heat and cold, touch, pressure, vibration, and tissue injury; see somatosensory system and haptics.
3.     Heat regulation: the skin contains a blood supply far greater than its requirements which allows precise control of energy loss by radiation, convection and conduction. Dilated blood vessels increase perfusion and heatloss, while constricted vessels greatly reduce cutaneous blood flow and conserve heat.
4.     Control of evaporation: the skin provides a relatively dry and semi-impermeable barrier to fluid loss. Loss of this function contributes to the massive fluid loss in burns.
5.     Aesthetics and communication: others see our skin and can assess our mood, physical state and attractiveness.
6.     Storage and synthesis: acts as a storage center for lipids and water, as well as a means of synthesis of vitamin D by action of UV on certain parts of the skin.
7.     Excretionsweat contains urea, however its concentration is 1/130th that of urine, hence excretion by sweating is at most a secondary function to temperature regulation.
8.     Absorption: the cells comprising the outermost 0.25–0.40 mm of the skin are "almost exclusively supplied by external oxygen", although the "contribution to total respiration is negligible". In addition, medicine can be administered through the skin, by ointments or by means of adhesive patch, such as the nicotine patch or iontophoresis. The skin is an important site of transport in many other organisms.
9.    Water resistance: The skin acts as a water resistant barrier so essential nutrients aren't washed out of the body.
PIGMENTS:
There are at least five different pigments that determine the color of the skin. These pigments are present at different levels and places.
·         Melanin: It is brown in color and present in the germinative zone of the epidermis.
·         Melanoid: It resembles melanin but is present diffusely throughout the epidermis.
·         Keratin: This pigment is yellow to orange in color. It is present in the stratum corneum and fat cells of dermis and superficial fascia.
·         Hemoglobin (also spelled haemoglobin): It is found in blood and is not a pigment of the skin but develops a purple color.
·         Oxyhemoglobin: It is also found in blood and is not a pigment of the skin. It develops a red color.
DISEASES OF THE SKIN:
PRIMARY LESIONS
·         Macule – A macule is a change in surface color, without elevation or depression and, therefore, nonpalpable, well or ill-defined, variously sized, but generally considered less than either 5 or 10 mm in diameter at the widest point.
·         Patch – A patch is a large macule equal to or greater than either 5 or 10 mm, across depending on one's definition of a macule. Patches may have some subtle surface change, such as a fine scale or wrinkling, but although the consistency of the surface is changed, the lesion itself is not palpable.
·         Papule – A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to less than either 5 or 10 mm in diameter at the widest point.
·         Plaque – A plaque has been described as a broad papule, or confluence of papules equal to or greater than 1 cm, or alternatively as an elevated, plateau-like lesion that is greater in its diameter than in its depth.[
·         Nodule – A nodule is morphologically similar to a papule, but is greater than either 5 or 10 mm in both width and depth, and most frequently centered in the dermis or subcutaneous fat.The depth of involvement is what differentiates a nodule from a papule.
·         Vesicle – A vesicle is a circumscribed, fluid-containing, epidermal elevation generally considered less than either 5 or 10 mm in diameter at the widest point.
·         Bulla – A bulla is a large vesicle described as a rounded or irregularly shaped blister containing serous or seropurulent fluid, equal to or greater than either 5 or 10 mm, depending on one's definition of a vesicle.
·         Pustule – A pustule is a small elevation of the skin containing cloudy or purulent material usually consisting of necrotic inflammatory cells.These can be either white or red.
·         Cyst – A cyst is an epithelial-lined cavity containing liquid, semi-solid, or solid material.
·         Erosion – An erosion is a discontinuity of the skin exhibiting incomplete loss of the epidermis,a lesion that is moist, circumscribed, and usually depressed.
·         Ulcer – An ulcer is a discontinuity of the skin exhibiting complete loss of the epidermis and often portions of the dermis and even subcutaneous fat.
·         Fissure – A fissure is a crack in the skin that is usually narrow but deep.
·         Wheal – A wheal is a rounded or flat-topped, pale red papule or plaque that is characteristically evanescent, disappearing within 24 to 48 hours.
·         Telangiectasia – A telangiectasia represents an enlargement of superficial blood vessels to the point of being visible.
·         Burrow – A burrow appears as a slightly elevated, grayish, tortuous line in the skin, and is caused by burrowing organisms.

