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Herpes treated by individualized homoeopathic medicine - Sulphur: A case report

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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



Figure 2: 20/07/2022


Figure 3: 27/07/2022

Figure 4: 10/08/2022


Figure 5: 7/09/2022





Figure 6: 5/10/2022                  


Figure 7: 4/11/2022


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

 

 




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