EXPLORING THE THERAPEUTIC POTENTIAL OF URTICA URENS IN HOMOEOPATHIC PRACTICE: NOVEL APPROACH TO URTICARIA MANAGEMENT – A CASE REPORT
Key words
Angioedema, Erythema, Nettle-rash, Hives, Mastocytosis, Histamine, IgE.
Abstract
Urticaria is an itchy rash associated with localized swelling (angioedema) on the skin that usually lasts for few hours to days before fading away. It is also known as hives.
Urticaria also called nettle-rash or hives or wheals in a common language, simply means itching with rash. Medically, urticaria may be defined as skin eruption, which is allergic in origin and is characterized by profound itching, red, circular or irregularly shaped eruptions on any part of the body. Urticaria is an allergic skin disorder. Characteristically the skin eruptions are erythematous, raised above the skin level, with intense itching and usually worsened by itching and with slight local warmth.
Introduction
Urticaria, commonly referred to as hives, is the most frequent dermatologic disorder seen in the epidermis. It appears as raised, well-circumscribed areas of erythema and edema involving the dermis and epidermis that are very pruritic. Urticaria may be acute (lasting less than 6 weeks) or chronic (lasting more than 6 weeks). A large variety of urticaria variants exist, including acute immunoglobulin E (IgE)–mediated urticaria, chemical-induced urticaria (non-IgE-mediated), urticarial vasculitis, autoimmune urticaria, cholinergic urticaria, cold urticaria, and many others. Acute IgE-mediated urticaria is the most benign form of anaphylaxis. It usually occurs independently, but it may be accompanied by the more serious clinical manifestations of anaphylaxis, angioedema, and anaphylactic shock. The etiology of both acute and chronic urticaria are numerous. The etiologic agent is more likely to be identified in acute urticaria (40-60%) than in chronic urticaria (10-20%). The lesions of IgE-mediated urticaria usually last less than 24 hours and are often migratory, leaving no residual skin abnormalities. The lesions of urticarial vasculitis usually last longer than 24 hours, are both painful and pruritic, and often leave purpuric and hyperpigmented lesions.
Homoeopathy is very effective in treating all types of a urticaria. In Urticaria immune power gets disturbed and can show exaggerated reaction to allergen. It activates the antibodies and produce histamines to cause rash and itching.
Homoeopathic constitutional dose strengthens the weakened immunity of the patient so that the body gains the capacity to overcome the disease on its own. It controls exaggerated reaction of immune power to allergens. Thus, ultimately decrease the activation of mast cells and the production of histamines. consequently, gradually all symptoms of Urticaria subside. Homoeopathic medicine can reduce the hereditary effect which is known to cause or aggravate Urticaria. It reduces the sensitivity of body to particular allergens by improving immunity. Homoeopathic medicine is primarily effective on mind. Stress is main cause of it; however, its effects on the body and mind can be dealt with by Homoeopathy, and in most cases similimum Urtica Urens is prescribed.
Causes
- The cause of acute generalized urticaria often is undetermined (some sources report that the cause is undetermined in more than 60% of cases). Known causes include the following:
- Infections (e.g., Pharyngitis, GI infections, Genitourinary infections, Respiratory infections, Fungal infections [e.g., Dermatophytosis], Malaria, Amebiasis, Hepatitis, Mononucleosis, Coxsackievirus, Mycoplasma infections, [e.g., Scabies], HIV, Parasitic infections [e.g., Ascariasis, Strongyloidiasis, Schistosomiasis, Trichinosis])
- Foods (particularly shellfish, fish, eggs, cheese, chocolate, nuts, berries, tomatoes)
- Drugs (e.g., penicillin’s, sulfonamides, salicylates, NSAIDs, codeine, antihistamines)
- Environmental factors (e.g., pollens, chemicals, plants, dander’s, dust, mold)
- Exposure to latex
- Exposure to undue skin pressure, cold, or heat
- Emotional stress
- Exercise
- Pregnancy (i.e, pruritic urticarial papules and plaques of pregnancy [PUPPP])
- Chronic urticaria can be related to all of the above as well as to the following:
- Autoimmune disorders (SLE, Rheumatoid arthritis, Polymyositis, Thyroid autoimmunity, and other Connective tissue diseases); probably up to 50% of chronic urticaria is autoimmune.
- Chronic medical illness, such as Hyperthyroidism, Amyloidosis, Polycythemia vera, Malignant neoplasms, and Lymphoma
- Cold urticaria, cryoglobulinemia, cryofibrinogenemia, or syphilis
- Familial cold autoinflammatory syndrome
- The etiology of chronic urticaria is undetermined in at least 80-90% of patients.
