BRIEF  RESUME  OF  INTENDED  WORK:

NEED  FOR  STUDY:

“Healthy skin is a reflection of overall wellness.”

-Dr. Murad

·       Dermatophytosis is the commonest fungal infection of skin and known in common language as “ringworm” due to its ring-like appearance. It has been reported that 1-12 cases out of every 1,000 patients are found to be affected with fungal infection. ⁽¹⁾

·       According to a study published in the Indian Journal of Dermatology, the prevalence of superficial dermatophytosis (ringworm) in India has reached epidemic proportions. ⁽²⁾ The study reports that a tertiary care academic department in North India found a prevalence of about 5%–10% of all new cases, many presenting with recurrent, chronic dermatophytosis with varied clinical presentations.  ⁽²⁾

·       Individuals ages 21–40 years are most commonly affected.

·       Selection of conservative mode of treatment it will be fade up and create a misdiagnosed disease picture called as “tinea incognito”, Atypical appearance, called tinea incognito, which may involve less erythema (redness), less scale, and indistinct lesion borders. Unusual shapes or patterns can mimic other conditions like atopic dermatitis (eczema).  ^(3) (4)

·       The lack of understanding of Etiology of ringworm has resulted in treatments that are based upon trial and error. These treatments include antifungal, anaesthetics, topical and systemic, corticosteroids and alternative (herbal) remedies. These treatments reduce the symptoms and give temporary result having no curable effect. Unfortunately, there is no proven therapy of preventing the onset and recurrence of Tinea (ringworm). Here, Homoeopathy has a role to play.

·       Our master Dr. Hahnemann gave the definition of cure in §-2 of Organon of medicine which denotes that cure should be gentle and permanent having most harmless way of treatment. Homoeopathic method of treatment is well known for its gentle and holistic approach in treating a sick.  ⁽⁵⁾ This mode of treatment based on natural laws with exhaustive literature regarding verified medicines used for treating sick person.

·       Homoeopathy has insightful and deep understanding towards the treatment of skin diseases. Homeopathy strongly believes in understanding the holistic causative factors while handling skin diseases, whereby the study of skin, mind, constitution, miasmatic background and genetic influences which are put together for selection of similimum remedy.

·       As we know spreading of ringworm may be from unhygienic condition. So, treatment of ringworm is important part in duty of any physician. Homoeopathic medicines are like Physician’s tool for accomplishing his mission. In Homoeopathy, there are many different ways of prescriptions with indicated medicines are used to treat cases of ringworm. Among all these constitutional, antimiasmatic and therapeutic prescription which are as suitable for cases used to prescribed accordingly. And maintained results of before and after complaints of patient on physical as well as mental aspect.

REVIEW  OF  LITERATURE:

RINGWORM (TINEA)

DEFINITION

Ø  Dermatophytes are fungi capable of causing superficial skin infections known as Ringworm or dermatophytosis. ⁽⁶⁾

Ø  It is a chronic infection of the hair, skin or nails by dermatophytes (a type of fungi that invade the superficial layer of epidermis and survive on the keratin of the skin, hair and nails)  ⁽⁷⁾

Ø  There are three genera of dermatophytes: Trichophyton, Microsporum and Epidermophyton. They are grouped according to their natural habitat as geophilic (soil), zoophilic (animals), and anthropophilic(humans). ⁽⁸⁾

Ø  Transmission may be indirect (via desquamated epithelium) or direct through bodily contact. ⁽⁸⁾

HISTORICAL VIEW

à Robert Remak (1815-1865): discoverer of the fungal character of Dermatophytoses

      Robert Remak was the first scientist to undertake successful research on fungal skin infections. A neurologist, physiologist, and embryologist, Remak was the first to observe the fungal changes causing the disease of favus; however, he gave credit for the discovery to Professor Johann Schönlein and denied all attempts by others to credit him with the discovery by calling them a mistake. He named the disease Achorion schönleinii; however, over time, the name was changed to Trichophyton schoenleinii.  ⁽⁹⁾

Ø PREDISPOSING FACTORS

Warm, humid climate, poor nutrition and hygiene, obesity, diabetes mellitus and debilitating illness. ⁽⁸⁾

CAUSES

Ø  Age, sex, genetic and racial factors

Ø  Endocrine and metabolic factors

Ø  Temperature and microenvironment

Ø  Competing organisms and co-pathogens ⁽¹⁰⁾

PATHOLOGY

Ø  Invasion of the epidermis by dermatophytes follows a common pattern, starting with adherence between arthroconidia and keratinocytes, followed by penetration through and between cells and the development of a host response.  ⁽¹⁰⁾

