Stasis Dermatitis - Case Presentation

Case Presentation of Stasis Dermatitis

1. CASE PRESENTATION

2. A CASE OF Stasis Dermatitis

3. CASE RECORDING Name – Mrs D.P Age – 42 Yrs. Sex- Female Religion - Hindu Occupation - Factory Worker Address – Lucknow Date- 15 th June, 2013

4. PRESENTING COMPLAINTS Swelling , redness in feet Deep cracks and scaling in soles of feet Duration:- 2 months Sensation:- Burning pain, Itching

5. PHOTO OF THE PATIENT On 15 th June, 2013

6. PAST HISTORY Typhoid- 10 years back Chickenpox- In childhood

7. Treatment History Taken Allopathic treatment for Typhoid Applied allopathic ointment for presenting complaints which only gave temporary relief.

8. Family History Father : Diabetic Patient Mother: Backache since 2 years.

9. Personal history Developmental landmarks: All are on time Diet: Vegetarian Marital status: Married for past 20 yrs Addictions: None Allergy: None Education: Illiterate Occupation: Factory Worker Hobbies: Nothing Specific

10. Gynae History : MENOPAUSE: At 40 years of age Obs History : G 3 P 3 A L 3 All deliveries were normal. OBS & GYNAE HISTORY

11. Physical Generals Appetite – Decreased Thirst – For large quantities of cold water at large intervals Desire – Spicy food Aversion – Nothing specific Stool – Constipated with no urging, hard, dry stool Urine – Normal in colour and frequency Perspiration – Nothing specific Sleep – Restless during sleep Thermal Reaction - Hot patient

12. Mentals Cheerful, talkative Desires company

13. GENERAL PHYSICAL EXAMINATION Built – Average Temperature – 98.8 F Pulse – 75 per minute, full, regular Rate of Respiration – 16 breaths per minute

14. Pallor – Absent Icterus – Absent Cyanosis – Absent Oedema – Absent Clubbing – Absent Lymph glands – Not enlarged Tongue – Clean and Moist

15. SYSTEMIC EXAMINATION Respiratory System – NAD Cardio-vascular System – NAD Nervous System – NAD Skin – Location- Feet and soles Character- Swelling and redness. Cracks and scaling of soles Distribution- Over feet and soles Discharge- Absent

16. CASE PROCESSING

17. DIFFERENTIAL DIAGNOSIS ATOPIC DERMATITIS CONTACT DERMATITIS XEROTIC ECZEMA STASIS DERMATITIS

18. ATOPIC DERMATITIS ATOPIC DERMATITIS (AD ) also known as  Atopic eczema is an  inflammatory , relapsing, non-contagious and  itchy  skin disorder. SIGNS AND SYMPTOMS Pattern of atopic eczema varies with age People with Atopic Dermatitis often have dry and scaly skin that spans the entire body, except perhaps the diaper area, and intensely itchy red, splotchy, raised  lesions   to form in the bends of the arms or legs, face, and neck . These lesions then weep, crack, swell, and crust over. These lesions are at a heightened risk for  bacterial ,  fungal , or  viral   colonisation . CAUSE The cause of AD is not known, although there is some evidence of genetic factors, and some evidence that growing up in a sanitary  environment encourages AD.

19. CONTACT DERMATITIS Contact dermatitis  is a type of skin inflammation . It results from exposure to  allergens   or  irritants  . SYMPTOMS Contact dermatitis is a localized  rash  or irritation of the skin caused by contact with a foreign substance. Only the superficial regions of the skin are affected in contact dermatitis . Inflammation of the affected tissue is present in the  epidermis  (the outermost layer of skin) and the outer  dermis  (the layer beneath the epidermis). Contact dermatitis results in large, burning, and itchy rashes. CAUSES Common causes of allergic contact dermatitis include:  nickel , gold and  chromium . Millions of cases occur each year in North America alone. Common causes of irritant contact dermatitis include: Solvents Metal working fluids Latex, Kerosene, Ethylene oxide Certain foods and drink Food flavorings and spices Perfume etc.