SECONDARY LESIONS
·         Scale – dry or greasy laminated masses of keratin that represent thickened stratum corneum.
·         Crust – dried serum, pus, or blood usually mixed with epithelial and sometimes bacterial debris.
·         Lichenification – epidermal thickening characterized by visible and palpable thickening of the skin with accentuated skin markings.
·         Excoriation – a punctate or linear abrasion produced by mechanical means (often scratching), usually involving only the epidermis, but commonly reaching the papillary dermis.
·         Induration – dermal thickening causing the cutaneous surface to feel thicker and firmer.
·         Atrophy – refers to a loss of tissue, and can be epidermal, dermal, or subcutaneous. With epidermal atrophy, the skin appears thin, translucent, and wrinkled. Dermal or subcutaneous atrophy is represented by depression of the skin.
·         Maceration – softening and turning white of the skin due to being consistently wet.
·          Umbilication – formation of a depression at the top of a papule, vesicle, or pustule.

 

Chronic Skin Conditions

Chronic skin conditions typically aren’t curable, but they can be managed using drugs and by paying close attention to your lifestyle. Learn more about symptoms, treatments, and ways to feel better.
Eczema
Eczema is term for a group of medical conditions that cause the skin to become inflamed or irritated.

Psoriasis
Psoriasis is a common skin disorder that produces thick red plaques covered with silvery scales.

Acne
Although acne remains largely a curse of adolescence, about 20% of all cases occur in adults.

Rosacea
Rosacea is a common disorder that mainly affects skin on the face. It causes redness on the nose, chin, cheeks, and forehead.





ECZEMA





Definition:

Dermatitis and eczema is non-contagious inflammation of the skin, characterized by erythema, scaling, oedema, vesiculation and oozing. Herba says, “ Eczema is what looks like eczema”. Dermatitis literally means inflammation of the skin and as such can include all inflammations of the skin except by specific infections.

 Introduction:
The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes that are characterized by one or more of these symptoms: redness, skin edema (swelling), itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes due to healed injuries. Scratching open a healing lesion may result in scarring and may enlarge the rash.
The word eczema comes from Greek, meaning "to boil over". Dermatitis comes from the Greek word for skin – and both terms refer to the same skin condition. In some languages, dermatitis and eczema are synonymous, while in other languages dermatitis implies an acute condition and "eczema" a chronic one. The two conditions are often classified together.

Classifications:
The term eczema refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many synonyms used to describe the same condition. A type of eczema may be described by location (e.g., hand eczema), by specific appearance (eczema craquele or discoid), or by possible cause (varicose eczema).
The classifications below is ordered by incidence frequency.

Common

·         Atopic eczema (aka infantile e., flexural e., atopic dermatitis) is an allergic disease believed to have a hereditary component and often runs in families whose members also have asthma. Itchy rash is particularly noticeable on head and scalp, neck, inside of elbows, behind knees, and buttocks. Experts are urging doctors to be more vigilant in weeding out cases that are, in actuality, irritant contact dermatitis. It is very common in developed countries, and rising.

·         Contact dermatitis is of two types: allergic (resulting from a delayed reaction to some allergen, such as poison ivy or nickel), and irritant (resulting from direct reaction to a detergent, such as sodium lauryl sulfate, for example). Some substances act both as allergen and irritant (wet cement, for example). Other substances cause a problem after sunlight exposure, bringing on phototoxic dermatitis. About three quarters of cases of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable, provided the offending substance can be avoided and its traces removed from one's environment.

·         Xerotic eczema (aka asteatotic e., e. craquele or craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather, and limbs and trunk are most often affected. The itchy, tender skin resembles a dry, cracked, river bed. This disorder is very common among the older population. Ichthyosis is a related disorder.

·         Seborrhoeic dermatitis or Seborrheic dermatitis ("cradle cap" in infants) is a condition sometimes classified as a form of eczema that is closely related to dandruff. It causes dry or greasy peeling of the scalp, eyebrows, and face, and sometimes trunk. The condition is harmless except in severe cases of cradle cap. In newborns it causes a thick, yellow crusty scalp rash called cradle cap, which seems related to lack of biotin and is often curable.

 

Less common

·         Dyshidrosis (aka dyshidrotic e., pompholyx, vesicular palmoplantar dermatitis, housewife's eczema) only occurs on palms, soles, and sides of fingers and toes. Tiny opaque bumps called vesicles, thickening, and cracks are accompanied by itching, which gets worse at night. A common type of hand eczema, it worsens in warm weather.
·         Discoid eczema (aka nummular e., exudative e., microbial e.) is characterized by round spots of oozing or dry rash, with clear boundaries, often on lower legs. It is usually worse in winter. Cause is unknown, and the condition tends to come and go.
·         Venous eczema (aka gravitational e., stasis dermatitis, varicose e.) occurs in people with impaired circulation, varicose veins and edema, and is particularly common in the ankle area of people over 50. There is redness, scaling, darkening of the skin and itching. The disorder predisposes to leg ulcers.
·         Dermatitis herpetiformis (aka Duhring's Disease) causes intensely itchy and typically symmetrical rash on arms, thighs, knees, and back. It is directly related to celiac disease, can often be put into remission with appropriate diet, and tends to get worse at night.
·         Neurodermatitis (aka lichen simplex chronicus, localized scratch dermatitis) is an itchy area of thickened, pigmented eczema patch that results from habitual rubbing and scratching. Usually there is only one spot. Often curable through behavior modification and anti-inflammatory medication. Prurigo nodularis is a related disorder showing multiple lumps.
·         Autoeczematization (aka id reaction, autosensitization) is an eczematous reaction to an infection with parasites, fungi, bacteria or viruses. It is completely curable with the clearance of the original infection that caused it. The appearance varies depending on the cause. It always occurs some distance away from the original infection.
·         There are also eczemas overlaid by viral infections (e. herpeticum, e.vaccinatum), and eczemas resulting from underlying disease (e.g. lymphoma). Eczemas originating from ingestion of medications, foods, and chemicals, have not yet been clearly systematized. Other rare eczematous disorders exist in addition to those listed here.