CLINICAL FEATURES

These depend upon the site and the species of fungus involved,

v Tinea corporis - Typical infections consist of erythematous, scaly plaques, with an annular appearance that accounts for the common name “ringworm.” ⁽⁷⁾ The lesion starts as a papule which spreads ring-like peripherally with central clearing. The lesions are usually circinate with an active border consisting of vesicles and scaling. ⁽⁸⁾

v Tinea cruris - Deep inflammatory nodules or granulomas occur in some infections, most often those inappropriately treated with mid- to high-potency topical glucocorticoids. Involvement of the groin. It presents as a scaling, erythematous eruption sparing the scrotum

v Tinea pedis - variable erythema, edema, scaling, pruritus, and occasionally vesiculation. Infection of web space between the fourth and fifth toes.

v Tinea unguium - opacified, thickened nails and subungual debris.

v Tinea capitis - non-inflammatory infection with mild scale and hair loss that is diffuse or localized. Inflammatory dermatosis with edema and nodules. ⁽⁷⁾

v Tinea Barbae - It is invasion of hairs of beard by fungus, resulting in inflammatory lesion with follicular pustules. Usually due to unhygienic shaving by road side barbers. ⁽¹¹⁾

Ø CLINICAL CLASSIFICATION

 ^(8) (10)

DIAGNOSIS

Dermatophytes are seen as hyphae and spores in skin scales (obtained by scraping with a scalpel) or in nail or hair samples, and mounted in 10% KOH for 20 minutes. These can also be cultured on Sabouraud’s medium, or on Dermatophyte Test Medium (DTM). ⁽⁸⁾

Nail clippings may be sent for histologic examination with periodic acid–Schiff (PAS) stain. ⁽⁷⁾

DIFFERENTIAL DIAGNOSIS

·       Tinea capitis - Alopecia areata, Seborrheic dermatitis, Psoriasis, Bacterial infections and tumors, trichotillomania

·       Tinea corporis - Nummular dermatitis, Atopic dermatitis, Tinea versicolor, Granuloma annulare, Candidiasis, psoriasis, pityriasis rosea

·       Tinea manuum - Irritant or allergic contact dermatitis, Psoriasis

·       Tinea cruris – Candidiasis, Seborrheic dermatitis, Psoriasis and lichen simplex chronicus.

·       Tinea pedis - Contact dermatitis, Dyshidrotic eczema (pompholyx), Psoriasis

·       Tinea unguium – Psoriasis, paronychia, trauma. ⁽¹²⁾

COMPLICATIONS

à These include permanent alopecia due to scarring and an allergic vesicular reaction on the sides of fingers and palms. Atypical presentations of tinea occur in the immunosuppressed and when the rash is mistreated with topical steroids (“tinea incognito”). ⁽¹³⁾

Ø MANAGEMENT

Ø Prophylaxis

1.     Patients who sweat a lot should change their clothes frequently, wear cotton socks and avoid synthetic material.

2.     Clothes, especially the underwear, and towels should be boiled in hot water.

3.     Footwear should be of the open type permitting sufficient aeration.

4.     Intertriginous areas should be kept dry with powders, e.g. talcum or antifungal powder.

5.     Shampoo the hair immediately after visit to the barber’s shop. ⁽⁸⁾

Ø Treatment

Ø Treatment can be topical (terbinafine or miconazole cream) or systemic (terbinafine, griseofulvin or itraconazole). ⁽⁶⁾

Ø Homoeopathic management

“If we do not increase our knowledge of the capabilities of our homoeopathic drugs, our homoeopathic art will become static. It will make no progress.”  ⁽¹⁴⁾

-Dr. H.A. Robert

                        As we all know, our homoeopathic materia medica has been enriched with innumerable and valuable drugs. We are using practically the same materia medica that we did fifty or more years ago. It requires no alteration but we need a deeper acquaintance with our remedies by applying it therapeutically. ⁽¹⁴⁾

               Homoeopathy has been defined as the Science of Therapeutics which means that department of medical science which relates to the treatment of disease and action of remedial agents on the human organism, both in health and disease.

                So, some of homeopathic remedy which are much important for treatment of ringworm from sourcebook like pocket manual of homoeopathic materia medica & repertory by W. Boericke, Materia Medica of Homoeopathic Medicines by Dr. S.R. Phatak are as under;

v Arsenicum album: Itching, burning, swellings; oedema, eruption, papular, dry, rough, scaly; worse cold and scratching. Malignant pustules. Ulcers with offensive discharge. Anthrax. Poisoned wounds. Urticaria, with burning and restlessness. Psoriasis. Scirrhous. Icy coldness of body. Epithelioma of the skin. Gangrenous inflammations. ⁽¹⁵⁾      

