An 8 year old girl presented with asthma, whooping cough, multiple severe allergies, and remnants of suppressed eczema. She had had eczema as a baby.

Questions

1. What skin condition is shown in the picture?
2. What other conditions is it commonly associated with?
3. How would you treat this patient?

Answers

1. Atopic eczema with impetigo (superinfected with staphylococcus or streptococcus)
2. Atopic (or endogenous) eczema is commonly associated with asthma and hayfever
3. See discussion.

Discussion

Eczema

Eczema and dermatitis are words used interchangeably to describe acutely inflamed weeping skin ("eczema" is Greek for "boiling"). Eczema is nearly always itchy and has a range of clinical presentations. Acute eczema includes the formation of vesicles and bullae, while subacute eczema involves erythematous dry skin. In chronic eczema, the skin is usually thickened and lichenified.

One type of eczema, atopic eczema, is common, affecting about 5% of the UK population, and affecting one in 10 children at some stage.¹

Atopy

People with atopy readily produce IgE antibodies against materials that are commonly found in the environment. This overactive immune response to common environmental antigens leads to inflammation of the skin and the mucous membranes lining the nose and lungs.

Eight in ten people affected have a family history of atopy. Three quarters of atopic patients develop dermatitis before they are six months old and 90% by the age of five. Half of children have improved or "grown out of it" by the age of six and most of the rest have improved by the end of puberty.²

Conventional treatment approach

Orthodox medicine uses an allopathic approach. "Allopathy" is the Greek for "opposite suffering" and describes how conventional medicine heals by opposites. For example, doctors would use an analgesic to inhibit nervous transmission and kill the pain of a headache.

A standard approach to eczema treatment involves avoiding irritant clothing and bedding and reducing exposure to pet dander. Some practitioners advocate dietary manipulation, but most patients do not benefit from this. Using emollients and aqueous cream helps improve the dryness of eczema.

The aim of medical intervention is to suppress the immune response causing the skin inflammation. Corticosteroids can be used sparingly on inflamed skin when necessary. Bandaging and wet wrapping with bandages soaked in warm water are used (in conjunction with corticosteroids) for resistant eczema or lichenified skin.

Antibiotics may be necessary to treat secondary infection (flucloxacillin is suitable for staphylococcus) and sedating antihistamines can help with sleep, which is often disturbed by itching.

There are several systemic therapies available for resistant atopic eczema. These include ultraviolet phototherapy and oral immunosuppressives such as prednisolone, azathioprine, and ciclosporin.




Homeopathic treatment approach

The homoeopathic treatment approach opposes that of conventional medicine. "Homoeopathy" comes from the Greek meaning "similar suffering" and heals by similars. For example, a homoeopath might prescribe a remedy containing belladonna (deadly nightshade) for a headache. In a healthy person belladonna would cause many symptoms, including headache, and may be fatal.

In the 19th century, Dr Samuel Hahnemann formulated the principles of homoeopathy after discovering that he developed symptoms similar to those of malaria after ingesting Peruvian Bark (from which quinine is derived). More homoeopathic remedies were discovered through "provings," in which healthy subjects were given remedies under controlled conditions. The picture of symptoms that developed from each remedy was recorded in the homoeopathic Materia Medicas.

Dangerous substances are safe to use in homoeopathic remedies because they are diluted many fold. The law of the infinitesimal dose describes how remedies become more powerful as they are diluted. The theory proposes that at each dilution the remedy is mixed vigorously to add energy and "potentiate" it; this imprints the energetic image of the remedy on the solvent and progressively amplifies it.

Homoeopaths regard symptoms as the body's attempt to heal itself: skin symptoms are a manifestation of an internal disease trying to get out. Instead of suppressing symptoms, homoeopaths use remedies that imitate the symptoms, thereby stimulating the body's self healing power. By augmenting this intrinsic healing, homoeopathy can help eliminate the predisposition patients have to diseases, as well as the disease symptoms themselves.

A variety of remedies can be used for a particular symptom: in eczema the choice of remedy would depend on the appearance of the lesions and the pattern of itching, for example. Appropriate remedies are also selected based on the overall symptom picture of a patient, including their personality and temperament--this is called "finding the similimum." Homoeopaths believe that diseases affect the whole patient--body, mind, and spirit--so the choice of remedy is based on more than the generic symptoms presented. The homoeopath regularly reviews each patient and changes the remedies prescribed based on the clinical picture at each review.

The principle of direction of cure describes how diseases move from more to less important organs, from the inside to the outside. The approach to treating someone with atopy would result in the patient's eczema worsening as the asthma improved. The symptoms would disappear in the reverse order of their appearance--asthma would disappear before eczema--whereas atopic babies often develop eczema before their asthma becomes apparent.

The patient's asthma, eczema, whooping cough, and allergies had completely resolved within a year of starting homoeopathic treatment.

Clare Hughes final year medical student, Guy's, King's, and St Thomas's School of Medicine, London

Email: clarehughes@journalist.com

Haroon Jeggels registered homoeopath and physician, Cape town



June 2004



1. Kumar P, Clark M, eds. Clinical medicine. 4th ed. London: WB Saunders, 2002:1160.
2. Paige D. Atopic dermatitis. Medicine 2000;28:55-9.

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