ABSTRACT
Plantar warts (verrucae) are the lesions which develop on the sole. The Human papilloma virus (HPV) causes verruca vulgaris also called as plantar warts, flat warts and filiform warts. The warts are covered by a layer of thick keratin.This is a case study of a female aged 19 years having a complaint of painful hard eruptions on soles of both feet for 3 weeks. After detailed case taking and repertorization individualized homoeopathic medicine was selected, which treated the patient holistically and relieved her from the pain and debility in a rapid and gentle manner.
KEY WORDS: Plantar Warts, HPV, Staphysagria, Homoeopathy
ABBREVIATIONS- HPV- Human Papilloma Virus, <- Less than, L- Litres, Saclac- Saccharum Lactis.
INTRODUCTION
Viral warts are very common and people suffer from them at some time during their course of life. Transmission occurs by direct skin contact with the infected person or from the fragments of shed skin, and is provoked by trauma and moisture. [1] Verruca vulgaris also known as plantar warts, flat warts and filiform warts are caused by the Human papilloma virus (HPV). Small black dots (bleeding points) are usually seen inside the lesion. Children and adolescents are mainly affected. Warts may be sore if they are around nail folds or pressure points. Typical verruca vulgaris lesions have hyperkeratotic surfaces having small filamentous projections and are sessile, dome shaped, usually about one centimeter in diameter. [2]
One of the previous evidence based study shows the positive result of homoeopathic similimum given on the basis of totality in the case of plantar warts in a 10 yrs/male [3], another case series shows the effectiveness of individualized homoeopathic intervention in cases of plantar warts [4].
CLINICAL FEATURES
Plantar warts have a rough surface spreading out slightly from skin and are adjoined by a horny collar. A wart can grow to more than 1 inch in circumference if a person does not receive treatment. Plantar warts tend to be flat and hard. They usually have well defined borders and a rough surface. These warts are typically skin colored with tiny black dots. It may be painful, while calluses typically are not. [2]
DIFFERENTIAL DIAGNOSIS:
1. PLANTAR CALLUS: A plantar callus is thickened or hardened skin which forms as a response to recurrent friction and pressure over a long period of time. It typically forms on metatarso-phalangeal joint area, heels and small toes due to compression applied by tightly or ill fitted footwear.[5]
2. PLANTAR FIBROMA: Plantar fibroma is a fibrous mass which grows in the arch of the foot. It frequently causes discomfort and pain. The chief symptom is a slow-growing lump in the arch of the foot, which is <1 inch in size. The lump may be slightly painful or painless. [6]
CASE RECORD
Female aged 19 years presented with the complaint of painful hard eruptions on soles of both feet more on the right foot, since 3 weeks.
PRESENTING COMPLAINT
The patient presented with eruptions & hard painful skin on both feet more on right feet since 3 weeks. The thickened skin was extremely painful with slight redness and multiple blackish spots but no discharge.
HISTORY OF PRESENTING COMPLAINTS
The Patient was supposedly well but 2 weeks earlier due to much sweating on her feet she suddenly developed eruptions and started experiencing slight pain and hardness in her sole. The pain was little in the beginning but later on became severe, so much that she started having difficulty in walking.
FIGURE 1: BEFORE TREATMENT
OBSTETRICS AND GYNAECOLOGICAL HISTORY:
LMP- 13/04/2023 with no related complaints. Menstruation lasts for 5 days, occurs at 28-30 days without any irregularities.
PAST HISTORY:
Typhoid at the age of 12 years and pustular eruptions on the body at the age of 15-16 years. Took Allopathic treatment for the above and got treated.
FAMILY HISTORY:
Father- Diabetes Mellitus
Mother- Hypertension
PHYSICAL GENERALS
Thermals- Chilly
Appetite- Adequate, 3 meals/ day
Thirst- Thirsty, around 3-4L/day
Desire- Spicy, Sweet
Aversion- Oily food, causes nausea
Stool- Satisfactory, once a day
Urine- Satisfactory, 6-7 times a day
Sweat- more on axilla, non offensive, non staining
Sleep- 5-6 hours, frightful dreams almost everyday.
MENTAL GENERALS
Anxious and irritable because of her illness. Emotional about her personal life. Worries a lot about her family. Likes to make paintings and sketches. Does not want company.
PROVISIONAL DIAGNOSIS
Plantar Warts [1]
TABLE-1 ANALYSIS AND EVALUATION OF SYMPTOMS
| SYMPTOMS | INTENSITY | COMMON/UNCOMMON SYMPTOMS | MIASM |
| Mental Generals 1. Sentimental and emotional about her personal life. 2. Irritability 3. Likes doing artwork and making Painting | +++ ++ +++ | Uncommon Uncommon Uncommon | Psora Psora Psora |
| Physical generals 1. Desire-sour things and pickles 2. Aversion-Oily food 3. Thermal reactions-chilly 4. Dream-frightful | ++ ++ + + | Uncommon Uncommon Uncommon Uncommon | Psora Psora Psora Psora |
| Particulars 1.Hard painful skin thick skin<walking | +++ | Uncommon | Sycosis |
TOTALITY OF SYMPTOMS
-Sentimental about her personal life
– Irritable
– Likes doing artwork and making paintings
– Desires sour things and pickles
– Frightful dreams
– Hard painful thick skin of sole
– Aggravation on walking
REPERTORIAL TOTALITY
- MIND- SENTIMENTAL
- MIND- IRRITABILITY
- MIND- PAINTING- ability for
- MIND- ART- ability for
- GENERALS- FOOD AND DRINKS- sour foods, acids- desires.