- Recurrent urticaria can be related to the following:
- Sun exposure (solar urticaria, occurring only on skin exposed to the sun), Exercise (cholinergic urticaria). Emotional or physical stress, Water (aquagenic urticaria)
Pathophysiology
Urticaria results from the release of histamine, bradykinin, leukotriene C4, prostaglandin D2, and other vasoactive substances from mast cells and basophils in the dermis. These substances cause extravasation of fluid into the dermis, leading to the urticarial lesion. The intense pruritus of urticaria is a result of histamine released into the dermis. Histamine is the ligand for 2 membrane-bound receptors, the H1 and H2 receptors that are present on many cell types. The activation of the H1 histamine receptors on endothelial and smooth muscle cells leads to increased capillary permeability. The activation of the H2 histamine receptors leads to arteriolar and venule vasodilation.
Urticarial disease is thought to be caused by the release of histamine and other mediators of inflammation (cytokines) from cells in the skin. This process can be the result of an allergic or non-allergic reaction, differing in the eliciting mechanism of histamine release.
Allergic Urticaria
Histamine and other pro-inflammatory substances are released from mast cells in the skin and tissues, in response to the binding of allergen-bound IgE antibodies to high affinity cell surface receptors. Basophils and other inflammatory cells are also seen to release histamine and other mediators, and are thought to play an important role, especially in chronic urticarial diseases.
Non-Allergic Urticaria
Mechanisms other than allergen-antibody interactions are known to cause histamine release from mast cells. Many drugs, for example morphine, can induce direct histamine release, not involving any immunoglobulin molecule. Also, a diverse group of signaling substances called neuropeptides have been found to be involved in emotionally induced urticaria. Dominantly inherited cutaneous and neurocutaneous porphyrias (porphyria cutanea tarda, hereditary coproporphyria, variegate porphyria and erythropoietic protoporphyria) have been associated with solar urticaria. The occurrence of drug-induced solar urticaria may be associated with porphyrias. This may be caused by IgG binding not IgE.
Symptoms
In chronic cases, the itchiness may cause sleepless nights and lead to depression. The rash is very itchy and consists of a number of raised pale bumpy wheels surrounded by red skin. Ordinary urticaria tends to move about or migrate all over the skin surface. The condition tends to settle and then relapse again at times of viral illness, stress and after taking medication that contains aspirin. This chronic pattern may recur for many years. Tissue swelling, called angioedema, may occur with urticaria. This affects the lax tissues around the eyelids, lips, neck and groin. Occasionally, an inherited deficiency of the C1 esterase inhibitor enzyme leads to marked swelling without urticaria. This rare condition is called hereditary angioedema.
If urticaria doesn’t disappear after a few weeks, or doesn’t respond to antihistamine medication, and is accompanied by any other health problem, Blood tests may be able to identify an allergy or underlying immune disease.
Related Conditions
Angioedema is not related to urticaria. In angioedema, the swelling occurs in a lower layer of the dermis than it does in urticaria, as well as in the subcutis. This swelling can occur around the mouth, in the throat, in the abdomen, or in other locations. Urticaria and angioedema sometimes occur together in response to an allergen and is a concern in severe cases as angioedema of the throat (laryngialoedema) can be fatal.
Treatment and management
Urticarias can be very difficult to treat. There are no guaranteed treatments or means of controlling attacks, and some sub-populations are treatment resistant, with medications spontaneously losing their effectiveness and requiring new medications to control attacks. It can be difficult to determine appropriate medications Homeopathically needed and as the condition is intermittent and outbreaks typically clear up without any treatment.
Most treatment plans for urticaria involve being aware of one’s triggers, but this can be difficult since there are several different forms of urticaria and people often exhibit more than one type. Also, since symptoms are often idiopathic (unknown reason) there might not be any clear trigger. If one’s triggers can be identified then outbreaks can often be managed by limiting one’s exposure to these situations.
History
Homoeopathic physician should know the Information regarding history of previous urticaria and duration of rash and itching is useful for categorizing urticaria as acute, recurrent, or chronic to select the Homoeopathic similimum.
- For chronic or recurrent urticaria, important considerations include previous causative factors and the effectiveness of various treatments.
- Ask about precipitants, such as heat, cold, pressure, exercise, sunlight, emotional stress, or chronic medical conditions (e.g. hyperthyroidism, systemic lupus erythematosus [SLE] rheumatoid arthritis, polymyositis, amyloidosis, polycythemia vera, carcinoma, lymphoma).
- Ask about other medical conditions that can cause pruritus (usually without rash), such as diabetes mellitus, chronic renal insufficiency, primary biliary cirrhosis, or other no urticarial dermatologic disorders (e.g. eczema, contact dermatitis).
