Section - 7

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Section - 7

TINEA INFECTIONS

Introduction

� Ringworm (tinea) is a fungal skin infection caused by several different fungi and generally classified by its location on the body.

� It usually affects keratinized structures like skin, hair or nails.

Incidence

� Fungal infections are common in tropical and humid countries.

Etiology

� Contagious infection of the skin caused by a group of dermatophytes called fungi.

Predisposing factors include

� Trauma

� Warm and humid environment

� Lack of fresh air and sunlight to the affected part

� Previous infection with fungus

� Debility

Diagnosis chart for fungal infections

� Wearing tight clothes

Classification

Classified on the basis of the site of infection:

� Tinea capitis: fungal infection involves scalp

� Tinea pedis: fungal infection involves feet

� Tinea unguium: fungal infection affecting nails

� Tinea corporis: fungal infection involving the body

� Tinea cruris: fungal infection involving groins or inner part of thighs

Type of fungal infection Causative organisms Identifying features

TINEA CAPITIS

� Highly contagious and is very common Microsporon or � Scaly variety (caused by Microsporon)

among children Trichophyton • Circular patch of partial hair loss with thin

� Males are more commonly grayish scales

infected than females � Kerion variety (caused by Trichophyton)

• Initially, it causes small boil like lesions with

little oozing and no pus

• In later stages red, painless, boggy swelling of

the lesions

• Irregularly distributed on the scalp with

areas of partial alopecia, appearing with a

grayish sheath on the hair

� Black dot variety: (caused by Trichophyton)

• Complete alopecia

• Black dot are visible at the periphery of the

lesions

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Type of fungal infection Causative organisms Identifying features

TINEA PEDIS

� Also known as Athlete’s foot Trichophyton or � Lesions with mild scaling with or without redness

� Common fungal infection, usually appears during Epidermophyton and itching

warm and rainy weather � Severe scaling, with painful cracking

� Heavy, closed and ill fitted shoes worn for long (fissuring) of the skin

hours predispose to fungal infection � Scaling may involve a small area or the entire

� Infection may spread by sharing bathrooms, sole of the foot

swimming pools and walking bare foot � Vesicles or blisters can also form

Type of fungal infection Causative organism Identifying features

TINEA UNGUIUM

� In chronic inter-digital form

• White membranes covering a glazed,

fissured skin seen in inter digital area

� In chronic hyperkeratotic variety, check

for scales on soles and sides of feet

• Defined patches of hyper keratotic powdery

scaling on erythematous thickened base

can be seen

� Tinea unguium, sometimes consequential to Trichophyton � Onycholysis

tinea pedis � Thickened, discolored (white, yellow, brown,

� Infection is more common on the toe nails than black), brittle and dystrophic nails

on the fingernails � An infected toe nail may separate from the

toe nail bed, crumble or flake off

� Inflammation is rare, if present it may cause

pain


Type of fungal infection Causative organism Identifying features

TINEA CORPORIS

� Tinea corporis is a common infection seen in Trichophyton � Begins as erythematous, scaly plaque like

typically hot and humid climate lesion.

� Tinea corporis secondary to tinea capitis typically � Lesion may become annular or ring shaped,

occurs in children with an area of central resolution.

� Develops anywhere on the skin and can spread � As a result of the inflammation, scales, crusts,

rapidly to other parts of the body papules, vesicles, and even bullae may

develop

Type of fungal infection Causative organisms Identifying features

TINEA CRURIS

� Infection may spread from infected toes or nails Trichophyton, � Occurs on inner side of thighs

� Fungus may also be transmitted by infected Microsporum, or � May spread to adjoining areas such as genitals

lavatory seats and by laundry clothes Epidermophyton and later to buttock and trunk

� Lesions characterized by a well defined patch of

scaling, vesicles and pustule. May be

associated with inflammation which is more

marked at the periphery of lesions

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Case presenting with erythematous, scaly, plaque like lesions with central

clearance and inflamed border (ring like lesion) or thickened brittle toe nails

General condition

improved

Continue treatment till

all symptoms relieve

Start homoeopathic treatment and advice

to follow preventive management

Call for follow up after 7 days

Complaints not improved

or aggravated

Advice patient to wait, review the

prescription and call for second follow up

General condition improved

Continue treatment till skin

complaints are cured

Not improved till four

weeks follow up

Refer to

Dermatologist

Advice for preventive management

� Do not share towels and personal items

like comb, hair brush, clothing, etc.

� Advice to dry the body thoroughly and

particularly the areas with folds and joints

after bathing.

� Wear loose-fitting cotton clothing.

� Change socks and underwear at least

once a day.

� Keep skin clean and dry.

� Maintain hygiene.

� Overweight patients should be advised

to lose weight to reduce chafing and

sweating.

� Wear slippers or sandals in public bathing

areas.

� It is advised to shower and shampoo

well after any sport.

� Dry clothes well under sun.

� Oozing lesions or containing pus usually

indicates secondary bacterial infection.


Homoeopathic management

No local treatment is recommended. Instead it needs constitutional treatment on the basis of miasmatic dyscrasia as taught by Hahnemann

in his Organon of Medicine. The remedies most frequently indicated in the different forms of Tinea are as follows:

Medicines General indications Particular symptoms

Bacillinum Tubercular diathesis; constant disposition to take cold; • Ringworm, especially of the scalp.

taciturn, sulky, snappish, fretful, irritable, fear of dogs. • White, bran-like, scales cover the lesion.

• Intense itching worse at night, when undressing and

after bathing.

• Scaly eruptions on margin of eyelids.