- DREAMS- FRIGHTFUL
- EXTREMITIES-FEET- Complaints of, sole of
REPERTORIAL ANALYSIS
Repertorization was done with Synthesis repertory RADAR 10.0 software [7]
PRESCRIPTION
First prescription (25/04/23) – STAPHYSAGRIA 200 1 DOSE, followed by placebo for 1 week. [8, 9]
Patient was advised to take rest, walk only when necessary and keep feet clean and dry.
TABLE -2 FOLLOW UPS
| DATE | SYMPTOMS | PRESCRIPTIONS |
| 02/05/23 | The hard skin is beginning to soften and there is slight reduction in pain. The patient is less irritable now. | SAC LAC 30/TDS/2 WEEKS |
| 16/05/23 | Skin has soften very much. Pain persists. Patient is able to walk but feels slight pain on walking. No irritability. | STAPHYSAGRIA 200/OD/ 3 days. SAC LAC 30/ TDS/ 2 weeks |
| 30/05/23 | Skin has softened. Much relief in pain. Patient is able to walk without any pain. No irritability | SAC LAC 30/TDS/ 2 WEEKS. |
| 13/06/23 | Skin has healed. No pain. Patient is able to walk with comfort without any pain on walking. No irritability. No new complaint | SAC LAC 30/TDS/2 WEEKS. |
FIGURE 3: AFTER TREATMENTDISCUSSION:
Homoeopathy being a holistic mode of treatment, treats the patient as a whole. This case report shows the importance of thorough case taking and selection of individualized homoeopathic remedy on the basis of totality of symptoms. This also verifies the authenticity of Materia Medica and Repertory as both were used for the selection of similimum.
Dastagiri P, Chakravarthy S.G.S and Mittal R, in their case series of 14 cases found the effectiveness of individualized homoeopathic medicines namely Sepia (5), Causticum (3), Natrum muraticum (2), Silicea (1), Lachesis (1), Calcarea carb (1), Calcarea sulphurica (1), all in 30C potency in cases of verruca vulgaris and verruca plana, out of these Sepia was most indicated due to its affinity towards females and sycotic predominance [4]. Syed A. Athar & Roselin G. Nadar in their evidence based study on warts and corns showed the effectiveness of homoeopathic similimum selected on the basis of totality of symptoms for a 10yrs old male patient whose warts on foot got treated within 3 months by homoeopathic treatment. [3]
The present case report shows the effectiveness of Staphysagria which was selected on the bases of totality of symptoms and repertorization as it covered all the 7 rubrics and scored maximum. The patient was treated within 2 months of time period with the remedy in potency 200 C without the use of any external application.
Dr. Hahnemann in § 185 states that in treatment of local diseases the remedy administered must be homoeopathic and further condemns the practice of removing the sycotic growths by external application or excision.[10]
CONCLUSION
This case report validates the effectiveness of Homoeopathic treatment in the cases of plantar warts. Furthermore it confirms the usefulness of Staphysagria in cases of plantar warts. This case report confirms that Homoeopathic medicines can cure patients gently in a plausible amount of time without making any surgical cuts or without any external application. For writing the manuscript Consent of the patient was obtained.
REFERENCES
1. Kasper L. Dennis, Fauci S. Anthony, Longo L. Dan, Braunwald Eugene, Hauser L. Stephen, Jameson Larry J. Harrison’s Principles of Internal Medicine. McGraw Hill. 16th Edition. P- 1056-1057.
2. Boon A. Nicholas, Colledge R. Nicki, Walker R. Brian, Hunter A. A. John. Davidson’s Principles & Practice of Medicine. Elsevier Limited. 20th Edition. P-1295-1296.
3. Athar SA, Nadar RG. Warts and Corns in Homoeopathy an Evidence Based Study. JMPI. 2022 Oct 5; 9(50): 30-33.
4. Dastagiri P, Chakravarthy S.G.S, Mittal R. Effectiveness of individualized intervention in warts A case series. IJRH. 2023 Sept 12; 17(3): 187-198.
5. Available from: https://en.wikipedia.org/wiki/Callus.
6. Kumar Parveen, Clark Michael. Kumar & Clark Clinical Medicine. Elsevier Limited. 6th Edition.
7. RADAR 10.0 Homoeopathic Software, Schroyens F synthesis repertory.
8. Boericke W. Boericke’s new manual of homoeopathic materia medica with repertory; 3rd Revised and augmented edition based on 9th ed. New Delhi: B Jain Publishers (P) Ltd; 2018. P-535-536.
9. Kent JT, Lectures on Homoeopathic Materia Medica, New Delhi, B Jain Publishers (P) Ltd; 2014. P- 945-948.
10. Sarkar BK. Hahnemann’s Organon of Medicine. 9th ed. Delhi: Birla Publications; 2004, p- 409-11.