v Mezerium: Eczema; intolerable itching; chilliness with pruritus; worse in bed.  Ulcers itch and burn, surrounded by vesicles and shining, fiery-red areola. Zona, with burning pain. pain worse night, touch, damp weather. Eruptions ulcerate and form thick scabs under purulent matter exudes. ⁽¹⁵⁾ Intolerable; itching; agg. by warm bath; changes place on scratching; coldness after. Pruritus senilis. Eruptions; ooze, acrid, gluey moisture; form thick crusts, with pus beneath; or chalky white. Deep hard, painful ulcers agg. touch and warmth. ⁽¹⁶⁾

v Sepia: Herpes circinatus in isolated spots. Itching; not relieved by scratching; worse in bends of elbows and knees. Ringworm-like eruption every spring. Hyperidrosis and bromidrosis. Sweat on feet, worse on toes; intolerable odor. ⁽¹⁵⁾

v Tuberculinum: Dry, harsh; sensitive, easily tanned; itching in cool air, Branny scales, Psoriasis, Chronic eczema. Itching changes places on rubbing. ⁽¹⁶⁾

v Sulphur: Dry, scaly, unhealthy; every little injury suppurates. Freckles. Itching, burning; worse scratching and washing. Pimply eruption, pustules, rhagades, Excoriation, especially in folds. Skin affections after local medication. Pruritus, especially from warmth, is evening, often recurs in spring-time, in damp weather. ⁽¹⁵⁾  Eruptions almost of every kind. Skin; dry, rough; wrinkled, scaly. Itching; voluptuous; violent, agg. at night; in bed; scratching and washing. Unhealthy; Breaks Out; festers and would not heal. Burning when scratched; painfully sensitive to air, wind, washing etc. Eruptions alternate with other complaints, asthma etc. ⁽¹⁶⁾

v Tellurium: Circular; eruptions; lesions. Ringworm; cover the whole body; lower limbs; on single parts, scrotum, perineum etc. Itching, pricking; as from bugs.  Burning in old scars. barber’s itch. Itching agg. in cool air. ⁽¹⁶⁾ Itching of hands and feet. Herpetic spots; ringworm. Ring-shape lesions, offensive odors from affected parts. Stinging in skin. Fetid exhalations. Offensive foot-sweat. ⁽¹⁵⁾

v Bacillinum: Introduced by Dr. burnett. Ringworm; pityriasis. Eczema of eyelids. Glands of neck enlarged and tender. ⁽¹⁵⁾ Useful as an intercurrent remedy. < at Night and early morning, by cold air. ⁽¹⁶⁾ Alopecia areata. Eczematous condition of eyelids. ⁽¹⁷⁾

v Oleander: Humid, scaly, offensive -smelling, bitter-itching eruption, especially on back of head and behind ears, oozing fluid and breeding vermin; slight friction causes soreness and chafing. ⁽¹⁸⁾

v Viola tric.: urine smell like cat’s urine, tinea capitis, with frequent involuntary urination; impetigo on hairy scalp and face; crusta lactea; thick incrustations; thick yellow fluids which agglutinates the hair; burning most at night; skin difficult to heal. ⁽¹⁸⁾

Ø According to Dr. Richard Hughes…

            Tinea is a generic name, applicable to all parasitic affections, whether they be of animal or of vegetable origin. The " tinea tonsurans " is the ringworm of the scalp, "Tinea favosa " is now commonly called " favus." The treatment of this disease is one of the triumphs of homoeopathy, re commending Sulphur, Dulcamara, Viola tricolor, Oleander, and Hepar sulphuris according to the symptoms. " Tinea circinata,’: or ringworm of the surface (which must not be confounded with herpes circinatus, which is a constitutional affection), must be similarly treated (without epilation), as also " tinea decalvans "—the parasitic form of alopecia areata, and " tinea " or " pityriasis versicolor " (chloasma). Sulphurous acid makes an excellent lotion for these affections.

           Herpes circinatus (which must not be confounded with tinea circinata—" ringworm of the surface") has in my hands, since the proving of Tellurium produced so similar an eruption, always been treated by this remedy.

           Ringworm—That this disease is, when recent, amenable to internal remedies alone, seems to disprove the theory of its primarily parasitic origin; The great medicine for it is Sepia, at about the 6th dilution. But if this fails, you must resort to some local parasiticides, of which a solution of Sulphurous acid or of corrosive sublimate is the best. ⁽¹⁹⁾

Ø According to J. C. Burnett (M.D.) …

“The trichophyton is not the disease itself, but its organic scavenger. Cure the internal disease, and this scavenger dies.”  ⁽²⁰⁾

-Dr. J. Compton Burnett

à Ringworm is an Internal Disease of the organism having for its outward sign the ringworm consisting of fungi thriving in a certain order: the fungi are the guests of the diseased host; cure the host’s diseased state, and the fungus—the ringworm—dies off from lack of a proper medium.