Natrum muriaticum Hot patient; poorly nourished; great emaciation (marked • Dry eruptions along the margin of hair; bends of joints

on neck); losing flesh while eating well; craving for salt; and behind ears.

aversion to bread and fatty things; constipated; increased • Eruption raw and red; worse when eating excessive

thirst; mapped tongue with red insular patches; melancholic, salt, in warmth and at sea shore.

sad, plays alone, irritable, cross, cries when spoken to; • Itching worse from warmth and better on sweating.

awkward, hasty, drops things from nervous weakness;

disposition to weep without cause, consolation aggravates.

Sepia Chilly patient; thin built with yellow saddle across the upper • Eruptions more on flexures of the body: elbows, knees,

part of the cheeks and nose; big belly; dry flabby skin; face, hands and anterior surface of body.

predisposed to take cold at change of weather; desire for • Herpes circinatus (tinea corporis) in isolated spots on

sour food which aggravates; cheerful, active when well but upper part of body.

indifferent and quarrelsome when sick; self-absorbed, sad, • Eruptions worse in spring.

weeping and indolent. • Brownish or yellowish brown coloured vesiculo-papular

rings.

• Itching changes to burning on scratching.

• Itching in the lesions, not better by scratching.

Tellurium Offensive, acrid discharges, especially foot sweat; craving • Herpes circinatus and tinea capitis.

for apples; fear of being touched, forgetful, careless. • Ringworm of the face, occiput, back of ear and body.

• Red, elevated, intersecting rings on any part of the

body.

• Body thickly covered with elevated rings.

• Ring shaped lesions.

• Offensive odor like fish brine or garlic from affected

parts.

• Severe itching day and night; worse from cold and

sweating.

Chrysarobinum Prone to skin affections, foul smelling discharges. • Ringworm and herpes tonsurans (tinea capitis).

• Vesicular lesions and crust formation associated with

foul smelling discharge.

• Small crusts tend to become confluent and give

appearance of a single large crust.

• Violent itching of thighs, legs and ears.

• Dry scaly eruptions around eyes and ears, scabs with

pus underneath.

Clematis erecta Emaciation; great sleepiness; drowsy; aversion to washing; • Scabby, scaly, vesicular eruptions; itches and burns

better in open air; indifferent, weak memory, confused. terribly.

• Itching worse washing in cold water and new moon.

• Glands hot, painful and swollen.

Viola tricolor Chilly patient; aversion to open air; disobedient, ill-humored, • Tinea capitis with copious, disagreeable cat-like odor

morose, hurry in movement, capricious. of urine.

• Tinea favosa; affects scalp and nails, with swelling

and induration of cervical glands.

Contd...

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• Eruptions, particularly over face and head with

unbearable burning and itching, worse at night.

• Thick scabs, which crack and exude tenacious yellow

pus, matting the hair.

• Nervous paroxysm after suppressed skin eruptions.

Dulcamara Chilly patient; skin affections brought on or worse by exposure • Ringworm, especially on face, scalp, genitals and

to cold damp rainy weather; restless and irritable. hands.

• Tinea circinata.

• Thick, brown and yellow crusts, bleed when scratched.

• Skin eruptions brought on in cold wet weather but

relieved by cold applications.

Mezereum Chilly patient; sensitive to cold air; after effects of vaccination; • Tinea capitis with secondary infections.

prone to skin affections; constant longing for food, craving for • Thick, leathery crusty lesions with copious pus oozing

fat; indifferent, vexed and angry at trifles but is soon sorry from underneath the crusts.

for it, aggravation while alone. • Child scratches face continuously.

• Inflammatory redness of face.

• Eruptions moist and intense itching worse at night and

when in bed.

• Chilliness with pruritus.

• Very sensitive to touch.

• Burning and erythema around the lesions.

Sulphur Hot patient; kicks off the cloth at night; dirty, filthy, does not • Dry, scaly, unhealthy skin.

want to be washed; lean, thin, stoop-shouldered children who • Skin affections that have been treated by medicated

walk and sit stooping; red orifices; desires sweets; when the soaps and washes.

best selected remedy fails to improve; restless, quick • Tinea capitis.

tempered. • Voluptuous itching of skin; better scratching. “Feels

good to scratch”.

• Scratching causes burning; worse from heat of bed.


SCABIES

Definition

� Scabies is an itchy skin condition characterized by burrow formation along with erythematous papules, excoriations, nodules,

vesiculopapular, or bullous lesions.

Incidence

� Affects people of all the races. More common in children younger than 2 years of age.

Etiology

Causative organism:

� Sarcoptes scabiei

Spread of infection:

� Contact with infected individuals

� Contact with infected clothes, bed linen, towels, etc.

Predisposing factors:

� Poor hygiene

� Crowded living conditions

� Conditions such as natural calamities, wars

� Immunocompromised state

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Clinical features and diagnosis

A child presents with complaints of:

� Vesicular, papular or erythematous skin eruptions

� Itching in finger webs, hands, wrists, groins and between buttocks

� Itching more severe at night

On examination

� Burrows formation, excoriation or nodules formation

� Erythematous papules or vesiculo-papular or bullous lesions

Look and check for

� Site of burrows : slightly elevated, grayish tortuous or dotted line, usually on hands, in finger webs, wrists, feet and also on male genitalia

� Scratching destroys the burrow and presence of mites or egg may be found in the nails.


Note:

Skin condition

improved

Continue

treatment till

skin complaints

are cured

Start homoeopathic treatment

and advice preventive measures

Call for follow up after 15 days

Skin condition

improved

Not improved or

Complaints aggravated

Reassess the case,

continue treatment

and call for second

follow up after a week

Complications

Not improved

Refer to

Dermatologist

Preventive measures:

� Secondary bacterial infection may occur: can

be detected by formation of pus or fever.

