Abstract :
Acne vulgaris is a common skin disease that affects young people. It mostly affects the pilosebaceous unit, which may lead to hyper pigmentation and scarring, and has a psychological impact that is often underestimated. Homoeopathy uses an effective method to treat the disease. Clinical repertories were born out of necessity; these are the hidden treasures of homoeopathic literature. This Article takes an in depth look at one of the most widely used clinical repertory; Oscar Eugene Boericke’s Repertory and describes its utility for Acne vulgaris. It seeks to promote the use and research of Clinical Repertories.
Key word :
Acne vulgaris, Boericke Repertory, Homoeopathy
Introduction :
Acne vulgaris is defined as a chronic inflammation of the pilosebaceous unit characterised by a polymorphic eruption of comedones, erythematous papules, pustules & nodules. Inflammatory & non-inflammatory lesions occur chiefly on the face but can also occur on the upper arms, trunk & back.
Acne is estimated to affect 9.4% of the Global population, making it the most prevalent disease worldwide.
Historical Background :
Acne has been around since ancient times, with its roots dating back to Egypt, Greece and Rome. It is a contagious skin condition that can ruin an individual’s complexion.
The word “Akut,” which was later translated as “boils, blains, sores, pustules, or any inflammatory swelling” is recorded in the Eber Papyrus.
Aetius Amidenu’s writings suggest that “Acne” is derived from the Greek word “Acme”, meaning “point or spot”.
Etiopathogenesis :
Acne vulgaris is a cutaneous chronic inflammatory disorder with complex
pathogenesis. Four factors play an important role in the pathophysiology of acne
vulgaris.
- Increased production of sebum
- Altered keratinisation of the pilosebaceous duct (Ductal Hypercornification)
- An abnormality of the microbial flora (Follicular colonisation with propionibacterium acne)
- Inflammation
Clinical features :
Acne usually affects the face and often the trunk. The 1st lesion, usually comedones & is a hallmark feature.
Three type of lesions,
- Non inflamed lesions
- Inflamed lesions
- Scarring
- Non Inflamed Lesions
More frequent in younger patients. Early acne is comedonal affecting the mid portion of the face. Later, lesions tend to cluster on the forehead, lower cheeks and neck.
Different type of comedones as follows.
Open comedones, Close comedones, Micro comedones, Macro comedones, Drug induced comedones etc.
- Inflamed lesions
Lesions May be superficial or deep.
Superficial inflammatory lesions: either papules or pustules. Such lesions are less than 1 cm in diameter. (Usually 1-3 mm). Deep inflammatory lesions: may be nodules or deep pustules.
- Scarring
There are two type of scarring,
Where there is loss of collagen tissue,
Where there is an increase in collagen tissue.
Ex : ice pick scar, Hypertrophic scar, Keloid scar etc.
Grading of Acne :
Grade 1: Mild acne: Comedones < 30, Predominance of comedones Papules < 10, No scarring
Grade 2: Moderate acne: Comedones any number, Predominance of papules > 10, Nodules < 3, Mild scarring ±
Grade 3: Severe acne: Comedones any number, Predominance of nodules/cysts Papules any number, Nodules/cysts > 3, Extensive scarring
Investigation :
Investigations are not Required in typical Acne vulgaris is clinically diagnosed.
Lab tests are only done to evaluate for hormonal imbalance.
Management :
Acne treatment plans are based on severity, and presence of associated features such as cutaneous hyperandrogenism.
General management: Gentle washing of the face with soap and water without vigorous scrubbing is recommended.
Cosmetics should be non-comedogenic. Diet has no effect on acne.
Medicinal management: In the early stages with comedones and papules, a topical retinoid such as tretinoin 0.025% to 0.1%, adapalene 0.1% or tazarotene 2.5% at night and benzoyl peroxide 5% in the morning would suffice.
Homeopathic Management:
Homoeopathy is a system of medicine introduced by Dr. C. F. S. Hahnemann, is based on the law of similar and considers the patient as a whole rather than any particular organ or tissue to be diseased.
Homoeopathic treatment involves selecting a treatment according to the precise symptoms of each individual patient. Acne vulgaris though considered an only disease of the outer covering i.e., the skin of a human being but affects the patient at all levels of health (mental, emotional, and physical) and needed to be addressed similarly. The selection of medicine for acne vulgaris should be based on the totality of symptoms.
Here we discuss –
Utility of Boericke Repertory and Rubrics releted to acne in Boericke Repertory
Homeopathic Therapeutics
- Utility of Boericke Repertory in case of Acne vulgaris :
Repertories are very useful in finding out simillimum in case of Acne vulgaris. Different Repertories are useful in different type of cases and every Repertory has different philosophical background , construction. Depending upon philosophical background, construction and rubrics, utility of repertory differs. As per the data available in the case i.e as per the totality of symptoms available, following repertories are selected for study depending upon philosophical background, construction and rubrics.
