KNOW Homoeopathy Journal Vol–3 &
Issue-2, 18 October 2023, Published at https://www.knowhomoeopathyjournal.com/2023/10/volume-3-issue-2.html,
Pages: 22-29 , Title: Herpes
treated by individualized homoeopathic medicine - Sulphur: A case report, Authored By: Dr. Yogeshwari Gupta (Prof,
PhD (Hom.), Former Dean Homoeopathy Rajasthan Ayurved University, Jodhpur; Principal
& HoD Materia Medica, Swasthya Kalyan Homoeopathic Medical college and
Research Centre, Jaipur, Rajasthan, India.) & Co-Authored By: Dr. Shivani
Saini (M.D. (PGR), Materia Medica, Swasthya Kalyan Homoeopathic Medical College
and Research Centre, Jaipur, Rajasthan, India.), Dr. Stuti Rastogi (M.D. (PGR), Materia
Medica, Swasthya Kalyan Homoeopathic Medical College and Research Centre,
Jaipur, Rajasthan, India.)
CASE REPORT
Title: Herpes treated by individualized homoeopathic medicine - Sulphur: A case report
Authored By: Dr. Yogeshwari Gupta[1] & Co-Authored By: Dr. Shivani Saini[2] & Dr. Stuti Rastogi[3]
[1]Prof, PhD (Hom.), Former Dean Homoeopathy Rajasthan Ayurved University, Jodhpur; Principal & HoD Materia Medica, Swasthya Kalyan Homoeopathic Medical College and Research Centre, Jaipur, Rajasthan, India.
[2][3]M.D. (PGR), Materia Medica, Swasthya Kalyan Homoeopathic Medical College and Research Centre, Jaipur, Rajasthan, India.
Received: 15/07/2023 Accepted: 10/08/2023 Published: 18/10/2023
© 2023 KNOW Homoeopathy Journal https://www.knowhomoeopathyjournal.com/p/copyright-policy.html
How to cite this Case report:
Gupta Y, Saini S, Rastogi S. Herpes
treated by individualized homoeopathic medicine - Sulphur: A case report, KNOW
Homoeopathy Journal, 2023; 3(2):22-29, available at https://www.knowhomoeopathyjournal.com/2023/10/herpes-treated-by-individualized-homoeopathic-medicine
-sulphur.html
ABSTRACT
Shingles
is the common name for herpes zoster. This infectious disease occurs when the
varicella-zoster virus (VZV) reactivates after lying dormant in the dorsal root
ganglia or sensory ganglia of the cranial nerve following a prior episode of
varicella infection. Varicella is frequently referred as chickenpox which
affects the younger age group whereas herpes zoster affects the adult age
group.
Case
Summary: A 28-year-old female came to us with a complaint of
severe burning and itching accompanied with redness. A complete and systematic
case analysis was conducted and was thoroughly studied and after
repertorization of the case, Sulphur was prescribed based on individualization.
This article seeks to provide evidence and observations demonstrating the
effectiveness of Sulphur in the cases of herpes zoster.
Keywords: Herpes Zoster, Homoeopathy, Shingles, Sulphur.