� Treat all members of the family concurrently even when there are no skin lesions.

� Maintain hygiene and do regular bathing with

soap.

� Do not share personal belongings like clothes,

towels, etc with the infected patients.

� Nails to be trimmed frequently.

� During and after completion of treatment, all clothes and bed linen should be boiled, sun-dried and subjected to hot ironing.

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Homoeopathic management

Common homoeopathic medicines used and their symptomatic indications

Medicines General indications Particular symptoms

Sulphur Hot patient; kicks off the cloth at night; dirty, filthy, does not • Vesicular, pustular eruptions with tendency for

want to be washed; lean, thin, stoop-shouldered children who ulceration; with offensive discharge.

walk and sit stooping; red orifices; desires sweets; when the • Voluptuous itching and burning, worse from washing,

best selected remedy fails to improve; restless, quick warmth of bed and at night.

tempered. • Scabies with secondary infection.

Mercurius solubilis Sensitive to changes of temperature; lax musculature; profuse • Vesicular and pustular eruptions.

offensive perspiration; tongue flabby with imprint of teeth, • Itching all over, worse at night, from warmth of bed

increased salivation; worse at night, in wet damp weather; and perspiration.

weak memory, fearful, shy, hurried, violent, impulsive, • Skin almost always moist.

nervous, irresolute.

Psorinum Extremely chilly patient, wants to cover even in hottest • Tendency for skin diseases.

summer weather; pale, delicate, sickly; scanty perspiration; • Dry, coarse skin; dirty looking, filthy skin, as if never

offensive discharges; wakes up at night feeling hungry; washed.

anxious, fearful, child is good all day while restless and • Eruptions disappear in summer, return in winter.

troublesome at night. • Intolerable itching, worse in warmth of bed causing

sleeplessness.

• Eruptions around fingernails, easily suppurate.

• All the discharges have carrion- like odor.

Few other medicines which can be used for Scabies on symptomatic indications are:

Anthrakokali, Croton tiglium, Hepar sulphuris, etc.

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MOLLUSCUM CONTAGIOSUM

Introduction

� It is a viral disease, mainly affecting skin and mucous membranes.

Incidence

� Endemic disease with higher rate of incidence in overcrowded communities and institutes.

Etiology

Causative agent:

� Pox virus

Predisposing factors:

� Poor hygiene

� Immunocompromised patients

Mode of infection:

� Direct contact with an infected host or from fomite.

� Auto-inoculation causes spread to different parts of body, through contaminated objects like towels, clothings, toys etc.

Incubation period:

� Average incubation period is more than 2 weeks (may extend upto 6 months)

Clinical presentation

� Skin lesions: Smooth, discrete, pearly, skin colored, dome shaped papular eruptions, vary in size from 1-5 cm.

� They typically have a central umblication from which plug of cheesy material can be expressed.

� The papules may occur anywhere on the body (face, eyelid, neck, axilla and thighs are site of predilection).

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Check the immune

status

Immunity not compromised

Improvement

Call for follow up after 15 days

� Lesions reduced

� No new eruptions

seen

Continue

treatment till skin

complaints are

cured

Underlying cause for immuno compromised state

Start homoeopathic treatment and advice for preventive measure

No improvement

or

Complaints

aggravated

Re-assess the case and advice patient to

continue treatment

Note: Molluscum is a self limiting condition and usually subsides in 6-9 months.

Homoeopathic management

Common homoeopathic medicines used and their symptomatic indications

Preventive measures:

� Maintain hygiene.

Begin appropriate

homoeopathic treatment in

consultation with Pediatrician

or Dermatologist

� Do not share personal belongings like clothes, towels,

etc. with the infected patients.

� Avoid scratching as it will prevent spread of auto

infection.

� Regular trimming of nails.

Medicines General indications Particular symptoms

Bromium Chilly patient; delicate skin, red cheeks; fatty; fair; tendency to • Molluscum commonly appears on the face, arms and

have crops of boils; great weakness and easily overheated shoulders.

then sweat profusely and sensitive to drafts; glandular affinity; • Sensation of something alive in the skin.

tremulous; better by eating; quarrelsome and/or friendly, • Worse warmth or warm, damp weather.

cheerful and fairly happy.

Calcarea arsenicum Chilly patient; anemic; tendency for epilepsy and nephritic • Pearly eruptions.

conditions; infantile hepato-splenomegaly; restless, anxious • Vesicular, small and shiny eruptions.

and emotional child; dreads to be alone.

Silicea Extreme chilly patient; all symptoms worse by cold except • Eruptions heal with difficulty and suppurate easily.

stomach complaints, which are ameliorated; profuse, offensive • Vesicular, smooth and shiny eruptions.

discharges; sweats profusely especially on feet; easy

suppuration; glandular affinity; large head and distended

abdomen, weak ankles; slow in learning to walk; constipation,

Contd...


stool being partly expelled recedes back again; obstinate,

head strong, cries when spoken kindly to, nervous,

apprehensive, oversensitive, irritable and fearful.

Thuja occidentalis Dark, fleshy children with greasy face, dark hair and unhealthy • Eruptions only on covered parts.

skin, looks dirty with brownish spots; perspiration on uncovered • Umbilical form of eruptions.

parts, smells sweetish and strong; complaints worse in damp,

humid weather; lazy.

Dulcamara Chilly patient, with skin affections brought on or worse by • Ailments after taking bath in swimming pool, after

exposure to cold, damp, rainy weather; restless and irritable. being chilled while hot.