It is said that O. E. Boericke’s repertory is one of the important general clinical repertory. Clinical repertory is an index of remedies applicable to various more or less fixed symptom syndromes to which nosological labels can be given.
Boericke’s Pocket Manual of Materia Medica And Repertory:
It is used in cases where:
-Clinical cases with clear diagnosis, Short cases with few symptoms
-Cases lacking in mental and general characteristic symptoms but rich in common
symptoms with its cause, location and character of pain and modalities (aggravating
and ameliorating factors).
Few Acne releted rubric from pocket manual of M.M and Repertory by Dr.O.E Boericke:
[Boericke] [EARS] – ERUPTIONS –acne – Calc.s.
[Boericke] [FACE] – APPEARANCE – greasy, shiny, oily – Nat. m., Plumb., Psor., Sanic., Selen., Thuya.
[Boericke] [FACE] – ERUPTIONS ON FACE – Acne Rosacea – Ars. br., Carbo an., Chrysar., Eug. j., Kreos., Ophor., Psor., Sul., Sulphurous ac.
[Boericke] [FACE] – ERUPTIONS ON FACE – Acne Simplex – Ambra, Ant. c., Bell., Berb. aq., Calc. p., Calc. s., Carbo v., Cim., Clem., Con., Crot. t., Eug. j., Graph., Ind., Jugl. r., Kali ars., Kali br., Kali c., Led., Med., Nat. m., Nux v., Phos. ac., Sul., Thuya.
[Boericke] [FACE] – ERUPTIONS ON FACE – Comedones – Abrot., Eug. j., Jugl. r., Nit. ac., Sul.
[Boericke] [FACE] – ERUPTIONS ON FACE – Pustules – Ant. c., Bell., Calc. c., Calc. s., Cic., Graph., Hep., Indium, Merc., Psor
[Boericke][FEMAL SEXUAL SYSTEM] – PREGNANCY AND LABOR –Complaints during pregnancy – Acne – (See skin.) — Bell., Sab., Sep.
[Boericke][SKIN] – ACNE ROSACEA -Agar., Ars., Ars. br., Ars. iod., Bell., Carbo an., Caust., Chrysar., Eug. j., Hydrocot., Kali br., Kali iod., Kreos., Nux v., Oophor., Petrol., Psor., Radium, Rhus r., Rhus t., Sep., Sul., Sul iod., Sulphurous ac.
[Boericke][SKIN] – ACNE SIMPLEX –Abuse of KI, from – Aur.
[Boericke][SKIN] – ACNE SIMPLEX –Abuse of mercury from -Kali iod., Mez., Nit. ac.
[Boericke][SKIN] – ACNE SIMPLEX – Cosmetics from – Bov.
[Boericke][SKIN] – ACNE SIMPLEX – Gastric derangements with – Ant. c., Carbo v., Cim., Lyc., Nux v., Puls., Robin
[Boericke][SKIN] – ACNE SIMPLEX – Menstrual irregularities with –Aur. m. n., Bell., Bellis, Berb. aq., Berb. v., Calc. c., Cim., Con., Eug. j., Graph., Kali br., Kali c., Kreos., Nat. m., Psor., Puls., Sang., Sars., Thuya, Ver. a.
[Boericke][SKIN] – ACNE SIMPLEX – Scars unsightly , with – Carbo an., Kali br
- Homeopathic Therapeutics :
Arsenicum Bromatum : Acne rosacea, with violet papules on nose; worse in the spring. Acne in young people.
Berberis Aquafolium : Acne. Blotches and pimples. Clears the complexion.
Kalium Bromatum : Face has a blotchy red appearance with multiple acne especially during puberty. Scars remains after the acne had disappeared.
Psorinum : Greasy skin. Acne rosacea with dirty, rough scabby skin, pustules near fingernails.
Pulsatilla : Acne at puberty. Acne exacerbated on eating rich or fatty food and more in warmth or heat. Acne appear near menstrual periods. Individual usually fair complexion and prone for emotions & moodiness.
Radium Bromatum : Acne rosacea; naevi; moles; ulcers; cancers; dermatitis of fingers. Small pimples, erythema and dermatitis with itching, swelling and redness. Necrosis and ulceration. Burning and itching all over the body; burning as if on fire.
Sulphur : People who are unclean, prone to skin complaints & dislike being cleaned. Pustular eruptions, dry, scaly, unhealthy skin with itching and burning. Worse on scratching and washing. Especially indicated skin eruptions after local applications.
Conclusion :
Acne is one of the most common skin diseases observed in clinical practice , So with help of finding appropriate Rubric from O.E.Boericke’s Repertory and treating Acne vulgaris.
References :
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