Authored by K. Sirini
Introduction:-
Melasma is a common skin problem.The condition causes dark, discolored patches on skin.it is also called cholasma or “mask of pregnancy” when it occurs in pregnant women.
The condition is much more common in women than in men . According to American academy of dermatology 90% of people who develop Melasma are women.
Risk factors:-
Mostly dark skinned individuals are more at risk than those with fair skin.
Oestrogen and progesterone sensitivity are also associated with the conditions i.e OC pills, PREGNANCY and HORMONE THERAPY can trigger Melasma.
Stress and thyroid diseases are also thought to be cause of Melasma. symptoms of Melasma:-
Melasma causes patches of discoloration.The patches are darken than usual skin colour.it typically occurs on face and is symmetrical with matching marks on both sides of the face.other areas of body that are often exposed to sun can also develop Melasma.
Brownish coloured patches usually appear on the CHEEKS,FOREHEAD,BRIDGE OF NOSE and CHIN
It can also occur on the neck and forearms.The skin discoloration doesn’t do any physical harm but may feel self conscious about the way it looks.
Differential diagnosis:-
Post inflammatory hyperpigmentation. Systemic lupus eryhthematous Melasma
Rosacea
DIAGNOSIS:-
WOOD’s LAMP EXAMINATION:-
This is a special kind of light that helps to skin.it allows to check for bacterial and fungal infections and determine how many layers of skin does it affects.
SKIN BIOPSY:-Recommended in case of serious skin condition CASE PROFILE:-
A 36years female
reported on 18.05.20
with brownish discolored patches on face
since 8years. The patches
are present on both cheeks,bridge of nose,above eyebrows
and upper lip.
Complaint started gradually,first she had a small patch on bridge of nose and later it have spread to cheeks,above eyebrows and upperlip.she used allopathic medication but had no relief.she developed itching by using them so she stopped using it.
Past history:no history of major illness or surgeries Family history:-no similar sufferings in her family.
Personal history:-appetitte is good,she has great desire for sweets and aversion to meat,thirst for small quantities of water at small intervals and she is chilly patient.
Mind:-
She gets irritated easily,she has less patience,shouts on children and husband when they do not obey her words and gets irritated when her husband found a fault in her and for and even gets irritated while doing works,she wanted to do it fastly,if it takes time she gets irritated and shouts on others.
She doesn’t bear contradiction.very dominating type,like her words are only correct and if some one oppose her words she never bear it.she thinks that whatever I have said is correct and if somebody argues she could not bear it
she is religious.worships God for hours together.she spends most of her time in worshipping and she use to read prayer books of God whenever she is free.
Menstrual and obstetric history:-she got menarche at the age of 13years cycle is regular, character of blood is bright red with duration of 2-4 days.she had 2children(FTND).
General physical examination:-signs of pallor is found . patient is of thin built with fair complexion.
Physical examination of skin:
-Brownish discolored patches on cheeks, bridge of nose,upper lip and above eyebrows.size is about 5-6cm and shape is bilaterally symmetrical on both sides with smooth surface.
Analysis of symptoms:-
Mentals:-1) Religious 2) intolerance to contradiction 3)irritable
Physical generals:-desires sweets++, aversion meat,aggravation by exposure to sunlight Particulars:-discolored patches on face.
Repertorial
totality:-Religious,irritable, intolerance to contradiction, desires weeets,
aversion to meat, aggravation by exposure to
sunlight, discolored patches on face
Repertorisation:- According to Kent’s repertory
Miasm:sycotic(sycosis has distributed pigment metabolism producing both hyper and depigmentation, which occurs in patches or is diffused in different parts.
Remedy selection:sepia 200 (3 doses) Follow up:-
Initially on 18.05.2020 pt was advised to take 3doses of sepia and was asked to report after 15days
On 03.06.2020
Pt reported with results.There is disappearance of patches on both cheeks,above eyebrows and upper lips..20% remaining on nose.
And pt was advised to take sac lac for 1week
Result:-
Selection of remedy was based on constitution and repertorisation.
The application of constitution is gold standard for homeopathic treatment of chronic cases.The selection of constitutiona medicine was guided by a few characteristic features.In this case the constitution of person is narrow pelvis which is of male type, straight from the shoulders all the way down and blonde (golden brownish)hair on extremities and scalp.patches across saddle which is of butterfly shape of sepia showed good results in this case
The positive
role of sepia
in melasma has been observed through a retrospective observational
study.
“Kent”recommended in his materia Medica as sepia is suited to tall,slim women with narrow pelvis,a woman has the hips of a well built man, straight from the shoulders all the way down,shallowness of face with saddle across nose and down the sides of face.
“Boericke”mentioned in his materia Medica as sepia is mainly suited for Burnetts and has yellow saddle across nose, brownish distribution around nose and cheeks.
Conclusion:-
The case is one of the evidence based that shows the effectiveness of homeopathic treatment.
However From practice point of view,fixed protocol cannot be recommended for the treatment of all patients suffering from Melasma.
Reference:- Kent Repertory
Kent’s Homeopathic materiamedica Boericke materiamedica
Practice of dermatology by P.N Behl A.Agarwal
About the author
K. Sirini
BHMS final year
Student of MNR Homeopathic Medical college. Sangareddy, Hyderabad