• Humid eruptions on face, genitals, hands etc.

• Flat, pearly eruptions.

• Worse from sudden changes of temperature.

Belladonna Delicate skin; dryness; bright redness; burning heat; throbbing; • Red, inflamed molluscum.

pains appear and disappear suddenly; wildly delirious, restless, • Burning of the skin, also felt by the hand and it continues

sensitive, nervous; child jovial and entertaining when well but to burn after touching the skin, as though a hot stove

violent when sick. has been touched.

• Shiny redness of the skin, with dryness, and swelling

of the parts.

Few other medicines which can be used for molluscum contagiosum on symptomatic indications are:

Calcarea carbonica, Causticum, Natrum muriatcum, etc.

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PYODERMA

Introduction

� Pyoderma refers to a group of conditions caused by infection of skin by pus forming organisms.

� The most common causative organisms are Staphylococcus aureus and Streptococcus pyogenes.

Pyodermas affecting epidermal layer

of the skin

(Infection of the upper epidermis of the skin

caused by Streptococcus pyogenes or

Staphylococcus aureus)

Impetigo contagiosa

Occurs secondary to

other skin conditions

such as scabies,

pediculosis, insect

bites, herpes,

eczemas, etc.

Commonest site of

occurrence is on the

face.

Characterized by

formation of vesicles

which on rupturing

leave a crusted

exudate of honey or

yellow colour over

the superficial

erosion. The

infection is

contagious and

spreads to distal

areas from

scratching.

Impetigo

Bullous impetigo

Commonest site of

occurrence is trunk

and extremities in

newborns and

young children.

Presents as

diffusely scattered,

bullae which are

filled with purulent

fluid. Bullae rupture

leaving flat,

brownish crusts.

Types of Pyoderma

Infection of the lower

epidermis and upper

dermis

Ecthyma

Occurs commonly in

older children on legs

and feet.

Predisposing factors:

• Poor hygiene

• Malnutrition

• Tropical climate

• Crowded living

conditions

• Underlying skin

conditions

Characterised by

formation of vesicles,

which dry up to form

dark brown or black,

hard crust, adherent to

the skin. Crust after

removal forms a

shallow, purulent,

irregular ulcer. Pus is

usually blood stained.

Pyodermas affecting dermal

layer of the skin

Infection of deep dermis of

the skin and the

subcutaneous tissue

Infection of upper

layer of dermis

Cellulitis Erysipelas

Commonly occurs in

the area of skin

trauma or skin barrier

breakdown.

Predisposing factors:

Underlying skin

conditions such as

surgical wounds,

injuries, cutaneous

ulcers, etc.

Characterised by

spreading redness

with indistinct borders,

warmth and

oedematous

appearance of the

skin.

Usually caused by

Streptococci. Common

in infants and young

children.

Presents as sharply

defined, slightly

elevated tender

erythematous area

with constitutional

symptoms such as

fever, chills, malaise,

regional

lymphadenopathy.


Laboratory diagnosis

Culture examination reveals Staphylococcus, most commonly in combination with Streptococcus pyogenes or other Group A haemolytic streptococci,

but either may occur alone.

Pyoderma of less than 10 pustules → → Begin appropriate Homoeopathic treatment

Pyoderma of more than 10 pustules → Homoeopathic treatment in consultation with Pediatrician

Homoeopathic management

General management

� Avoid touching or scratching the affected parts.

� Use soap and water to bathe the child.

� Avoid sharing of clothes, towels, etc. with the infected child.

Prevention of Impetigo and Ecthyma

� Use soap and water to bathe the child.

� Pay special attention to cuts, rashes, insect bites and allergic reactions.

� Avoid scratching of affected sites.

� Keep finger nails of the child clipped short.

Common homoeopathic medicines along with their symptomatic indications used for pyoderma are:

Medicines General indications Particular symptoms

Arnica montana Putrid phenomenon; septic conditions; prophylactic for • Tendency to small and painful boils one after another.

purulent conditions; offensiveness; bruised, soreness all • Extremely sore boils.

over body as if broken; desires sour; aversion to meat and • Itching and burning in eruptions.

milk; nervous, fear of being touched or being approached,

aversion to company.

Hepar sulphuris Extremely chilly patient; hypersensitive (to cold, pain), faints • Slightest injury suppurates.

easily; scrawny; glandular constitution; sweats easily; worse • Discharges from all parts of the body smell like old

in dry, cold air, better in damp weather; quick, hasty speech cheese.

and drinking; irritable, difficult to please. • Inflamed spots, eruptions, boils or suppurations have

splinter like pains.

• Skin affections extremely sensitive to touch, pain often

causing fainting.

• Ulcers, herpes, surrounded by little pimples or pustules

and spread by coalescing.

• Worse from cold air, uncovering; better warmth in

general.

Echinacea Septic conditions with foul discharges; emaciation and • Recurring boils.

angustifolia great debility. • Irritation from insect bite, poisonous plants and

lymphangitis.

• Delayed healing or non-healing ulcers.

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Mercurius solubilis Sensitive to changes of temperature; lax musculature; • Vesicular and pustular eruptions.

profuse offensive perspiration; tongue flabby with imprint of • Ulcers irregular in shape with undefined edges.

teeth, increased salivation; worse at night, in wet damp • Skin inflamed, hard with burning and stinging pains.

weather; weak memory, fearful, shy, hurried, violent, • Inflamed parts with tendency to indurate.

impulsive, nervous, irresolute. • Constantly moist; abscesses, slow to suppurate.

• Every little injury suppurates.