Causes:

The cause of eczema is unknown but is presumed to be a combination of genetic and environmental factors.

The hygiene hypothesis postulates that the cause of asthma, eczema, and other allergic diseases is an unusually clean environment. It is supported by epidemiologic studies for asthma. The hypothesis states that exposure to bacteria and other immune system modulators is important during development, and missing out on this exposure increases risk for asthma and allergy.

While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mites, with up to 5% of people showing antibodies to the mites, the overall role this plays awaits further corroboration.

Researchers have compared the prevalence of eczema in people who also suffer from celiac disease to eczema prevalence in control subjects, and have found that eczema occurs about three times more frequently in celiac disease patients and about two times more frequently in relatives of celiac patients, potentially indicating a genetic link between the two conditions.

Clinical Features:


  1. Pruritus and scratching

   
2. Course marked by exacerbations and remissions

   
3. Lesions typical of eczematous dermatitis

   
4. Personal or family history of atopy (asthma, allergic rhinitis, food allergies, or eczema.

   
5. Clinical course lasting longer than 6 weeks

   
6. Lichenification of skin
Diagnosis:
Diagnosis of eczema is based mostly on history and physical examination. However, in uncertain cases, skin biopsy may be useful.

Management:

  • Avoiding dry skin
  •  Moisturizing
  •  Eczema can be exacerbated by dryness of the skin. Moisturizing is one of the most important self-care treatments for sufferers of eczema. Keeping the affected area moistened can promote skin healing and relief of symptoms.

Environmental measures

While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mites, with up to 5% of people showing antibodies to the mites, the overall role this plays awaits further corroboration.

Various measures may reduce the amount of mite antigens, in particular swapping carpets for hard surfaces.

Diet and nutrition

Dietary elements that have been reported to trigger eczema include dairy products and coffee (both caffeinated and decaffeinated), soybean products, eggs, nuts, wheat and maize (sweet corn), though food allergies may vary from person to person.

Homoeopathic Management of Eczema:

The core wisdom of the body is to push illness from a more vital to less important tissue. Thus, though eczema is a completely curable condition, this often requires professional, constitutional prescribing. Simultaneously clearing up associated allergies or overall immune weakness, If eczema co-exists or alternates with asthma or hay fever, merely treating the skin will not resolve the whole syndrome, Nonetheless, the remedies listed here can give considerable relief, and in fact are the ones most commonly used to cure eczema on the deepest level. Sulphur is often indicated if there has been suppression by various ointments. Sulphur and other remedies can also cause skin “aggravations”- the condition gets worst first as part of the cure.Calendula is the best and usually only medicine that should be used to soothe itchy, chaffed or broken skin.