20. XEROTIC ECZEMA Xerotic eczema  (also known as "Eczema craquelé ", " Pruritus hiemalis ", " Asteatotic eczema", "Winter itch” and "Winter eczema") is a form of  eczema  that is characterized by changes that occur when  skin  becomes abnormally  dry ,  itchy , and cracked. Lower  legs  tend to be especially affected, although it can appear in the  underarm  area as well. Xerotic eczema is common in  elderly  people, though it is not uncommon for people in their 20s. It can appear in red,  bumpy ,  pimple -like  irritations .  Shaving  can cause it to become  inflamed .

21. STASIS DERMATITIS  (also known as "Congestion eczema," "Gravitational dermatitis," "Gravitational eczema," "Stasis eczema," and "Varicose eczema“) Refers to the  skin  changes that occur in the leg as a result of "stasis" or  blood pooling from insufficient  venous  return; the alternative name of  varicose eczema  comes from a common cause of this being  varicose veins . Insufficient venous return results in increased pressure in the  capillaries  with the result that both fluid and cells may "leak" out of the capillaries. This results in red cells breaking down, with iron containing  hemosiderin  possibly contributing to the  pathology  of this entity. STASIS DERMATITIS

22. Symptoms The skin appears thin, brown and tissue-like, with possible skin lesions ( macule  or patches), red spots, superficial skin irritation and/or darkening and/or thickening of the skin at the ankles or legs The skin may be weakened and may ulcerate in areas Legs, ankles, or other areas may become swollen Itching and/or leg pains Sometimes pain may persist from swollen tissues and may feel like "stabbing" or "needle pricks"

23. Provisional diagnosis STASIS DERMATITIS

24. ANALYSIS OF SYMPTOMS (According to dr.j.t.kent ) MENTALS : Cheerful Talkative Desires Company PHYSICAL GENERALS : Appetite- Decreased Thirst- For large quantities of cold water at large intervals Desire- Spicy food Stool- Constipated with no urging, hard, dry stool Thermal Reaction- Hot Sleep- Restless during sleep

25. PARTICULARS: Swelling, redness of feet Cracks and scaling of soles Sensation- Itching, burning pain

26. EVALUATION OF SYMPTOMS S.NO SYMPTOMS INTENSITY 1 Cheerful ++ 2 Talkative ++ 3 Desires Company +++ 4 Appetite- Decreased ++ 5 Thirst- Large quantities of cold water at large intervals ++ 6 Desire- Spicy food ++ 7 Stool- Constipated with no urging, hard, dry stool ++ 8 Thermal Reaction- Hot +++ 9 Sleep- R estless during sleep + 10 Swelling, redness of feet ++ 11 Cracks and scaling of soles +++ 12 Sensation- Itching, burning pain ++

27. MIASMATIC DETERMINATION (According to Comparison of the Chronic Miasms By PHYLLIS SPEIGHT S.No Symptoms Psora Syphilis Sycosis Tubercular 1. Cheerful + + 2. Talkative + 3. Desires Company + 4. Appetite- Decreased + 5. Thirst- Large quantities of cold water at large intervals + 6. Desire- Spicy food + 7. Stool- Constipated with no urging, hard, dry stool + 8. Thermal Reaction- Hot + 9. Sleep- R estless during sleep + + 10. Swelling, redness of feet + 11. Cracks and scaling of soles + 12. Sensation- Itching, burning pain +

28. TOTALITY OF SYMPTOMS Cheerful Talkative Desires Company Appetite- Decreased Thirst- Large quantities of cold water at large intervals Desire- Spicy food Stool- Constipated with no urging, hard, dry stool Sleep- Restless during sleep Thermal Reaction- Hot Swelling, redness of feet Cracks and scaling of soles Sensation- Itching, burning pain