- Swelling that is generally nonpitting and nonpruritic and usually occurs on the mucosal surfaces of the respiratory tract (lips, tongue, uvula, soft palate, and larynx) and GI tract (swelling of the intestine leading to severe abdominal pain)
- For acute urticaria, ask about possible precipitants, such as the following:
- Recent illness (e.g. fever, sore throat, cough, rhinorrhea, vomiting, diarrhea, headache)
- Medication use including penicillin’s, cephalosporins, sulfas, diuretics, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), iodides, bromides, quinidine, chloroquine, vancomycin, isoniazid, antiepileptic agents, and other agents.
- Travel (amebiasis, ascariasis, strongyloidiasis, trichinosis, malaria). Foods (e.g. shellfish, fish, eggs, cheese, chocolate, nuts, berries, tomatoes)
- New perfumes, hair dyes, detergents, lotions, creams, or clothes. Exposure to new pets (dander), dust, mold, chemicals, or plants
- Pregnancy (usually occurs in last trimester and typically resolves spontaneously soon after delivery).
- Contact with nickel (e.g. jewelry, jeans stud buttons), rubber (e.g. gloves, elastic bands), latex, industrial chemicals, and nail polish. Sun or cold, exposure exercise.
Prognosis
- Acute urticaria usually resolves with only symptomatic treatment. If a known triggering factor is present, the urticaria should resolve with appropriate avoidance. If a patient continues to be exposed to a known trigger, the condition may become chronic.
- The prognosis in acute urticaria is excellent, with most cases resolving within 1-4 days by Homeopathically.
- The prognosis in chronic urticaria is more guarded and depends upon the comorbid disease causing the urticaria as well as the response to therapy.
SCOPE OF URTICA URENS IN HOMOEOPATHIC MANAGEMENT OF URTICARIA.
Urtica Urens: – Is having the vast scope in treating the Urticaria and many skin complaints and diseases. It has the following symptoms for the selection of similimum for the patients. Itching blotches, Urticaria, burning heat, with formication; violent itching. Consequences of suppressed nettle rash. Rheumatism alternates with nettle rash. Burn confined to skin. Urticaria nodosa. Erythema with burning and stinging. Angioneurotic oedema. Also develops vesicles and bullae. In nettle rash it suits in acute cases, for the consequences of suppressed hives Apis is useful and compares with ARSENIC and SULPHUR. Worse from snow air, water, cool moist air and touch. Antidotes ill effects of eating shellfish. Symptoms return at the same time every year. Rheumatism associated with Urticaria like eruptions.
IN CASE OF URTICARIA SENSITIVITY OF PATIENT TO CERTAIN CONDITION AND THERE INDICATED REMEDIES –
- Allergy to food – Pulsatilla 30
- Indigestion – – Ant Crud 30
- Winter & cold – – Dulc 30, Plus 30
- Emotion – -Anacardium 30,200, Ars. Alb.30,
- Sun heat itching – -Nat carb 30, Phos 200
- Burning itch – -Led 200, Thy. 30
- Itch – -Agarius 30, Petro 30
- Honeybee insect bite– Graphitis 30, 200
- Mosquito bite – Dulca 30
A CASE
PRELIMINARY DATA
Name – Mr. XYZ
Age – 48 yrs.
Sex – Male
Religion – Muslim
Address – Malgaon, Maharashtra
Occupation – Police
Marital status – Married
- O. I. – 07/02/2024
CHIEF COMPLAINTS
- Rash all over body with burning heat, in the last 3 months
H/O CHIEF COMPLAINTS
Rash all over body with burning heat in the last 3 months
- Gradual onset
- Red swelling all over body
- < Masur Dal, Palak, Meat, Flower, Brinjal
- < Evening, Summer
PAST HISTORY
- Herpes Zoster before 2 -3 yrs.
- H/O boil (recurrent) associated with urticaria rash
FAMILY HISTORY –
- No any major illness in family
PERSONAL HISTORY
Thermally – Hot patient++
Diet – Mixed
Appetite – Good
Desire – Meat, milk
Aversion – Sweet, salt
Thirst – Large quantity of water
Perspiration – Moderate
Bowel – Unsatisfactory in the last 2 days
Urine – 5-6/0-1, D/N
Sleep – Sound
Dreams – Not specific
Habits – Tobacco chewing
Constitution – Tall, well built
MIND
- Quite disposition
GENERAL PHYSICAL EXAMINATION
Built – Average
Nourishment – Well
Eyes – Conjunctiva –Pink – Sclera – White
Head – No deformity
Ear – No discharge
Nose – No discharge
Tongue – Pink
Nails – Pink
Pallor – Absent
Oedema – on skin rash region
Cyanosis – Absent
Clubbing – Absent
Lymphadenopathy – Absent
VITAL DATA
Temperature – 98° F
Pulse Rate – 80 beats/min.