Rhus toxicodendron Chilly patient; sore, bruised and stiff; restless, can’t rest in • Cellulitis and infections.

any position; red triangular tip of tongue; worse in damp, cold, • Carbuncles in early stages.

rainy weather, during rest and sleep, better by continued • Eruptions vesicular, yellow with much swelling,

motion; increased thirst; great apprehension at night, sad inflammation

and anxious. • Burning, itching and stinging pains.

• Red, swollen with intense itching.

• Great sensitiveness to open air.

• Worse during sleep, cold, wet rainy weather and after

rain; better from warm applications.

Silicea Extreme chilly patient; all symptoms worse by cold except • Unhealthy skin, every little injury suppurates.

stomach complaints, which are ameliorated; profuse, offensive • Pus offensive.

discharges; sweats profusely especially on feet; easy • Promotes expulsion of foreign bodies from tissues.

suppuration; glandular affinity; large head and distended • Skin: moist eruptions, pimples, pustules, abscesses,

abdomen, weak ankles; slow in learning to walk; constipation, felons.

stool being partly expelled recedes back again; obstinate,

head strong, cries when spoken kindly to, nervous,

apprehensive, oversensitive, irritable and fearful.

Anthracinum Septicemia; hemorrhages; black, thick, tar-like, rapidly • Succession of boils.

decomposing blood; gangrene; malignant ulcers. • Terrible burning in boils.

• Felons with rapid tendency to sepsis causing septic

fever, rapid loss of strength, sinking pulse and fainting.

• Insect stings painful with swelling, whose color

changes.

• Red streaks from the lesion map out the course of

lymphatics.

• Septic conditions with intolerable burning when

Arsenicum album or other best selected medicines fail

to relieve.

���


IMPETIGO

Introduction

� Impetigo is a contagious, superficial, bacterial skin infection, most common amongst children between 2 to 6 years of age.

� Infection is carried in the fluid that oozes from the blisters.

Definition

� Impetigo lesions are characterized by multiple, honey, crusted skin lesions commonly present on face, nares and extremities.

Etiology

� Caused by species of Streptococcus or Staphylococcus bacteria

Predisposing factors

� Poor hygiene

� Warm climate and high humidity

� Crowded living conditions

� Prior use of antibiotics

� Pre existing skin diseases (dermatitis, chicken pox, tinea or fungal infections)

� Injury or trauma to the skin

Classification: Bullous Impetigo and Non-bullous Impetigo

Clinical features and diagnosis

� Vesicular or pustular eruptions on face, lips, arms, or legs filled with yellow or honey colored fluid/pus

� Associated with oozing and crusting

� Localized lymphadenopathy (Swollen lymph nodes near the infection)

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Start homoeopathic treatment and advice to follow general management

Homoeopathic treatment on the basis

of symptom similarity

Call for follow up after 3 days

Improvement

� No pruritus

� No new eruptions

� Lesions: reduced

� General condition

improved

Continue

treatment

till infection is

completely

resolved

No

improvement

or

Complaints

aggravated

Refer to

Dermatologist

General management:

Signs of sepsis:

� Fever or low body

temperature

� Altered body tone

� Poor sucking: refusal to feed

� Lethargy

� Failure to gain weight or loss

of weight

� Fast heart rate

� Rapid breathing

� Change in mental status,

such as confusion or

decreased alertness

� Diarrhea

� Low blood pressure

� Warm, flushed skin or skin

rash or bleeding

� Decreased urine output

Immediately refer to

the hospital

� Maintain hygiene: Simple washing hands with

soap and water aids in removing the infected

crusts. Always use a clean cloth and towel

each time you wipe the child.

� Avoid scratching the skin lesions, as it will

lead to further spread of infection.

� Do not share personal belongings like clothes,

towels, etc. with the infected person.


Homoeopathic management

Common homoeopathic medicines used and their symptomatic indications are:

Medicines General indications Particular symptoms

Sulphur Hot patient; kicks off the cloth at night; dirty, filthy, does • Eruptions itch and ooze.

not want to be washed; lean, thin, stoop-shouldered children • Voluptuous itching at night in bed, and in the morning

who walk and sit stooping; red orifices; desires sweets; on waking up.

when the best selected remedy fails to improve; restless, • Itching worse from warmth of the bed.

quick tempered. • Burning after scratching.

• Crops of boils and little boil-like eruptions.

Antimonium crudum Inability to bear heat of sun, worse from over-exertion in the • Eruptions of thick hard scabs often honey colored with

sun and from over-heating; aversion to cold bathing and oozing of green fluid.

aggravated therefrom; tendency to grow fat; thick milky white • Itching especially on neck, chest, back and limbs.

coated tongue; thirstlessness; craving and intolerance for • Itching, worse from heat of the bed and cold bathing.

acids, pickles, bread; desires raw foods and vegetables; • Gastric derangements with skin complaints.

fretful, peevish, irritable, cannot bear to be touched or

looked at.

Cicuta virosa Chilly patient; sensation of internal chill; desire for indigestible • Chronic impetigo.

things; melancholy with indifference, mistrustful, violent, • No itching, exudation forms a hard, lemon-colored

moaning and howling. crust.

• Eruptions especially on the face and hands.

• Elevated eruptions, as large as peas.

Viola tricolor Chilly patient; aversion to open air, disobedient, ill-humored, • Intolerable itching.

morose, hurry in movement, capricious. • Eruptions, particularly over face and head, with burning

and itching.

• Thick scabs, which crack and exude tenacious yellow

pus.

• Worse from cold.

Arum triphyllum Acrid discharges; worse in cold wet weather and in cold wind, • Useful in Impetigo contagiosa with acrid secretions.

lying down; cross, irritable, stubborn, nervous. • Scarlet rash; raw, bloody surfaces.