INTRODUCTION
VZV is the responsible agent for both varicella (chickenpox) and herpes zoster (shingles).[1] This virus spreads through droplet infection and direct contact with individuals who have chickenpox or herpes zoster.[2] Before the appearance of zoster lesions, individuals often experience mild to severe itching, tenderness, or pain in the affected area. The pain can be felt across the entire nerve segment, confined to a specific part, or even referred to other regions of the body.[3][4]
The pain experienced can be misinterpreted as pleural or cardiac diseases, cholecystitis, other abdominal issues, renal or ureteral colic, sciatica, or various other ailments, depending on its location. Within the affected dermatome, there are neurological changes that lead to heightened sensitivity, abnormal sensations, or reduced sensitivity. The period between the onset of pain and the appearance of related symptoms can vary, with some cases taking up to 10 days, though the average is around 3 to 5 days. Certain patients, particularly children, may not exhibit any sensory changes. While the pain typically subsides within a few weeks, it's worth noting that around 73% of patients over the age of 60 continue to experience discomfort lasting beyond 8 weeks. [3]
Initially, the zoster lesions emerge on the posterior aspect and then progress towards the front and periphery of the affected nerve. In rare instances, the eruption can be bilateral.[4]
The first noticeable signs are erythematous macules, papules, and plaques, and within a day, grouped vesicles usually appear, though in some cases, blisters may not develop at all. The plaques can be irregularly scattered along a segment of the dermatome or may merge. The mucous membranes within the affected dermatomes are also impacted. As time goes on, the vesicles become filled with pus, form crusts, and eventually heal within 1 to 2 weeks. A few vesicles (around 10 to 25) can appear outside the affected dermatome, but this does not indicate dissemination of the condition.[3]
Post-herpetic neuralgia is characterized by persistent pain that continues for more than a month and can last for up to 120 days after the vesicles have resolved. In cases where the pain starts within 120 days of the rash, it is known as subacute herpetic neuralgia. During the acute phase of the infection, the virus directly damages and leads to inflammatory neuritis of the peripheral nerve fibers, dorsal root ganglia, and the spinal cord. As the inflammatory response diminishes, fibrosis and nerve tissue destruction occur, affecting various levels of the pain pathway. This process contributes to the development of the lingering pain associated with post-herpetic neuralgia.[5]
HISTOPATHOLOGY OF SKIN LESIONS:
I. EARLY STAGE:
The initial change occurs in the nuclei of the epidermal cells. The chromatin in the nuclei clumps at the periphery and later exhibits a homogenous ground glass appearance. These changes start at the basal layer and gradually involve the entire epidermis.[6]
II. VESICULAR STAGE:
The formation of intraepidermal vesicles results from two types of changes:
1)Ballooning degeneration, and
2)Reticular degeneration. Ballooning degeneration is unique to viral vesicles. Affected cells swell and lose their connections to neighboring cells, leading to their separation (secondary acantholysis).[7] Some of these separated cells, known as Tzanck cells, become multinucleated with intensely eosinophilic and homogeneous cytoplasm. In certain cases, the basal layer of the epidermis is also affected, resulting in the formation of a sub-epidermal vesicle.[8] Reticular degeneration is characterized by increasing hydropic swelling of epidermal cells, making them large and clear, with fine cytoplasmic strands at the edges. Eventually, these cells rupture, contributing to vesicle formation.[8]
Reticular degeneration is characterized by increasing hydropic swelling of epidermal cells. The cells become large and clear with fine cytoplasmic strands present at the edge. They ultimately rupture which further helps in the formation of a vesicle.[9]
III. LATE STAGE:
During the late stage, the skin lesions show the presence of ballooned cells and eosinophilic intranuclear inclusion bodies. Neutrophils can also be found within the vesicles at this point.[10]
CASE RECORD
Mrs. XYZ, 28 yrs. old came to us with a complaint of itching and burning with redness on a circumscribed area around the suprasternal notch, right chest, right abdomen, right arm, on forehead.
PRESENTING COMPLAINTS
The patient came to us with a complaint of severe burning and itching accompanied by redness on a circumscribed area around the suprasternal notch, right chest, right abdomen, right arm, on the forehead since 2 days. Burning was severe and on slight touch, even clothing was unbearable on the affected area. Neuralgic pain while stretching neck around the suprasternal notch which <from warmth, heat. Also, 1-2 vesicles were seen on the affected area. The patient likes comfortable clothing otherwise suffers from bloating.
HISTORY OF PRESENTING COMPLAINTS
The patient started feeling pain in supra clavicular lymph nodes followed by intense pain two days ago. Afterward, itching in the affected areas started. It gradually started severe burning and became reddish. 1-2 vesicles were present.
PAST HISTORY
Past history: Jaundice – At 8 years of age
Chicken pox-At age 14 yr of age
FAMILY HISTORY
Father: Healthy and Alive; Age-57 years
Mother: Healthy and Alive; Age- 55 years
Grandmother: Diabetic, Hypertension; Age- 85 years
CONSTITUTION
Wheatish complexion.
Height- 152cm and weight- 53Kg (BMI= 22.6 kg/m2- normal weight)
PATIENT AS A WHOLE
Desire: Spices.
Aversion: Milk.
Appetite: 3-4
chapaties/meal; 2 meals/day.
Thirst: 1-2
lit./day. Takes seasonal water.
Stool:
Satisfactory but sometimes disturbed bowel habit.
Sweat: on armpits, on soles and palms, on face,
offensive, staining the linen yellow.
