Tinea Corporis treated with homoeopathy- Series of 3 cases

Abstract

The prevalence of superficial mycotic infection worldwide is 20–25% of which

dermatophytes are the most common agents. Management involves the use of
topical antifungals in limited disease, and oral therapy is usually reserved for more
extensive cases. The last few years have seen a significant rise in the incidence of
chronic dermatophyte infections of skin which have proven difficult to treat.
However, due to the lack of updated national or international guidelines on the
management of tinea corporis, cruris, and pedis, treatment with systemic
antifungals is often empirical. Here is series of 3 cases of Tinea corporis treated
efficiently with homoeopathic medicines on the basis of keynote prescription. The
main lesson to be taken from this case series is that keynote prescribing is an
effective and easy homoeopathic prescription.

Introduction

Tinea corporis is present worldwide. It is defined explicitly by the location of the

lesions that may involve the trunk, neck, arms, and legs. Alternative names exist
for dermatophyte infections that affect the other areas of the body. These include
the scalp (tinea capitis), the face (tinea faciei), hands (tinea manuum), the groin
(tinea cruris), and feet (tinea pedis). The dermatophyte's ability to attach to the
keratinized tissue of skin forms the basis for the dermatophytoses (superficial
fungal skin infections).1
The dermatophytes causing tinea corporis belong to genera Trichophyton,
Epidermophyton, and Microsporum. Trichophyton rubrum is the most common
species to cause dermatophyte infections in the last 70 years.
Tinea corporis is exceedingly common worldwide. Dermatophytes are the most
prevalent agents of superficial fungal infections. Excessive heat, high relative
humidity, and fitted clothing have correlations to more severe and frequent
disease2.
All people do not have equal susceptibility to fungal infection, and there are
familial and genetic predispositions possibly mediated by specific defects in innate
and adaptive immunity. Patients with low defensin beta 4 may demonstrate a
predisposition to all dermatophytes. Some other predisposing factors include
underlying diseases such as diabetes mellitus, lymphomas, immunocompromised
status, Cushing syndrome, excess sweating, or old age. The currently held view is
that a cell-mediated immune response is responsible for the control of
dermatophytosis
Despite the increasing prevalence of cutaneous dermatophytosis across the world,
and especially in tropics, research in this area has often been neglected. In fact, one
has to go back nearly two decades to find guidelines on the management of tinea
corporis and cruris (by the American Academy of Dermatology),3 and these at best,
appear inadequate in today's world. The more recent guidelines published by the
British Association of Dermatology and in the British Medical Journal have largely
focused on tinea capitis and tinea unguium with scarce reference to tinea
corporis/cruris.4,5,6 Updated Cochrane reviews on the use of topical therapy in tinea
corporis, cruris, and pedis, and few on oral therapies have helped to bridge this
knowledge gap but still well-designed trials, national and/or international
evidence-based guidelines and recommendations on the dose and duration of the
use of systemic antifungals in tinea corporis/cruris are conspicuous by their
absence.7,8,9
Case series

Here is a series of 3 cases of Tinea corporis with extensive lesions all over the
body came in the OPD , all of them were treated with homoeopathic medicine on
the basis of keynote prescribing and improved without any relapses.

Case 1

A 18 Years boy belonging from reported at CRI, OPD, Noida on 27 june 2019 with
complaint of small, circular, itchy scaly lesions all over the body especially on
forearms and groin region since 6 months. He was treated with differrent kinds of
fungal ointments with no relief. Itching and burning were also present on affected
area aggravated during changing clothes, after scratching, cold air and ameliorated
by warmth.

Treatment

On the basis of keynote symptoms (Skin: itching of various parts; < by cold, > by
warmth; when undressing, uncovering or exposing to cold air) and referring to
these symptoms with materia medica, Rumex Crispus was selected. Rumex
Crispus 30 single dose stat was prescribed followed by placebo in form of globules
of 30 size, TDS for 7 days.

First visit

SECOND VISIT
 THIRD VISIT LAST VISIT

TREATMENTALL

Date Follow up Treatment

4/7/19 Mild improvement in itching and Placebo 30 TDS X 7days
burning
12/7/19 No new eruption , Mild Placebo 30 TDS X 7days
improvement in discolouration
20/7/19 No further improvement in Rumex Crispus 200 1dose stat
Itching Burning again returned Placebo 30 TDS X 7days
30/7/19 Itching and burning reduced Placebo 30 TDS X 7days
mild improvement in
discolouration
9/8/19 No itching and burning now Placebo 30 TDSX 7days
,improvement in discolouration
7/8/19 significant improvement in Placebo 30 TDS X 7days
discolouration
3/9/19 significant improvement in Placebo 30 TDSX 7days
discolouration

2. CASE

1. A 48 years old married hindu male belonging from middle socio- economic
status reported at CRI, Noida , on 6 july, 2019 with complaint of multiple small red
eruptions in a circular pattern on trunk and back & axilla. One reddish discolored
patch on abdomen since 1 year. Itching and burning were also present on affected
area which were aggravated in night after going to bed .
Treatment

Tellurium 30 Bd for 7 days was prescribed followed by placebo on the basis of

keynote symptoms: Ringworm, ring shaped lesions, offensive odors from affected
parts and stinging sensation in affected area.