• Sleeplessness from itching of skin.

Ferrum iodatum Tendency for glandular affection; anemia; easily excitable. • Crops of boils.

• Impetigo of the cheek.

Malandrinum Bad effects of vaccination. • Unhealthy dry, rough skin remaining for years after

vaccination.

• Greasy-looking pustular eruptions.

• Dry, itchy rhagades of the hands and feet; worse in

cold weather and from washing.

• Impetigo covering back of head, on extensors of

forearms, extending over back to buttock.

• Thick, greenish crusts with pale, reddish scabs.

• Itching worse in the evening.

Mezereum Chilly patient; sensitive to cold air; after effects of vaccination - • Eruptions covered with elevated white scabs.

prone to skin affections; constant longing for food, craving for • Inflammatory redness of face.

fat; indifference, vexed and angry at trifles but is soon sorry • Child scratches face continuously.

for it, aggravation while alone. • Eruptions moist, itching worse at night.

• Ulcers with thick, yellowish- white scabs, under which

thick, yellow pus collects.

Dulcamara Chilly patient; skin affections brought on or worse by exposure • Eruptions: vesicles, dry, brown, humid crusts.

to cold damp rainy weather; restless and irritable. • Multiple little boil-like eruptions (bullae formation).

• Eruptions come on the face, forehead, nose and

especially on the cheeks.

Contd...

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178

Other medicines which are useful in managing Impetigo are:

Calcarea sulphuricum, Kali sulphuricum, Ferrum iodatum, Arsenicum album, Tarteric acid and Thuja occidentalis, etc.

���

• Thick, brown and yellow crusts; bleeding when

scratched.

• Skin eruptions brought on in cold, wet weather but

relieved by cold applications.

• Enlargement and hardness of the glands.

Silicea Extreme chilly patient; all symptoms worse by cold except • Eruptions itch only in the day time and evening.

stomach complaints, which are ameliorated; light complexion; • Pus offensive.

profuse offensive discharges; sweats profusely especially on • Skin: moist pustular eruptions;

feet; easy suppuration with glandular affinity; large head and • Stinging pain on touching the eruptions.

distended abdomen; constipation, stool when partly expelled,

recedes back again; obstinate, head strong, cries when

spoken kindly to, nervous, apprehensive, oversensitive,

irritable and fearful.


WARTS

Introduction

� Warts are local growths on the skin caused by human papillomavirus (HPV) infection.

� The appearance of warts can differ based on the type of wart.

� Warts are common in children. Up to 30% of warts disappear by themselves within 6 months. Most will disappear without any treatment

within 3 years.

Predisposing factors

� Skin abrasions

� Immuno-suppression

Type of warts Clinical presentation

Common wart or verruca vulgaris � Benign tumors of skin.

� Appear as dry, rough skin colored papules.

� Most common on hands especially on periungual region.

� Common in children having habit of biting or picking nails.

� Usually asymptomatic but sometimes cause mild pain, especially when they are on weightbearing

surface (eg, bottom of the feet).

On examination

� Sharply demarcated, rough, round or irregular, firm, and light gray, yellow, brown, or gray-black

nodules 2 to 10 mm in diameter.

� May be painful.

Flat warts or verruca plana � Mildly hyper pigmented, smooth, flat-topped lesions typically found on face and extremities

(e.g. arms, dorsum of hands and knees).

� Usually spread by scratching (autoinoculation).

On examination

� Flesh colored flat topped warts.

� Often multiple.

Filiform warts � Long, narrow, frond like growths.

� Usually located on the eyelids, face, neck, or lips.

� Usually asymptomatic.

On examination:

� Long, narrow, thread or finger like growths, yellowish papules.

Plantar warts � Flattened by pressure and surrounded by cornified epithelium.

� Occurs on palms and sole.

� Often tender and can make walking and standing uncomfortable.

� Transmitted through contaminated floor surfaces.

� May occur in large numbers over a wide area of the sole or closely set plantar warts are called

mosaic warts.

On examination

� When thin sheath of surface is gently removed, fine bleeding (Pinpoint bleeding) is revealed.

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Type of warts Clinical presentation

Condylomata accuminata or genital warts � Commonly occurs on genitalia and perianal region.

� Raises suspicion of sexual abuse in children.

Start homoeopathic treatment and advice to follow

preventive management

Homoeopathic treatment on the basis

of totality of symptoms

� If widespread and persistent then immune deficiency should be suspected.

On examination:

� Typical skin lesions are soft, pink and pedunculated.

Warts: reduced

in size

Continue treatment till warts

completely resolve. The wart may

fall off or may disappear with

homeopathic treatment.

Call for follow up after 15 days

Preventive measures:

� Avoid scratching or peeling, as it can

lead to further spread of infection

Warts not improved or

complaints aggravated

Re-assess the case and advice

patient to continue treatment


Homoeopathic management

Common homoeopathic medicines used and their symptomatic indications are:

Medicines General indications Particular symptoms

Thuja occidentalis Dark, fleshy children with greasy face, dark hair and unhealthy • Tendency to grow fig warts, condylomata and wart -

skin; looks dirty with brownish spots; perspiration on uncovered like excrescences.

parts; sweat smells sweetish; complaints worse in damp, • Warts: large, seedy, pedunculated, soft and pulpy.

humid weather; lazy. • Warts bleed easily when rubbed.

