Abstract: Tinea infections are among the most common skin diseases worldwide and cause serious chronic morbidity. Although it is not life threatening but much troublesome & cause distress to the patient. The scope of conventional treatment of tinea infections is limited as the topical antifungal agents along with oral antifungal medicines only suppress the condition & recurrences rates are higher with more intensified symptoms. Whereas Homeopathy is known to be the most popular treatment modality used for skin problems. The constitutional approach always yields wonderful results with no recurrences.
Keywords: Homeopathy, tinea, ringworm, dermatophytes, fungal, skin, Arsenicum album
Introduction:
The term ‘Tinea’ refers to superficial infection of skin, hairs & nails caused by pathogenic fungi known as dermatophytes belonging to three genera, Trichophyton, Epidermophyton and Microsporum. Dermatophytic infection of skin is often called as “ringworm”. Dermatophytes manifest in humans in various forms and most common infections are Tinea corporis and Tinea cruris most commonly caused by Trichophyton species. According to WHO, the superficial mycotic infection has a prevalence rate of 20-25% worldwide. It is more prevalent in tropical and subtropical countries like India where the heat and humidity is high for most part of the year.
Classification of tinea on the basis of location involved:
| Tinea capitis | Ringworm of scalp |
| Tinea faciei | Face |
| Tinea barbae | Beard |
| Tinea manuu | Wrist |
| Tinea corporis | Ringworm of trunk |
| Tinea cruris (jock’s itch) | Ringworm of groin |
| Tinea pedis (athlete’s foot) | Ringworm of foot |
| Tinea unguium (onchomycosis) | Nail fungus |
The fungi affects keratinized tissues and spread by direct contact with infected human beings, animals, soil and indirectly by fomites.
Clinical Presentation of tinea lesions:
The gross appearance of the lesion is an outer ring of active, progressing infection, with central healing. Infection may proceed more deeply from superficial involvement, depending on the fungus, site of infection, and immune status of the host.
Among all, Tinea corporis is the commonest clinical type.
Tinea capitis is predominantly seen in pre-pubertal children. Tinea cruris occurs only in adults especially the males and rarely in children. Tinea pedis and Tinea unguium, Tinea corporis are more common among adults
Risk factors:
Several risk factors have been identified that predispose an individual to tinea infection, including moisture (humid weather, excessive perspiration), occlusive clothing, unhygienic conditions, diabetes mellitus, immunocompromised state, and lower socioeconomic status.
Diagnosis based upon the appearance:
On physical examination, an erythematous, scaly, annular plaque with a raised leading edge and central clearing can be visualized involving the groin region. The infection spreads centrifugally and results in annular patches of varying sizes.
Tinea infections may mimics other conditions, which can manifest identical lesions, sometimes making the clinical diagnosis unreliable. For example, tinea corporis can be confused with eczema, tinea capitis can be confused with alopecia areata, and onychomycosis can be confused with dystrophic toenails, which may results from repeated low-level trauma. The confirmatory test could be done with a potassium hydroxide preparation or culture.
Points to be considered while treating Tinea cruris:
The pruritic rash of tinea sometimes accompanied with secondary infections which results in much irritation, inflammation, pain and discomfort which needs extra care. Other conditions which may be responsible for the maintenance & prolongation of infection like history of diabetes, immunocompromise, renal disease, or hepatic dysfunction must be elucidated. Enquiry should be made about excessive sweating, wardrobe changes, and personal hygiene habits, patient’s environmental and occupation exposures, including people, pets, animals, and contaminated soil, which may be contributory to the skin condition.
This information could help you in management of the case in better way; helps in removing exciting or maintaining cause if any & provide effective treatment which will give relief to the patient that will sustain & help you avoid recurrences.
Case report:
Introduction
Mr D, aged 28 years, unmarried boy came to me on 1st January 2022 with the complaint of annular eruptions on the inner sides of thighs & genitalia for 3 years. He is frustrated with the itching & offensiveness of it.
Presenting complaints
The chief complaints of the patient was itchy annular eruptions on the inner sides of thighs & genitalia which is horribly offensive. The itching aggravates by perspiration & after having eggs
History of presenting complaints
The patient was apparently well 3 years back then he noticed circular, inflamed itchy eruptions on the sides of thighs which slowly increased over the genitals. He looks very frustrated with the itching & especially the offensive smell from the eruptions.
Treatment history: Consumed many anti-fungal oral medications in the past but with no relief. Used antifungal ointments too with temporary relief.
Past history: Nothing Specific
Family history: Nothing specific was found
Physicals generals
The patient’s appetite was moderate, thirsty. Desires for sour things. He perspires more on genitals. Chilly patient.
Mental generals
Patient is very irritable due to extreme itch, burst out in anger & shouts. He has marked anxiety about his health, used to go for laboratory investigations on frequent basis. Full of fears, fear of getting infected or illness and very anxious. He doesn’t likes to be alone, desires company.
Analysis & Evaluation of symptoms
After detailed case taking, proper analysis & evaluation of the symptoms was done to construct the totality. The following characteristic, uncommon, peculiar symptoms which includes mental & physical generals as well as particular symptoms were considered for repertorization.
| Mental Generals | Physical Generals | Particulars |
| Irritability, shouts in anger+ Anxiety about health+++ Fearful, anxious++ | Thirst- increased Desire for sour things+ Perspiration on genitals+ Chilly patient | Ringworm, Itching over the sides of thigh, genitals ++ Offensive+++ < Perspiration, egg++ |
Symptoms considered for Repertorization using Hompath were:
- Eruptions (tendenct to): Herpetic (ringworm)
- Mind – Anxiety: Health, about
- Stomach- Thirst: Extreme
- Skin- Itching: Perspiration aggravates
- Genitalia- Male, Perspiration
- Stomach- Desires: sour, acids etc.
- Mind- irritability
- Mind- Delirium: frenzy, anxious, fearful etc.
Repertorial Result
Selection of remedy with justification:
The repertorial result showed the highest ranked remedies which includes Calcarea, Sepia, Sulphur, Arsenic & belladonna. Among these remedies, Arsenic was selected as the individualized constitutional medicine of the case. The reason for selecting arsenic was that the general constitution and mental picture of the patient was very much similar to Arsenicum album, covering his anxiety, irritability & fear. After considering materia medica, arsenic was covering most of his symptoms & found to be a useful remedy for ringworm as described in materia medica. So according to the totality of the symptoms, SINGLE DOSE of Arsenicum album 200CH was prescribed considering the susceptibility of the patient.
Prescription
Arsenicum album 200CH, single dose
Followed by Placebo 30, thrice a day for 15 days.
Follow -UPs
| Date | Symptoms | Prescription | Justification |
| 18th Jan 2022 | Patient was feeling much better with a sense of relief upto 80% | Placebo 30 | Prognosis : good Next step should be “Wait & watch” |
| 11th Feb 2022 | Patient is relieved of his suffering, Skin eruptions have been cleared up, no residual eruptions or itching present. | Placebo 30 | Wait & watch |
Click the link provided below to listen the patient testimonial:
Conclusion
Homeopathy have promising results in dermatological cases. Homeopathy treats the patient as a whole, not just the disease. It target the root cause; hence prevent recurrences. Individualisation plays the major role in the selection of most similar remedy. Patients may respond well to the constitutional remedy than to a specific or therapeutic remedy.
About the author:
Dr Shweta Singh, MD (HOM.)
Senior Homoeopathic Consultant, Orbit Clinics, New Delhi
Senior Research Fellow: Central Council for Research in Homoeopathy, New Delhi
Medical Director, Muskan Foundation, New Delhi
President, Delhi Homoeopathic Medical Association
Chief Administrator, KHA Homeopathy Study Group, USA
Former Assistant Professor; Department of Organon of Medicine (JRK Homoeopathic Medical College & Hospital, Rohtak)