29. REPERTORISATION

30. REPERTORIAL TOTALITY (According to Synthesis Repertory)

31. REPERTORISATION (According to Synthesis Repertory) With the help of synthesis repertory – Dr. Frederik schroyens

32. REPERTORIAL CHART

33. REPERTORIAL RESULT Sulphur– 30/14 Phosphorus – 29/13 Arsenic – 21/12 Zinc. Met. – 20/12 Causticum – 17/12

34. SULPHUR PHOSPHORUS ARSENIC ZINC. MET. CAUSTICUM MIND Dread of being washed Difficulty in thinking Selfish Nervous, weak Oversensitiveness to light, noise, odour , touch Does not like to be alone Dread of death when alone Excessive anxiety & restlessness Hasty in all motions Very sensitive to noise Averse to talk Intensely sympathetic Ailments from long lasting grief APPETITE Ravenous appetite, but as soon as he sees the food, his appetite vanishes. Hunger soon after eating Loss of appetite Great greediness when eating Ravenous hunger Takes food in hurry THIRST Drinks much but eats little For very cold water, icy cold For cold water in sips Hasty drinking No thirst

35. SULPHUR PHOSPHORUS ARSENIC ZINC. MET. CAUSTICUM DESIRE For fat, highly seasoned food, pickles, sweets For cold food & cold drinks Alcoholic drinks, warm drinks & warm food Cold drinks & cold food Beer, cold drink, smoked meat Refreshing things STOOL Stool hard dry; constipation alternating with diarrhoea Faeces : Slender, long, dry, tough & hard. Voided with great straining and difficulty Diarrhoea after eating or drinking; dark with much prostration Hard, small, constipated stool Soft and small. Hard , tough covered with mucous. Expelled with much straining or standing up SLEEP Talks, jerks and twitching during sleep Slight noise awakens Short naps & frequent wakens Yawning & sleepiness Disturbed due to dreams Nervous motion of feet when asleep Very drowsy, can hardly keep awake

36. SULPHUR PHOSPHORUS ARSENIC ZINC. MET. CAUSTICUM SKIN Dry, scaly, unhealthy Itching, burning. Skin affections after local medication Burning: In spots along spine, between scapulae, palm of hands Small wounds bleed profusely Dry, rough scaly; worse cold and scratching. Ulcers with offensive discharge Varicose veins of lower extremities Eczema especially in the anemic Soreness in folds of skin. Pains of burns Old injuries reopen THERMAL REACTION Hot Chilly Chilly Chilly Chilly

37. FIRST PRESCRIPTION- 15/06/2013 Rx 1. Sulphur 30. 2 doses 2. Rub. Met. 30. B.D for 2 weeks Patient was advised to apply coconut oil when itching occurs.

38. JUSTIFICATION OF SULPHUR (Acc. To Boericke And Kent Materia medica ) Burning pain in feet and soles Itching Swelling of feet Loss of appetite Desire for spicy food Drinks much Hard stool Restless during sleep Hot Patient

39. FOLLOW UP

40. FOLLOW UP - 02/07/2013 Burning reduced Itching slight reduced Swelling same Appetite same Rx Sulphur 30. 2 doses Rub. Met. 30. B.D for 15 days

41. FOLLOW UP - 04/08/2013 Patient returns after 1 month - Relief in swelling and redness Burning reduced Appetite Improved Scaling slight relieved Rx Rub. Met. 30 BD for 15 days JUSTIFICATION There was relief in symptoms So the action of medicine was not disturbed.

42. PHOTO OF THE PATIENT On 4 th August, 2013 On 15 th June, 2013

43. Management Wear pressure stockings.   These tight elastic stockings put pressure on your legs. This improves blood flow and prevents blood from collecting in your legs. Elevate  your legs above the level of your heart for 30 minutes, 4 times a day. This will help decrease swelling and pain. Prop your legs on pillows or blankets to keep them elevated comfortably. Exercise regularly.  Exercise improves the blood flow in your legs. Apply coconut oil or vaseline  to keep your skin moist and decrease itching. Do not scratch your legs:  Your skin can break open if you scratch. This can lead to sores or an infection.

44. STRENGTH OF THIS CASE Shows – Scope of Homoeopathy in cases of skin. Role of Sulphur in skin diseases.

45. SHORT COMINGS Modalities were not taken because patient was unable to present her condition properly. Patient didn’t come after two follow ups. Mentals were not proper.

46. THANK YOU