Antimonium crudum Inability to bear heat of sun, worse from over-exertion in • Tendency for warts and callosities.

sun and from over-heating; aversion to cold bathing and • Warts painful, hard and horny, like excrescences, grow

aggravated therefrom; tendency to grow fat; thick milky on the hands and under the nails.

white coated tongue; thirstlessness; craving and intolerance

for acids, pickles, bread; desires raw foods and vegetables;

fretful, peevish, irritable, cannot bear to be touched or

looked at.

Dulcamara Chilly patient; skin affections brought on or worse by ·• Warts fleshy, large, smooth, on face or back of hands

exposure to cold damp rainy weather; restless and and fingers.

irritable.

Nitricum acidum Chilly patient; takes cold easily; thin built; sickly; anemic • Warts: Small, on upper eyelids with sensation of sticks;

and emaciated; weakness; affected from long sufferings; bleed easily; in and around the nostrils.

face pale, yellow, sallow and sunken; disposed to diarrhea; • Numerous large warts on back.

strong smelling urine; headstrong, irritable, fearful, vindictive,

sensitive to noise and light.

Causticum Chilly patient; dark hair and eyes; delicate; weak; prone to • Tendency to grow warts.

intertrigo or convulsions during dentition; slow in learning to walk; • Warts on the face, eyelids, tip of nose, ends of fingers

desire for salt, aversion to sweets, meat and vegetables; worse and on hands.

from dry, cold winds or in clear fine weather; restless whole • Warts: large, jagged, often pedunculated; bleeding

night, does not want to go to bed alone, least things make easily; exuding moisture.

him cry. • Warts bleed easily.

Hepar sulphuris Extremely chilly patient; hypersensitive (to cold, pain), faints • Unhealthy skin; every little injury suppurates.

easily; scrawny; glandular constitution; sweats easily; worse in • Fig warts; warts crack open and bleed, sting, burn and

dry, cold air, better in damp weather; quick, hasty speech and suppurate; offensive odor.

drinking; irritable, difficult to please. • Cannot bear to be uncovered; wants to be wrapped up

warmly.

Ferrum picricum • Suited to children with dark hair and eyes.

• Remedy for warts and lupoid growths; mostly appear

on hands.

• Multiple and pedunculated warts.

• Warts associated with deafness.

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ECZEMA

Introduction

� Eczematous eruptions are a diverse and common group of inflammatory skin conditions characterized by itching, burning, redness,

papules, vesicles and crusting in its acute phase and thickened plaques with accentuated skin markings (lichenification) and scaling in

its chronic phase.

� In contrast to Psoriasis, eczema is more likely to be found on the flexor aspects of joints.

Etiology

Hereditary cause Triggering factors

Family history of hay fever or asthma � Changes in temperature

� Synthetic or woolen clothing

� Food allergies, esp. to eggs, peanuts, butter milk, etc.

� Exposure to pollens, danders or dust, etc.

� Exposure to harsh soaps and chemicals

Types of Eczemas

Common Eczemas Less Common Eczemas

� Atopic eczema � Dyshidrotic eczema (pompholyx eczema)

� Contact dermatitis � Discoid eczema

� Xerotic eczema

� Seborrhoeic dermatitis

Identifying features

• Chronic,

relapsing

inflammatory

eczema with

hereditary

component.

• Itching often

precedes the

onset of skin

lesions.

• Family history

of hay fever,

allergies and/or

asthma is

present.

Atopic eczema

• Eczema

occurring within

few minutes or

hours after

exposure to

some skin

irritant or after

contact with

some allergen.

Contact

dermatitis

• Eczema

occurring

secondary to a

very dry skin.

• Worsens in dry,

winter weather

• Most commonly

found on the

lower part of

legs.

• Characterized by

erythematic

rash with

fissuring pattern

(crackle glaze

appearance).

Xerotic eczema

• Eczema appears

in children

between 2-6

months of age.

• Nappy area is

affected first and

then eczema

spreads to scalp,

face, neck and

armpits.

• Skin looks red,

inflamed and

flaky.

• Oily, waxy

patches or thick,

yellow, greasy

crusts over the

scalp.

Seborrhoeic

dermatitis

• Eczema

occurring on

palms, soles,

sides of fingers

and toes.

• Intense burning

or itching

sensation with

small, deep

blisters on skin.

• Eczema

worsens in

warm weather.

Dyshidrotic

eczema

• Eczema of

unknown

cause,

characterized

by round disc

shaped, clearly

demarcated

eczematous

patches.

• Most commonly

found on the

limbs and trunk.

• Eczema

worsens in

winter.

Discoid eczema


General signs and symptoms

� Dryness and redness of skin

� Intolerable itching, often worse at night

� Blisters with oozing fluid discharges

� Repeated scratching leading to thickened, crusty skin

Complications

� Repeated scratching of the skin leads to thickening and hardening of the skin called lichenification.

Prevention

� Avoid exposure to sudden change in temperature or humidity.

� Avoid getting overheated or sweating too much.

� Avoid synthetic clothes. If possible, dress the child in 100% cotton clothes.

� Avoid using harsh soaps and chemicals.

� Avoid environmental factors that trigger allergies (e.g. pollens, molds, mites, and animal dander)

� Be aware of food items that may cause eczema and avoid those food items.

Management

� Bathe the child daily with lukewarm water. Don’t use hot or warm water as it may make skin red and itchy.

� Avoid scratching.

� Apply lotions, moisturiser or creams immediately after bathing to prevent skin dryness.

� Apply cold compression on skin lesions.

� Avoid exposure to sudden temperature changes.

� Keep child’s bedroom and play areas free of dust mites.

� Use mild soaps for bathing the child and washing his/ her clothes.

� Dress the child in preferably in cotton clothing.