Thermal Reaction: Hot+; feet get warm even in winter and have to put out of blanket.
Menstrual History: 4-5
days/30 days cycle, bright reddish bleeding, no clots present, bearable
dysmenorrhea on the first day.
Obstetric
history - G0 P0 A0 L0
Sexual
history - Satisfactory
MIND:
Joyous.
Consolation amelioration. Cries when angry. The patient was mild and cooperative.
Emotional. Fear of animals.
SLEEP:
7-8 hrs.
of sleep at night. Refreshing, sound sleep.
ANALYSIS OF CASE
MENTAL GENERALS:
Joyous.
Consolation
amelioration.
Cries when
angry.
The
patient was mild and cooperative.
Emotional.
Fear of animals.
PHYSICAL GENERALS:
Desire for
Spices
Aversion
to Milk
Prefers
loose clothing
Sweat: on armpits, on soles and palms, on face,
offensive, staining the linen yellow.
Thermal Reaction Hot.
PARTICULARS:
Severe
burning and itching accompanied by redness on a circumscribed area around
suprasternal notch, right chest, right abdomen, right arm, on the forehead;
<from warmth, heat; 1-2 vesicles seen on the affected area. Severe burning
and on slight touch, even clothing was unbearable. Neuralgic pain on stretching
neck.
EVALUATION OF SYMPTOMS
Joyous.
Cries when
angry.
Fear of
animals.
Desire for Spices
Aversion
to Milk
Prefers
loose clothing
Sweat
offensive
Herpetic
eruptions
Burning
and itching
Complaints
right sided
TOTALITY
Joyous
Cries when
angry
Fear of
animals
Offensive
perspiration
Herpetic
eruptions
Burning
and itching
Complaints
right sided
Loosening
of clothes ameliorates
Aversion
to milk
Repertorization
was done using RADAR 10.0. Synthesis Repertory has been chosen due to the presence
of marked Mental generals and particulars and the reportorial sheet is shown in
[Figure 1].
Figure 1: Repertorization sheet
FIRST PRESCRIPTION:
On 20 July 2022, Sulphur.30C/1Dose/stat.
SELECTION OF MEDICINE:
Sulphur was selected after considering the totality of symptoms and remedy differentiation with the help of Materia Medica. Moreover, Sulphur was selected because it covers the totality of symptoms. Also, the thermal reaction of the patient was hot. Sulphur 30C/1Dose/Stat, was prescribed. The potency was changed based on assessment of improvement in itching, burning, and pain in subsequent follow-ups as shown in Table-1.
|
Date
|
Symptoms
|
Prescription
|
Justification
of potency & doses |
|
20/07/2022 (Figure 2) |
Severe burning and itching on slight touch, even clothing was
unbearable. Redness on a circumscribed area
around suprasternal notch, right chest, right abdomen, right arm, on
forehead. 1-2 vesicles are seen on the affected area. Neuralgic pain on stretching neck. |
Rx Sulphur 30/1D/ stat Rubrum 30/TDS/7 days |
Low potency chosen because of low susceptibility. |
|
27/07/2022 (Figure 3) |
The patient feels slight relief in complaints of burning and itching
in eruptions. No improvement in pain and redness. No vesicles were further seen. |
Rx Sulphur 30/1D/ stat Rubrum 30/TDS/14 days |
Medicine is repeated again because of low
potency. |
|
10/08/2022 (Figure 4) |
Marked relief in burning and itching in eruptions. No improvement in pain and redness. |
Rx Phytum 30/1D/ stat Rubrum 30/TDS/14 days |
No medicine was suggested, as it left to act. |
|
24/08/2022 |
No marked improvement was further seen. |
Rx Sulphur 200/1D/ stat Rubrum 30/TDS/14days |
High potency was chosen because no improvement
seen. |
|
7/09/2022 (Figure 5) |
No burning and itching in eruptions. Slight improvement in pain No redness. Skin became dry and formed scar. |
Rx Phytum 30/1D/ stat Rubrum 30/TDS/14days |
No medicine was suggested, as it left to act. |
|
21/09/2022 |
No improvement in pain was noticed. |
Rx Sulphur 200/1D/ stat Rubrum 30/TDS/14days |
Potency repeated due stand still condition |
|
5/10/2022 (Figure 6) |
No pain was noticed since 7 days and tissue granulation seen on
affected areas. |
Rx Phytum 200/1D/ stat Rubrum 30/TDS/30days |
No medicine was suggested, as it left to act. |