And patient was advised to apply coconut oil on the affected parts and to maintain
proper personal hygiene.
Date Follow-up Prescription
20/07/19 Mild improvement in itching Placebo 30 TDSX 15days
and burning
03/08/19 No new eruption, Moderate Placebo 30 TDSX 15days
improvement in itching and
burning.
16/08/19 Itching and burning reduced Placebo 30 TDSX 15days
mild improvement in
discolouration also.
30/08/19 No further improvement. Tellurium 200 2 doses BD for
Itching and burning returned 1 Day followed by
Placebo 30 TDS X 15days
10/09/19 significant improvement in Placebo 30 TDSX 15days
discolouration
28/09/19 No itching, no new eruption. Placebo 30 TDSX 15days
Very much improved in his
last visit

First visit
Second visit

Third visit

Last visit
3. Case

A 50 years old lady who was suffering from tinea infection since 2 years came in our OPD .She had taken
so many medicines allopathic, ayurvedic for long time with no relief. Her eruptions were pustular, red
inflamed and were painful with severe itching which aggravates on exposure to open air and after
bathing. Lesions are surrounded by little pustular pimples which spread by coalescing.

Hepar sulph 30 bd for 3 days along with placebo was prescribed as a keynote prescription on the basis of
characterstics symptoms painful lesions surrounded by little pustular pimples which spread by
coalescing.

Date Follow up Prescription

15/4/19 No new pustular eruptions Placebo 30 TDS X 15days
developed
29/4/19 Old pustules begins to dry up, Placebo 30 TDS X 15days
inflammation got reduced
14/5/19 No pain now but itching persist Placebo 30 TDS X 15days
31/5/19 Itching same Hepar sulph 30 BD X 3 days
& Placebo 30 TDS X 12 days
11/6/19 Better, itching reduced Placebo 30 TDS X 15days
01/07/19 No pain, no new eruptions, no Placebo 30 TDS X 15days
pus, no itching

first visit
 second visit

last visit

Discusssion

Here in these three cases for remedy selection “Keynote Prescription” was used for
prescription on the basis of PQRS symptoms. In these cases less symptoms but
peculiar symptoms are present. It means, the field of selection has been narrowed
so keynote prescription is opted.

A characteristic or keynote symptom is a generalization drawn from the particular

symptoms by logical deduction. In paragraph 153 of The Organon, Hahnemann
says that in comparing the collective symptoms of the natural disease with drug
symptoms for the purpose of finding the specific curative remedy, "the more
striking, singular, uncommon and peculiar (characteristic) signs and symptoms of
the case are chiefly and almost solely to be kept in view; for it is more particularly
these that very similar ones in the list of symptoms of the selected medicine must
correspond to, in order to constitute it the most suitable for effecting the cure10.

All the patients in this case series presented with same nosological diagnosis but
with different characteristic symptoms. Therefore Rumex, Tellurium & Hepar
sulph were selected as a simillimum respectively for each case which established
the words of Dr. P. P. Wells who says: "Characteristic symptoms are those which
individualize both the disease and the drug. That which distinguishes the individual
case of disease to be treated from other members of its class is to find its
resemblance among those effects of the drug which distinguish it from other drugs.
This is what we mean when we say that with these the law of cure has chiefly to
do. When we say 'like cures like' this is the 'like' we mean."10

In some cases totality of symptoms is made up of Keynote symptoms which

become basis of prescription as told by Dr. Stuart Close in his book of philosophy.
There is usually something peculiar in case, some prominent feature or striking
combination of symptoms that directs the attention to a certain drug, and this is
what Dr. Guernsey called a keynote. Dr. Guernsey simply invented a new name for
the old Hahnemannian idea. Guernsey’s “keynotes” and Hahnemann’s
“characteristics” as synonymous terms, which they are, and making legitimate use
of Guernsey’s method, it has value.10

Dr. Adolph Lippe also gave emphasis on Keynote symptoms & says, “The
chacteristic symptoms will consist in the result obtained by deducting all the
symtoms generally pertaining to the disease with which the patient suffers, from
those elicited by a thorough examination of the case.” 11

In other words the characteristic symptoms are the symptoms peculiar to the
individual patient, rather than the symptoms common to the disease. Many
stalwarts like Allen, Boericke gave importance to the keynotes.10
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