Homoeopathic management

Common homoeopathic medicines used for eczema in children along with their symptomatic indications are:

Medicines General indications Particular symptoms

Graphites Chilly patient, takes cold easily; fatty; pale; tendency to skin • Rough, hard and persistent dryness of the skin.

affections and constipation; lumpy, thick, hard skin and glands; • Moist eruptions in the groins.

dislikes sweets; cautious, indecisive and lazy. • Rash at the bend of thighs, nates and groins.

• Eruptions oozing, discharging a watery, glutinous fluid,

thin and sticky.

Petroleum Chilly patient; lean, emaciated subjects; symptoms appear and • Skin: eczematous, dry, very sensitive, rough, leathery

disappear rapidly; ailments during winter; foul smelling sweat and cracked (especially at tips of fingers).

especially on hands and feet; worse before and during • Dirty, hard, rough and thickened skin- like parchment.

thunderstorm; easily offended by trifles. • Itching in skin lesions, worse at night.

Contd...

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• Skin symptoms worse during winters.

• Slightest scratch makes skin suppurate.

• Thick, greenish crusts with burning and itching; redness,

raw; cracks bleed easily.

Natrum muriaticum Hot patient; poorly nourished; great emaciation (marked on • Eczema: raw, red, and inflamed; worse, eating salt, at

neck); losing flesh while eating well; craving for salt; aversion seashore, from heat of sun.

to bread and fatty things; constipated; increased thirst; mapped • Dry eruptions, especially on margin of hairy scalp and

tongue with red insular patches; melancholic, sad, plays alone, bends of joints.

irritable, cross, cries when spoken to; awkward, hasty, drops • Eruptions itch, smart and burn.

things from nervous weakness; disposition to weep without • Skin greasy and oily.

cause, consolation aggravates.

Mezereum Chilly patient; sensitive to cold air; after effects of vaccination; • Eczema as a sequel to vaccination.

prone to skin affections; constant longing for food, craving for • Eczema with shiny fiery red areola and intolerable

fat; indifferent, vexed, angry at trifles but is soon sorry for it, itching, worse in bed.

aggravation when alone. • Small vesicles with terrible itching.

• Secretion from eruptions dries quickly, producing thick

leathery crust under which pus collects.

• Eczema of face, child scratches face continuously,

which is covered with blood.

• Eczema capitis, hair get matted with ichorus pus.

• Eczema worse from warmth.

Rhus toxicodendron Chilly patient; sore, bruised and stiff; restless, can’t rest in any • Eczematous eruptions with tendency to scale formation

position; red triangular tip of tongue; worse in damp, cold, rainy and cellulitis.

weather, during rest and sleep; better by continued motion; • Skin red, swollen with intense itching.

increased thirst; great apprehension at night, sad and anxious. • Itching all over, worse on hairy parts, better from warm

water.

• Rash worse at night, itching aggravates in wet weather

and winter.

• Parts swollen and edematous.

Psorinum Excessively chilly patient, wants to cover even in hottest • Skin: dry, coarse, dirty and filthy, as if never washed.

summer weather; pale, delicate, sickly; scanty perspiration; • Eczema behind ears.

offensive discharges; wakes up at night feeling hungry; • Eruptions around fingernails easily suppurate.

anxious, fearful; child is good all day while restless and • Eruptions disappear in summer and return in winter.

troublesome at night. • Intolerable itching; despair due to itching.

• Scratches skin till it bleeds.

• Itching worse from warmth of bed causing

sleeplessness.

Sulphur Hot patient; kicks off the cloth at night; dirty, filthy, does not • Dry, scaly eruptions with easy suppuration.

want to be washed; lean, thin, stoop-shouldered children who • Itching voluptuous; scratching ameliorates; feels good

walk and sit stooping; red orifices; desires sweets; when the to scratch, but scratching causes burning later.

best selected remedy fails to improve; restless, quick tempered. • Eczema worse at night, from warmth of bed, in damp

weather and spring.

Bovista Sweat smells like onion; awkwardness; ill-humor and irritability, • Eczematous eruptions: moist and forms thick crusts

absent mindedness and difficulty in fixing the attention; later.

stammering. • Itching worse on getting warm.

• Deep impressions from using blunt instruments,

scissors, knife, etc.

• Eruptions appearing in hot weather and during full moon.

Hepar sulph. Extremely chilly patient; hypersensitive (to cold, pain), faints • Vesicular eruptions which easily suppurate.

easily; scrawny; glandular constitution; sweats easily; slow • Eruptions moist and very sensitive to touch.

to act; worse in dry, cold air; better in damp weather; irritable, • Burning, stinging and splinter like pains in the eruptions;

difficult to please. worse by least touch.

Contd...


Few other medicines which can also be used are:

Arsenicum album, Belladonna, Lycopodium, Morgan p., Oleander, Tellurium, Antimonium crudum and Calcarea sulphurica etc.

���

• Unhealthy skin; every little injury suppurates.

• Cannot bear to be uncovered; wants to be wrapped up

warmly.

• Skin affections extremely sensitive to touch, pain often

causing fainting.

• Discharges from all parts of the body smell like old

cheese.

• Eczema, spreading by means of new eruptions

appearing just above the old parts.

• Eczema worse from cold air, uncovering; better warmth

in general.

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CHECK YOUR PROGRESS

1. What is the probable diagnosis of a child presenting with skin lesion (see picture) with

itching more severe at night and associated with no other complaints?

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2. Identify the skin lesion in the picture having no pain?

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3. What is the probable diagnosis of a child presenting with skin lesion (see picture) with

no itching / pain / other complaints?

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4. What is the probable diagnosis of a child presenting with skin lesion (see picture)

rapidly spreading all over the body with itching?

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