A CASE OF ACNE VULGARIS

Author: Dr Pramod K, MD (Hom) working as Chief Medical Officer in the Dte of AYUSH, Govt of NCT of Delhi

Key words: Acne Vulgaris, Calc.sulph.

IntroductionAcne vulgaris 1 is the formation of comedones, papules, pustules, nodules or cysts as a result of obstruction and inflammation of pilosebacious units. It most often affects adolescents. Diagnosis is by examination.

Etiology and Pathophysiology2

Acne occurs when pilosebaceous units become obstructed with plugs of sebum and desquamated keratinocytes and may be infected with normal skin anaerobe Propionibacterium acnes. Manifestations differ depending on whether P. acnes stimulate inflammation in the follicle; acne can be inflammatory or non inflammatory.Comedones are uninfected sebaceous plugs impacted within follicles. Comedones are termed open or closed depending on whether the follicles dilated or closed at skin surface.Inflammatory acne comprises papules, pustules, nodules and cysts. Papules appear when lipase from P. acnes metabolise triglycerides into free fatty acids(FFA),which irritates the follicular wall. Pastules occur when active P. acne infection causes inflammation within the follicle. Nodules and cysts occur when rupture of follicles due to inflammation, physical manipulation or harsh scrubbing releases FFAs, bacteria and keratin into tissues, triggering soft tissue inflammation.The most common trigger is puberty, when surges in androgen stimulates sebum production and hyperproliferation of keratinocytes.Other triggers include hormonal changes that occur with pregnancy, menstrual cycle, occlusive cosmetics, clensing agents, clothings, humidity and sweating.Association between acne exacerbation and diet, inadequate face washing, masturbation and sex are unfounded. Acne may improve in summer months because of sunlight’s anti-inflammatory effects.

Classification of Acne severity2

Mild <20 comedones, or < 15 inflammatory lesions or < 30 total lesions

Moderate 20 to 100 comedones, or 15 to 50 inflammatory lesions or < 30 to125 total lesions.

Severe >5 cysts, or total comedone count >100, total inflammatory count >50 or >125 total lesions

Diagnosis and Differential diagnosis

Diagnosis is obvious on examination. Differential diagnosis includes rosacea in which no comedones are seen, perioral dermatitis, acneiform drug eruptions and corticosteroid induced acne, in which lack of comedones and pustules are in the same stage of development.

Homoeopathic conceptAcne vulgaris is an expression of psoric miasm. Unhealthy skin, every little lesion passes into sores. Skin dry, rough and pimply, unwashed and unclean appearances are psoric manifestations3.Hahnemann highlighted the following regarding the treatment of these disease conditions. “No cutaneous eruptions, of whatever kind it may be, ought to be expelled through external means by any physician who wishes to act conscientiously and rationally”. In every case there is at the bottom a disorderly state of the whole internal living organism. Therefore the eruptions are only to be removed by internal healing and curative remedies which change the state of the whole. Then the eruptions which are based on the internal disease will be cured and healed by itself without the help of any external remedy and more quickly than it could be done by external remedies4.

Case Report:

Male patient aged18 yrs presented with pustular, indurated eruptions on face. Eruptions are painful and occasional itching when getting warm and discharge of pus and blood. The patient had been suffering from these complaints since 2-3 years and took various treatments and outcome was not satisfactory. It is observed from the history that all the comedones are turning into pustules and healing occurs with the discharge of its contents.

Personal History of the Patient:

Patient is a student, belonging to lower socioeconomic class.No addictionsMixed diet Appetite and thirst normal No marked desires and aversions observed. Bowels are regular and satisfactoryUrine –normalSleep wellPerspiration general Thermal reaction- intolerance towards warmth of all kinds

Previous history shows tendency to the formation of boils in the body especially in humid weather.Family history: No relevant complaints

Treatment history: Took allopathic treatment but had no long lasting improvement.Physical Examination: Moderately built and nourished no pallor, not icteric, no cyanosis, no lymphadenopathy, BP 110/70 mm of Hg, Pulse: 72/mt.

Examination of Skin : Multiple pustules, papules and cysts on both cheeks.

AnalysisAs this patient has few general symptoms, the particular symptoms are considered for the selection of remedy.The following rubrics were selected5

1. Skin –Unhealthy skin2. Eruption on face-acne simplex3. Eruption on face-pustules

Homoeopathic Treatment:

The patient has been advised to wash face with soap and shampoo the hair at regular interval. Also advised to avoid greasy cosmetics and hair oils.

Prescription & Follow upBased on the pathological symptoms, thermal reaction and tendency to suppuration Calc.sulph was selected and administered in 6x trituration thrice daily for 1 week and followed by 30c and 200c. Pustules are healed and almost disappeared in a period of one month.

Discussion

In this case, the lesions showed the signs of improvement within a week and it is more marked when the medicine was administered in centesimal potencies. Calc sulph, is a tissue remedy introduced by Schuessler and has been used on biochemic theory. Many authors have high lighted it’s efficacy in controlling the process of suppuration. This has to be studied further for verification to asses Calc sulph’s efficacy in centesimal potencies.

References

1. Beers, H Mark et.al (2006)The Merck Manual of Diagnosis and Therapy, Merck Research Laboratories Publication, Eighteenth Edition, p 9412. Beers, H Mark et.al (2006) ibid p 9423. Speight Phyllis (1994)A Comparison of the Chronic Miasm ,B. Jain Publications,

New Delhi, p 324. Hahnemann Samuel (1991) The chronic disease(1991) B. Jain Publications,New Delhi,p 174

5.Boericke E Oscar (1984), Pocket manual of Homoeopathic Materia Medica, B. Jain Publications, New Delhi, p 744

Photograph 1(a) Photograph 1 (b)

Photograph 2(a)

Photograph 2(b)

Photograph 3(a)

Photograph 3(b)

Photograph 1(a),(b) at the beginning of treatment.

Photograph 2(a),(b) during the course of treatment.

Photograph 3(a),(b) at end of one month.