|
4/11/2022 (Figure 7) |
No new complaints appeared. |
Rx Phytum 200/1D/ stat Rubrum 30/TDS/30days |
The individual is cure, but still under
observation with no pain seen. |
Table 1 – Follow
up table
DISCUSSION
The distinctive features of varicella are the centripetal distribution, the polymorphism in each affected site, and the rapid progression of the individual lesion from vesicle to crust. [4] The differential diagnoses of herpes zoster include HSV, localized bacterial infections such as bullous impetigo, contact dermatitis, and less commonly, other conditions such as trigeminal trophic syndrome. As opposed to the dermatomal distribution of herpes zoster, HSV and bullous impetigo are more likely to be localized centrally, crossing the midline, and more randomly distributed. Contact dermatitis is localized to the exposed area, which is usually different but may coincide with a dermatomal distribution. The trigeminal trophic syndrome presents with excoriations in a trigeminal distribution and usually spares the tip of the nose.[11] A case report by Parveen S et al. concludes beneficial effects of homoeopathic medicine hypericum in treating cases of post herpetic neuralgia.[12] Case series by Pareveen S et al. positive response of individualized homeopathic medicines in the treatment of childhood HZ. [13] This case highlights usage of Sulphur, which was selected on the basis of individualization in treating a case of herpes zoster. Also post herpetic complications were not seen.
CONCLUSION
Sulphur proved its effectiveness in the treatment of herpes of the patient which was selected on the basis of individualization of case. According to the photographs attached above it is evidently seen that the patient is completely cured with no recurrence.
REFERENCES
1) Heininger U, Seward JF. Varicella. Lancet 2006 ; 368:-1365-76
2) Gershon AA, Steinberg SP, Gelb L. Clinical reinfection with vareicella-zoster virus. J infect Dis; 1984; 149: 137-142
3) Arndt KA, Hsu JTS, Alam M, Bhatia AC, Chilukuri S. Manual of Dermatologic Therapeutics. 8th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2014, pp 165-166
4) Master, F. Skin Homoeopathic Approach to Dermatology. 2nd ed. New Delhi: Kuldeep Jain, 2005, pp 243-249
5) Harrison TR, Braunwald E. Harrison’s principles of internal medicine. 15th ed. New York, NY: McGraw-Hill; 2002, pp 95-105.
6) Huff JC, Krueger GG, Overall JC Jr et al. The Histo-pathologic evolution of recurrent herpes simplex labialis. J Am Acad Dermatol 1981; 5: 550-557.
7) Oxman MN and Rhoda Alani. Varicella and herpes zoster. In: Dermatology in General Medicine, 4th Edition. Thomas B. Fitzpatrick et al, Eds. Newyork: Mc Graw-Hill Incl., 1993, Vol.2: 2543-2572.
8) Grossman MC, Silvers DN. The Tzanck smear: can dermatologists accurately interpret it? J Am Acad Dermatol [Internet]. [Cited 2023 Feb 20] 1992;27(3):403–5. Available from: http://dx.doi.org/10.1016/0190-9622(92)70207-v
9) Neal Penneys. Diseases caused by viruses. In: lever’s Histopathobhy of the skin, Eighth edition. David Elder et al, Eds. Philadelphia: Lippincott-Raven publishers, 1997. p 569-589.
10) Erhard H, Runner Tm, kreinkamp M et al:Atypical varicella-zoster virus infection in an immuno compromised patient: result of a virus induced vasculitis. J Am Acad Dermatol 1995: 32: 908-911.
11) Nikkels AF. SnoeckR, Rentier B, Pierard GE, Chronic verrucous vermicelli zoster virus skin lesions, Clinical, histological, molecular and therapeutic aspects. clin Exp. Dermatol 1999:24: 346-353
12) Parveen S, Das S. Elderly patient with post-herpetic neuralgia treated with homoeopathic medicine: A case report. Indian J Res Homoeopathy 2021;15(4):256-262.
13) Parveen S, Ahmed Z, Das S. Homoeopathic treatment of childhood herpes zoster—A case series. Homœopath Links [Internet]. 2023 [Cited 2023 March 10] ;36(02):137–46. Available from: http://dx.doi.org/10.1055/s-0042-1756494