Homoeopathic Approach:
SKIN - ERUPTIONS - eczema
SKIN - ERUPTIONS - eczema - alternating with
SKIN - ERUPTIONS - eczema - dishydrotic
SKIN - ERUPTIONS - eczema - itching; not
SKIN - ERUPTIONS - eczema - menses agg.
SKIN - ERUPTIONS - eczema - seaside; at the
SKIN - ERUPTIONS - vesicular - sudamina
HEAD - ERUPTIONS - eczema
EAR - DISCHARGES - purulent - eczema; with
EAR - ERUPTIONS - eczema
EAR - ERUPTIONS - Behind the ears - eczema
EAR - ERUPTIONS - Meatus, in - eczema
HEARING - IMPAIRED - eczema; after a suppressed
FACE - ERUPTIONS - eczema
ABDOMEN - ERUPTIONS - eczema round navel
RECTUM - ERUPTIONS - about anus - eczema
MALE GENITALIA/SEX - ERUPTIONS - eczema
MALE GENITALIA/SEX - ERUPTIONS - Scrotum - eczema
FEMALE GENITALIA/SEX - ERUPTIONS - eczema
CHEST - ERUPTIONS - eczema
CHEST - ERUPTIONS - Axilla - eczema
CHEST - ERUPTIONS - Mammae - eczema
CHEST - ERUPTIONS - Mammae - nipples - eczema
BACK - ERUPTIONS - eczema
EXTREMITIES - ERUPTIONS - eczema
EXTREMITIES - ERUPTIONS - Joints - eczema
EXTREMITIES - ERUPTIONS - Joints - bends of - eczema
EXTREMITIES - ERUPTIONS - Upper limbs - eczema
EXTREMITIES - ERUPTIONS - Shoulder - eczema
EXTREMITIES - ERUPTIONS - Elbow - eczema
EXTREMITIES - ERUPTIONS - Elbow - bend of - eczema
EXTREMITIES - ERUPTIONS - Forearm - eczema
EXTREMITIES - ERUPTIONS - Wrist - eczema
EXTREMITIES - ERUPTIONS - Hand - eczema
EXTREMITIES - ERUPTIONS - Hand - back of - eczema
EXTREMITIES - ERUPTIONS - Fingers - eczema
EXTREMITIES - ERUPTIONS - Lower limbs - eczema
EXTREMITIES - ERUPTIONS - Thigh - eczema
EXTREMITIES - ERUPTIONS - Knee - eczema rubrum
EXTREMITIES - ERUPTIONS - Knee - hollow of - eczema
EXTREMITIES - ERUPTIONS - Leg - eczema
EXTREMITIES - ERUPTIONS - Leg - calf - eczema
EXTREMITIES - ERUPTIONS - Ankle - eczema
EXTREMITIES - ERUPTIONS - Foot - back of - eczema
EXTREMITIES - PAIN - burning - Hand - eczema, in
EXTREMITIES - SWELLING - Hand - eczema, with

Following remedies are important in the path of homeopathic treatment of eczema
Arsenicum

·         Intense itching. Turns to burning when scratches till raw; when burning stops, itching returns. Skin dry as paper. Flaking. Pussy. Small vesicles.
·         Eczema worst on uncovered parts or areas. Chilly, weakness. Sips cold water.
·         Restless. Anxious, worried about health, death, security, picky, miserly.
·         Worse: after midnight, cold air or bath, wet; better: hot bathing, warm room.

Graphites

·         Red itching pimples; oozing of honey like liquid, which crusts over.
·         Infects and scars easily, heals slowly. Overweight, sweaty, constipated.
·         Scalp. Hairline, behind ears, genitals, back of hands, palms, skin folds.
·         Thickened skin. Deep cracks in fingers, heels, etc. nails thick. Grooved.
·         Worse: night, menses, heat (though chilly). Better: cold application.

Mezerium

·         Violent itching; smarting, crawling, but parts feels cold, as if cool breeze.
·         Acrid oozing, forms hard, thick crusts with pus under them or white scabs, matting the hair. Intense burning after scratching. Eczema after vaccines.
·         Scalp, margins of hair, face, lids, eyebrows, hands and feet, cracked lips.
·         Worse: night, heat of bed or bath, drafts, damp, touch. Better: open air.

Nat Mur

·         Small itchy blisters with corrosive fluid; skin becomes red, raw, inflamed.
·         Margins of hair; bends of joints, behind ears. Dry flaky crusts form after.
·         Craves salt, thirsty. Greasy, oily hair. Dry skin in general. Underweight.
·         Eczema from suppressed emotion, inner grief. Avoids consolation, fuss.
·         Worse: warmth, salt, seashore, And menses, better: cool weather or bathing.

Petroleum

·         Red, raw, moist surface: burning and itching: oozing after scratching.
·         Deep cracks in folds, fingers. Bleed easily, become infected. Ulcerations.
·         Eruption of the palms, fingerprints, bends of joints, behind ears, genitals.
·         Itching, scratches until it bleed; the part becomes cold after scratching.
·         Worse: winter, cold air, moving vehicles, night. Better: warm air, dryness.

Sulphur

·         Moist, weeping eruptions, foul odor. Intensely itchy; scratches till it bleeds, causing burning. Skin bleeds easily. Dry, scaly, cracked areas.
·         Unhealthy skin, pimples, easily infected. Burning hot feet at night.
·         Hair margins, face, areas of perspiration, feet, bends of elbows, knee.
·         Intellectual dreamer. Lethargic, unmotivated. Tired and always hungry
·         Worse: night, warmth of bed, heat, bathing, wool. Better: dry, cool bathing.



Hydrocotyle

·         Erysipelatous redness.
·         Three spots almost completely circular, with slightly raised scaly edges.
·         Yellowish spots on both legs.
·         Papular eruption on the face.
·         Pustules on the chest.
·         Pricking on different parts.
·         Intolerable itching in several places.



Dr. D. Kumaresan

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