à The internal treatment of ringworm by Sulphur, Sepia, and Tellurium is good, the treatment of ringworm by the internal administration of very infrequent doses of high potencies of Bacillinum is direct, exact, radical, and beyond compare; the remedy being pathologically homoeopathic to the whole morbid state and crasis of the individual, and not merely pathologically similar to the superficial cutaneous manifestations.

à In daily life we find ringworm a difficult disorder to cure: a few cases yield to almost any sensible treatment, but the bulk of them offer a stubborn resistance.

1)    it is a constitutional complaint.

2)    it is generated by the together-being of numbers of young people in close spaces i.e., by their personal emanations, or anthropotoxine.

3)    it is so to speak, "subtuberculosis."

4)    it is curable by its pathologic similimum here termed Bacillinum, in high potency, internally and infrequently administered.

5)    That the mycosis is merely the concomitant external manifestation of the disease and not the disease itself.

6)    the external treatment of the disease is irrational, unscientific, and, probably, harmful to the patient.

7)    it is commonly bred in schools.

8)    truly healthy children cannot catch it because the fungus cannot grow upon such.

9)    There is, therefore, no reason why a ringworm child should be excluded from school life or the company of its fellows in home life.

10) And, finally, that the trichophyton of ringworm is to ringworm what the bacillus of Koch is to tuberculosis, —the trichophyton and the bacillus being, moreover, nearly related to one another. ⁽²⁰⁾

OBJECTIVE  OF  THE  STUDY:

·       To Study the Clinical Presentation of various types of ringworm (tinea) in Details.

·       To Study the Scope of Homoeopathy in Different types of ringworm (tinea).

·       To Determine the effect of Homoeopathic Medicines in treatment of ringworm.

material  and  methods:

SOURCES  OF  DATA:

PROJECT SITE:

Ø O.P.D of C.D. Pachchigar college of Homeopathic Medicine & Hospital; Near Navjivan Circle, Udhana Magdalla Road, Surat- 395001.

MATERIALS:

1)    College O.P.D. Standard case taking format.

2)    Homeopathic computerized software’s CARA PRO. V. 1.4

3)    synthesis: Repertorium Homeopathicum Syntheticum by Frederik Schroyens, MD.

4)    Consent form of patient.

5)    books - various books related to practice of medicine, materia medica, repertory.

METHOD  OF  COLLECTION  OF  DATA:

1)    Study Design - Experimental study

2)    Type of study - Prospective study

3)    Details of Data Collection:

A.    Duration of study: 9 months

B.    Study population – cases having complain of ringworm who treated with homoeopathic medicine at c.d. Pachchigar college of homoeopathic medicine and hospital.

C.   Sample Size: 30 cases

D.   Sampling technique: Patients will be selected randomly on the basis of inclusion & exclusion criteria. (simple random sampling)

E.    Selection Criteria for cases:

    Inclusion criteria:

1.     Including age between 16 to 60 years.

2.     Including both sexes.

3.     Including all socioeconomic classes.

4.     Cases which are diagnosed clinically according to history, sign & symptoms, through observation and also included pre-diagnosed cases.

    Exclusion criteria:

1.     Age of patient more than 60 years and less than 16 years.

2.     Patient having on any drug induced condition.

3.     Cases along with any kind of co-morbid illness.

4.     Cases with complication like lichenification and eczema.

4)    Case Taking will done as per the instructions given by Dr. Hahnemann in aphorisms § 83-104 in Organon of Medicine.

5)    Analysis & Evaluation of symptoms will be done after Totality formation.

6)    Totality Formation will be done as per the instructions given by Dr. Hahnemann in Organon of Medicine.

7)    Remedy will be selected on the basis of Totality of Symptoms. Therapeutic, constitutional and antimiasmatic remedy will be prescribed as per requirement of cases.

8)    Remedy will be administered in various potencies depending on the case. All the medicines will be administered through oral, sublingual route.

9)    Homoeopathic Remedies will be dispensed from C.D. Pachchigar College of Homoeopathic Medicine & Hospital - Homoeopathic pharmacy as per the guidelines of Dr. Hahnemann advised in Organon of Medicine (6^th edition).

10) Follow up cases will be done at every 7,15,21,30 days as per requirement of case.

11) Response will be analyzed in following way -Cure, Significant Improvement, Mild Improvement, Status quo, Left treatment.

CONCLUSION:

•        Finally, Conclusion will be drawn in view of objectives laid down in the study.

DOES  THE  STUDY  REQUIRING ANY  INVESTIGATION  TO  BE CONDUCTED  ON  PATIENTS  OR OTHER  HUMANS  OR  ANIMALS?

As per requirement of the case

HAS  ETHICAL  CLEARENCE BEEN  OBTAINED  FROM  YOUR INSTITUTE?

YES

BIBILIOGRAPHY: