IJAHMC, 2015; Vol 1(01): Sept-2015 (007 - 020)
ACNE & HOMEOPATHY
Dr Santoshkumar A. Gite 1
Dr.Amol Telore MD (Hom)1, Dr.Pardeshi Kailas MD (Hom)1
1 Lecturer, Ahmednagar Homeopathic Medical College A’ Nagar 414003.Maharashtra, India
Abstract:
Acne afflicts mostly the younger lot between the ages of 12 & 24. However people in forties and fifties too may continue to have this problem. Women tend to suffer from adult acne more than men because of the increasing hormone levels. Androgens (male sex hormones) increase in both boys and girls during puberty causing the sebaceous glands in the skin to enlarge and make more sebum resulting in pimples or acne.
Keywords: Homeopathy, Acne Etc.
7 IJAHMC, 2015; Vol 1(01): Aug-2015 (001 - 011) sebaceous glands in the skin to enlarge and make more sebum resulting in pimples or acne. Acne can Acne Myths: be hereditary. Hormonal changes during a) Chocolate and greasy foods cause Acne: Foods pregnancy, starting or stopping birth control pills, have little effect on the development of acne certain drugs all can cause acne. b) Poor diet causes acne: There is no connection Greasy cosmetics too can be the culprits at between diet and acne. In case certain foods times. Hard scrubbing of the skin, squeezing or triggers acne. Avoid them. Diet should include high picking blemishes can flare up the acne. fiber, fresh vegetables, fruits and plenty of water Acne and Mind: c) Dirty skin causes acne: Blackheads and other Acne impacts peoples psyche in a very acne lesions are noted caused by dirt. major way. In one sense it is an appearance d) Stress causes acne: Stress has nothing to do change, but then there is also insecurity and with acne formation. frustration. People are insecure how they have a big event coming up; they don’t know if their face e) Acne is merely a cosmetic problem: It is true is going to be clear. So there tends to be this level that acne does not pose serious threat to a of anxiety. person’s health. Yet, it can result in permanent scars and can influence the psyche. Getting rid of Acne: i) Let acne run its course: acne needs treatment Acne is not life threatening but it can leave behind and can be cleared up not only skin scars but also emotional scars. Up till now, the general consensus was leaving acne
alone. Acne Facts: However, acne should be treated because Acne afflicts mostly the younger lot treatment can cause a phenomenal change in one’s between the ages of 12 & 24. However people in health, in one’s personality--- a self-conscious forties and fifties too may continue to have this individual can turn into an extrovert. Also, problem. Women tend to suffer from adult acne individual with mild acne can get psychologically more than men because of the increasing hormone affected doctors trivialize the problem whilst levels. Androgens (male sex hormones) increase in patients exaggerate or underplay depending upon both boys and girls during puberty causing the the psychological impact.
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Each person requires his own assessment Definition : Acne vulgaris is a disease in which and treatment program. the pilosebaceous follicle becomes oversensitive to normal levels of testosterone
and it is an inflammatory dermatomes Acne Hygiene: (Chronic) Site: Appear at the site of heightened Wash your skin with a mild cleanser twice in a sebaceous activity. The common sited are face, day chest, back, upper arms and sometimes Never squeeze, pinch or pick your blemishes, buttocks, often face is only affected part. they may leave scars or dark blotches behind. Prevalence: This affects teen agers. Both sexes Also avoid rubbing and touching skin lesions. are affected. Peak age of severity in females is Choose cosmetics carefully with advice of 16-17 yrs. and in males 17-19 yrs. Acne clears doctor in a case you have acne and you are by the age of 23-25 yrs. in 90%, only 9% of under treatment women and 1.1 of men still needs treatment in Oil free preparations are recommended. their thirties or even forties.
Grading of Severity : (Morphological Acne Vulgaris: classification) a) Mild : Open and closed comedones Acne vulgaris commonly known as pimples & is an inflammatory disease of pilosebaceous unit with inflammatory lesions no.few to of the skin. Its manifestations include many
comedones (white and black), papules, b) Moderate : Few to many comedones, some papules and or pustules, cysts etc. The lesions often result in pustules ugly scaring. Onset of acne is in puberty, with c) Severe: Inflammatory papules, both the sexes being equally affected. The pustules, cysts, abscesses and or incidence of acne decreases as the age scarring. May include modules advances and by 25 yrs, individual is usually which lead to scarring free of acne. Etiological Factor : 1) Androgens Available online on www.ijahmc.com Page 9
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2) Hereditary 2) Bacterial colonization of duct and release of 3) Follicular Keratinization inflammatory mediators. 4) Proprionibacterium acne 3) Increased sebum secretion rate 5) Genetic and hormonal factors 4) Rupture of comedo with release of Exacerbating Factors : contracts into dermis a) Stress 5) Hair follicle b) Premenstrual period 6) Sebaceous gland c) Virilizing syndrome in women 7) Epidermis d) Occupational exposure e) Steroids Many factors combine to cause chronic f) Iodides inflammation of blocked pilosebacesus follicles. g) Antiepileptic drugs With all above mentioned factors – bacteria h) Androgenon and progesterone play a pathogenic role. It colonizes ducts, Pathophysiology : breaks down MI glycerides, releasing free fatty The principal factors involved in pathogenesis acids, produces substances chemotactic for of Acne are inflammatory cells, and induces the ductal 1) Increase sebum production epithelium of secrete pro-inflammatory 2) Abnormal keratinization of follicular cytokines. Rupture of the follicles is associated epithelium with intense inflammation. 3) Proliferation of Proprionibacterium acnes Clinical Features: 4) Inflammation 5) Androgenic stimulation causes increased 1) Lesion are limited to Face, upper chest, sebum activity which can cause acne. back 6) Results in white heads and blackheads 2) Seborrhea (grassy skin) is often present 3) Open comedones (blackheads) due to plugging by keratin and sebum of the Pathogenesis : pilosebaceous office 1) Occlusion of pilosebaceous duct
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4) Closed comedones (white heads) due to d) Pyoderma facile: More common in young accretions of sebum of keratin deeper in women with emotional stress the pilosebaceous ducts. e) Acne like eruption: Drug induced 5) Inflammatory papules, nodules and cyst occur. Acne Rosacea: 6) Scarring may follow Introduction:
1) Chronic facial skin disorder most Investigations: commonly seen in individuals between 1) Swabs: to exclude a pyogenic infection, the ages of 30 & 60 yrs. anaerobic infection and gram –via folliculitis 2) More common in women than men but often severe in men 2) Pelvic Ultrasound : to detect PCOD and others 3) Causes : Psychological distress
4) Similarity in appearance to acne vulgaris Management: 5) Features : Erythema Telangiectasia a) Managed by Homoeopathic medicines alone Papules b) Hygiene Pustules c) Regular washing with foam and water is essential Edema of mid facial Unusual Forms of Acne : skin a) Conglobate acne: Severe, with cysts, Synonym : Rosacea scarring ICDG code : 695.3 Rosacea b) Acne Fulminant: Conglobate acne with Cardinal Features fever, joint pain, high ESR 1) Facial involvement, rarely trifocal 2) Above point no. 5 c) Infantile acne: After 3months of age but 3) Eye involvement is common rare
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4) Progressive disease, commonly with period Race : Rarely in Africans-Americans occurs less of exacerbation and remission often in individuals of oriental or Hispanic 5) Above point 2 origin 6) Associated with easy flushing and blushing Appears most often in individuals of north and Cause : eastern European descent, such as centric or 1) Unknown Scandinavian populations 2) Psychological Genetics : F/H : Predisposes to disease 40% 3) Theories: Underlying vasomotor Geography: Mere common in areas where instability of blood or skin mite there are populations of individuals of northern Demodex Folliculorum, but there is little and eastern European descent evidence for either.
Epidemiology : a) Incidence and prevalence: Frequency D/D : 50/100 1) Acne V : A chronic disease of sebaceous follicle Men: C/F: Back and chest involvement scars, 20-30/1000 comedones, papules, pustules, nodules F: 60- Most commonly adolescents of young 80/1000 adults b) Demographics: 2) Drug Eruptions : Reaction to drugs-- Age : peak age onset 30-45 yrs. bromides and iodides Rate in prepubescent children C/F: Flushing of face and body
Gender : F: M :: 3:1 3) Dermatitis : An inflammatory skin disorder Women experience less severe disease than and may be seborrheric, contact or perioral men C/F: Scaling, introlevement of Flexures
4) S.L.E. : A chronic multisystemic disease of autoimmune origin Available online on www.ijahmc.com Page 12
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C/F: Malar rash in mid facial region, rash on other light exposed areas systemic Advanced Stage: symptoms. Deep persistent erythema 5) Sorcoidosis : A multisystem granulomatous Prominent and widespread facial telangiectasia disorder of unclear etiology characterized Papules and pustules pathologically by presence of noncaseating Increased skin and ocular inflammation granulomas Persistent conjunctivitis or blephritis C/F: Infiltrating plaques affecting the nose, Edema in the skin, particularly above nasolabial chicks or earlobes, systemic symp. folds 6) Cardinoid syndrome : A symptom complex Rhinophyma usually in men, ready caused by characterized by paroxysmal vasomotor sebaceous gland hypertrophy disturbances, diarrhea, broncho spasm and cutaneous flushing Symptoms: C/F: Telangiectasia, Flushing attacks Hepatomegaly Early stage:
Systemic symptoms Episodic flushing by local stimuli such as sunlight, hot drinks, alcohol, spicy foods and Signs and Symp. : emotion Signs: Early stage: Redness (Cheeks and chin women, includes Transitory erythema of mid facial area nose in male ) (mainly chin in women, include nose in men) Middle Stage:
Middle stage: Papules and pustules Sensation of ocular grittiness Episodic erythema of mid facial area (cheeks Persistent flushing sometimes accompanied and chin in w, includes nose in men) burning or stinging sensation Telangiectasia in affected areas Advanced stage: Papules and pustules Mild conjunctivitis or blepharitis (58%) Available online on www.ijahmc.com Page 13
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Permanent facial redness sometimes 5) Examination: accompanied by burning of stinging sensation 1) Is pt. well/unwell? : If systematically Painful papules and pustules unwell-suggests S.l.E., Sorcoidosis or Persistent eye irritation carcinoid syndrome Nasal swelling in men 2) Is the patient fair skinned? since fair
skin people like eastern European Associate Disorders: Conjunctivitis descent most commonly affected 3) Ex. Of Face : Blephritis Rosacea is a Centro facial Investigations:- disease, principally localized on the nose, cheeks, chin, and 1) F/H: 40% of suffers have a family method forehead of glabella. It is rarely with disease found elsewhere 2) Drugs: Medication or drug reaction can be Vivid red erythema and confused with rosacea. Topical or oral steroid Rx. telangiectasia’s, papules (may be can exacerbate symptoms of Rosacea. inflammatory or due to sebaceous gland hypertrophy) & 3) Ques: Any H/o since suffering from facial pustules are hallmarks of flushing triggered by any of following: Sun Rosacea exposure, stress, hot weather, alcohol Presence of comedones suggests consumption, spicy foods, exercise, wind, hot acne v, rosacea by itself has no baths, cold weather, hot drinks, skin care products: comedones so called flushes and blushers are signs of early Check for scaling. Aloe if suggest stage Rosacea. seborrheric dermatitis. Perioral 4) Q: Do you suffer from episodic attacks of or Flexure involvement suggests papules and or pustules associated with above perioral or contact dermatitis. triggers: Rosacea symptom can be exacerbated by these triggers.
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Inspect eyes for signs of Edema in the skin and Rhinophyma [usually in conjunctivitis or mild ocular men] in advanced cases involvement. Suspect rosacea if patient presents with any of Check for edema in facial skin these clinical findings but no systemic particularly above the nasolabial symptoms or comedones folds. Take into account patients race, sex, age Check for Rhinophyma in advanced stage rosacea in men. Clinical Pearls: I.e. it is clinical diagnosis and so no specific lab test to confirm Frequently mistaken for malar rash of systemic diagnosis. lumps with one must look beyond red cheeks at Skin biopsy of histologic finer joint of d/d sections, which are normally Presence of comedones suggests acne vulgaris performed by a specialist, can rather than acute rosacea; comedones need to show a characteristic be distinguished from follicular plugging of constellation of features, which discold lupus erythematous. may assist in difficult cases.
Management:
Diagnostic Decision: Goals:
Based on clinical findings Calm down any presenting Flare-up Episodic or persistent erythema of mid facial Reduce frequency and intensity of further flare area, telangiectasia, papules and pustules, mild up ocular involvement, sebaceous gland Slow or half progression of disease hypertrophy Health seeking behavior: The patient may have Absence of comedones or systemic symptom been using OTC acne Rx. or steroid preparation that can make symptoms worse. Available online on www.ijahmc.com Page 15
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Lifestyle Properties: wind, hot baths, cold weather, hot drinks, skin- care products, certain drugs. Conspicuous facial redness and blemishes of Education about these triggers factors. rosacea can have a deep impact on the life of Prognosis: an affected individual: 75% of suffers feel low self-esteem, 56% feel they have been robbed of Untreated rosacea tends to be persistent pleasure of happiness. disease with periods of relapse and remission Rx. should be aggressive in patients who are Prognosis of eye involvement is excellent sensitive to their appearance. except in cases of ocular keratitis Other: Periods of relapse and remission are common feature of rosacea. Advice patient on lifestyle recommendations Careful alteration to reducing triggers. e.g. sunscreen Complications: Cryosurgery laser therapy, electrosugery for Rhinophyma. 1. Mild eye involvement: Conjunctivitis, Patients often benefit from cool compresses Blephritis, irritation. after activity that includes flushing/blushing 2. Serious eye involvement: Keratitis e.g. exertion, sheso, heat, sun > Information for Patient: 3. Persistent edema leading to coarsening of skin and features Lifestyle adjustments are an imp past of Rx.. Other Therapies: 4. Rhinophyma (men)
Sunscreen : Effective in preventing false-ups 5. Rosacea fulminant (pyoderma facial) : and in managing acute episodes Sudden onset of coalescing nodules, abscesses and Life Style: sinuses which occurs very rarely.
Avoidance of a variety of factors that can 6. Lipoid rosacea: clusters of large, dull, red precipitate a flare-up of flushing of skin papules which are resistant to stad. Rx. changes: Sun exposure, stress, hot weather 7. Steroid rosacea alcohol consumption, spicy foods, exercise, Risk Factors: Available online on www.ijahmc.com Page 16
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1. Fair Skinned: Flusher of blusher skin & consequences thin, fragile skin, wrinkling, easy bruising that leathery hide look that we all 2. Modification: fear. a) Avoid alcohol “Prevention is better than cure”. It holds b) Avoid hot drinks and spicy food true here too.
c) Avoid exposure to cold, heat, wind Some tips below.
d) FlH: 40% A] Normal Skin type: This means that skin is neither dry nor completely oily. The forehead, e) Drug/H: OTC acne area around nose and chin is little oily & the rest of the face dry. This is a little difficult to maintain.
Rub two cubes of ice all over your face in the morning before your first face wash. This will
close your skin pores & ensure a fresh feel for the rest of the day.
Add lemon juice in water and apply for 10 minutes, massage and wash off with plane
water for healthier, softer and rosier skin.
Apply cucumber to feel cool. Cover face with chopped cucumber spread over damp cotton Prevention For Cosmetic problems: handkerchief. It is a natural cleanser. Cucumber juice mixed with milk is the best of all cleansers. Summer time can be rough and awfully dangerous, Oats, which have high fiber content, are good esp. in tropical countries like India. It causes for skin. dryness, premature aging. Data have shown that Face Pack: Mixed oats with honey, yogurt and even moderate sun exposure, without burning, ground almonds. Apply this on face, leave it for triggers the activation of enzymes that break down ten minutes and was with lukewarm water. Available online on www.ijahmc.com Page 17
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B] Dry Skin Care: C] Oily skin Care:
Dry skin type needs little care. The best is This type of skin is the most difficult one to to keep it moist. Do not leave the skin dry, as it will maintain. There is a need to frequently wash the darken the skin, so keep washing the face with face. Pat-dry it every now and them. Oily skin lukewarm water whenever patient can and use needs maximum care. The soap or face wash very good moisturizer. Use wet tissues instead of should be moisture fee. Avoid direct sun contact, handkerchief; this will help keep the skin moist. as it will induce the oil pores and the oil will surface on the face. Use umbrella while going out during Dry skin needs moisturizer; sunscreen is day time. Avoid oil rich diet. Instead eat more of replenishing moisture as well as a guard against fresh fruits, salad, and fruit juice to keep the skin in the sun. its right form. Use dry tissues to pat your face Do not use any scrubs or packs, as they will during day-time. This will help in absorbing excess further dry your skin. Instead try a chocolate oil even if patient is unable to wash his face often. mask to make skin smooth. Mask: Apply two ice-cubes all over the face first thing in the morning. This will remove the excess oil I/3 cup cocoa + 3 teaspoons of heavy from face and close the pores ensuring no cream, ground for pimples. I/3 cup ripe papaya + ¼ cup honey & 3 Use mud-based packs. They are very useful in teaspoons of oatmeal powder. Mix well and apply absorbing oil on the face. Wash with lukewarm water when dry. Mixture of curd and Basan is useful. Apply every morning. Add a pinch of haldi/turmeric as Use soap with moisture content. it is antiseptic too. Once a week give a good face massage and Rub thin apple slices on the face. It will help to then just sponge off the excess exam. Wash lessen oily shine from the face. Repeat it every after steaming with a hot face towel. day. Mix honey, lemon and vegetable all for a great Mixture: For oily skin, apply a mixture of homemade moisturizer for dry skin. Apply grapes, lemon and egg white. Leave it for 20 concoction for 10 minutes. minutes and rinse with warm water. While Available online on www.ijahmc.com Page 18
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lemon acts as natural cleanser, grapes will E.g. Berb aqua, Echinacea , Kali Brom, Ferrum phos Calendula, Macuna soften your skin and egg whites will tighten it. 1. Berb. Aqua: It affects the skin which Don’t worry if your skin tingles” becomes dry, rough, scaly, piroply eruptions on scalp extending to face and neck. Acne. Psoriasis,
Dry eczema, cleans she completion. It should be given in mother tincture. Therapeutic Approach: 2. Calendula: Used externally for
wounds of acne (Materia Medica & Repertory) 3. Ferrum Phos. : Ferrum phos powders used 1) (BTPB) to stop bleeding Antim crud, Ars, Caust, Graph, Hep, Merc, 4. Calf Flur & Sil: For face disfigurement due Nat. M, Nux. V, Rhus, Sep, Sul, Sil, to acne scars, left by ulcers, boils 2) (Pathak Repertory) Ast.r, Bell, Hep, Kali br, Merc, Sep, Sul, Ars. 5. Echinacea : It corrects blood dyscrasias, useful for septic Sil, Thuja conditions 3) (Dr. J.D. Patil) 6. Mucena: Useful to control Sulphur, Kali br, Sang, Ant – C, Berb A, Thuja bleeding 4) (R.D. Jain – Biochemic) 7. Kali – Brom: Acne, scar remaining Cal – F, CP, CS, KM, KP, KS, NPI, Sil eruptions 5) (Boerick’s Repertory) 8. Unwanted Hair growth: (Dr. Wishambhar Kali Brom, Cimicif, Berb aqua, Led, Das) Hydrocot, Antimon, Kal, Brom Arn. a) Thuja: Luxuriant growth on parts There are no specifics in Homoeopathy: That’s why otherwise not to be naturally covered by hair this list is not useful, but it is fruitless b) Oleum Jec: But some mother tinctures externally can be c) Yellow sulphate of Ars + quick lime: applied provided that the medicine should be given Equal parts Paste in hot water Apply & allow internally drying. No hair will see for weeks or may be neved
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REFERENCES:
Organon of medicine 6th edition: Samuel Hahnemann
Lectures on homeopathic Materia Medica by James Tyler Kent
Davidson’s Practice of Medicine
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