Respiratory Rate – 18 cycles/min.
B.P. – 130/90 mm of Hg
SYSTEMATIC EXAMINATION– NAD
DIFFERENTIAL DISEASE DIAGNOSIS
- Chronic Urticaria
- Dermatitis
- Scabies
INVESTIGATION – CBC, ESR,
FINAL DIAGNOSIS – Chronic Urticaria
ANALYSIS OF SYMPTOMS
Mental General
- Quite disposition
Physical General
- Desire meat, milk
- Aversion sweet, salt
Particular
- < Evening, summer
EVALUATION OF SYMPTOMS
Mental General
Grade I
- Quite disposition
Physical General
- Desire meat, milk
- Aversion sweet, salt
Particular
- < Evening, summer
DIFFERENTIAL REMEDIAL DIAGNOSIS
- Hepar sulph
- Urtica Urens
- Phosphorus
- Sulphur
- Kali carb
FINAL REMEDY – Urtica Urens
INDICATION
- Rash all over body with burning heat.
- < evening summer
- Itching all over body
PRESCRIPTION
Name – Mr XYZ
Age – 48 yrs.
Sex – Male
Rx
Urtica Urens 200
single dose
PL
4 – 4 – 4 x 7 days
Follows up after 7 days
| Date | Follows up | Prescription |
| 14/02/2024 | – Rash all over body 60% decreased
– Itching decreased 80% – B/B Satisfactory – Sleep – Sound |
Rx
PL 4 – 4 – 4 x 7 days |
| 21/02/2024 | – No Rash
– No Itching – B/B Satisfactory – Sleep – Sound |
Rx
PL 4 – 4 – 4 x 7 days |
| 28/02/2024 | – No new complaints
– Patient feels better |
Rx
PL 4 – 4 – 4 x 7 days |
CONCLUSION
Urticaria refers to an area of focal dermal oedema secondary to a transient increase in capillary permeability and Urtica Urens has vast scope in treatment of urticaria when it is used as indicated similimum.
Recently, an autoimmune pathogenesis for one of most common forms of urticaria, chronic idiopathic urticaria has been identified.
A directed history is still the best way to elicit any causes or precipitants of urticaria. A record of possible allergens, including drugs should be determined. The physical urticarias can be identified by appropriate questions and subsequently medically observed challenge.
Homoeopathy is often considered for treating urticaria (hives) by targeting the underlying immune response. The theory is that urticaria arises when the immune system reacts excessively to allergens, leading to the release of histamines and resulting in rashes and itching.
Homoeopathic remedies aim to strengthen the immune system, allowing the body to better manage allergic reactions. By enhancing the body’s resilience, these treatments may help reduce the activation of mast cells and histamine production, leading to a gradual alleviation of urticaria symptoms.
Additionally, homoeopathy may address hereditary factors and overall sensitivity to allergens. It is also thought to positively impact mental well-being, as stress can exacerbate symptoms. In many cases, a remedy like Urtica Urens is recommended to help balance both mind and body responses.
REFERENCES
- Lectures on Homoeopathic Materia Medica — J. T. Kent.
2. Text Book of Materia Medica – Dr. S. K. Dubey.
3. Repertory of the Homoeopathic Materia Medica – J. T. Kent
4. Textbook of DERMATOLOGY for Homoeopathic
– Ramji Gupta MD (AIMS) 5. Practice of Dermatology – P. N. Behi, A. Agrawal / – Govind Srivastava.
7. Pocket manual of Homoeopathic Materia Medica –- W. Boerike.M.D.
8. Textbook of Comparative M.M. by Farrington.
9. Textbook of Davidson’s Principles and Practice of Medicine- Sir
Stanley Davidson’s.
Authors –
Dr. Jineshwar Annasaheb Yaligouda M.D. (Hom)
: Professor & H.O.D Department of Human Anatomy,
: Gulabrao Patil Homoeopathic Medical College & Hospital, Miraj. Maharashtra State. India. 416410.
: N.S.S. Coordinator & Programme Officer Under Maharashtra University of Health Sciences, Nashik, Maharashtra, India
: President of Malgaon Medical Association Malgaon. Miraj, Sangli.
Mr. Padmraj Jineshwar Yaligouda – B.H.M.S. Final Year. Bharatesh Homoeopathic Medical College & Hospital, Belgavi, Karnataka State.
