Urticaria and Homeopathy

Urticaria is not a very pleasant thing to have. patients are taking long allopathy treatment with steroids and all and when they come up to homeopath for it we have perfect treatment plan for it

LETS SEE what it is 

URTICARIA

Synonyam
Nettle rash; Hives ; Weals.

Definition

Urticaria is a commonly seen clinical condition where there is a transient eruption of raised and circumscribed erythematous or oedematous swellings of the superficial dermis, associated with itching

There are a variety of its clinical variants seen, two of which are:

·         Angioedema (angioneurotic oedema, giant urticaria, Quinke’s  oedema)   Consists of transient swellings in the deeper dermal, subcutaneous and  Submucosal   tissues. Urticaria and angioedema often occur together and for practical purposes are similar processes. However, the form of pure angioedema that is caused by CI esterase inhibitor deficiency shows some differences clinically and in response to treatment.

Systemic anaphylaxis is an acute life- threatening condition induced by an IgE- medicated allergic reaction. It consists of a combination of symptoms and signs including diffuse erythema, pruritus, urticaria, angioedema, hypotension and cardiac arrhythmias. A similar clinical picture from non- allergic causes is called a systemic anaphylactoid reaction.

Classification  &  Etiology

        Urticaria can be broadly classified in terms of ‘duration’ or its ‘trigger factors’.

1.            In terms of duration, Urticaria can be divided into acute and chronic forms. Acute Urticaria is usually self- limited and the weals commonly resolve within 24 hours, but may last up to 4- 6 weeks. In chronic urticaria the weals continue daily or on most days for longer than 6 weeks. Acute urticarias are more common in young adults of both sexes, whereas chronic urticarias are more commonly seen in women, in their fourth or fifth decades. A cause or trigger factor can be easily found in acute urticaria, as compared to the chronic form.

2.            When classified in terms of trigger factors, it can be divided into:

a.      Nonimmunologic or nonallergic or ordinary urticaria:

These are caused by degranulation of mast cells and hista-mine release by mechanisms not involving antigen- anti- body reaction. The most commonly seen causative factors of nonallergic urticaria are:

• Drugs: Anesthetics, angiotensin converting enzyme in- hibitors, aspirin and other non- steroidal anti- inflammatory drugs, codeine, morphine,  penicillin, cephalospor-ins, sulfonamides and other antibiotics, diuretics, iodides, bromides, quinine, vancomycin, isoniazid and antiepileptic agents.

• Food:   Chocolates, eggs, fish milk and products, nuts, pork, shellfish, strawberries, tomato, and yeast.

• Food additives: Hydroxybenzoates, salicylates, sulhites, and tartrazine.

• Inhalants: Animal danders, grass pollens, house dust, mould spores, new perfumes.

• Infections: Pharyngitis, gastrointestinal, genitourinary, respiratory, fungal (e.g., scabies), HIV and parasitic infections (e.g., ascaris, strongyloides, schistosoma, and trichinella).

• Systemic disorders: Amyloidosis, carcinoma, hyperthy- roidism, lymphoma, polycythemia vera, polymyositis, rheumatic arthritis (RA), and SLE

• Physical: Cold, exercise, friction, perspiration, pressure, and sunlight.

• Miscellaneous: Contact with nickel (e.g., cheap jewelry, jean stud buttons), latex, nail polish or rubber (e.g., gloves and elastic bands); emotional or physical stress; pregnancy (usually occurs in last trimester and typically resolves spontaneously soon after delivery); and recent use of new clothes, creams, detergents, or lotions.

        b.          Immunlogic or allergic or idiopathic or autoimmune urticaria:  Genes

                     tend to play a role in a few urticarial conditions, where a strong personal or

                     family history of atopic disorders can usually be found. Angioedema and a

                      few rare urticarial variants can be of a hereditary type occurring due to a

                     CI esterase inhibitor deficiency.

Clinical Features

                        The urticarial lesions begins as itchy erythematous macules, which develop into weals consisting of pale-pink or red, oedematous, raised skin areas, of varying shapes and sizes, often with a surrounding flare. These usually transient and migratory lesions can form linear, annular (circular) or actuate (serpiginous) patterns, and can occur anywhere on the body in variable numbers. These wheals are generally very itchy, especially at night, but the patients tend to usually rub the part, rather than scratch and thus these lesions resolve leaving a normal skin surface, without any excoriation marks. In a number of cases, these weals are seen to get worse in the evenings or nights and also usually before menses. Urticarial vasculitis should be suspected if the lesions last for more than 24 hours.

        Half the cases of urticaria are associated with angioedema, where large, non-pruritic or slightly itchy, non-pitting, pale or pink, diffuse swellings occur, especially on the face, affecting the eyelids, lips, tongue, pharynx and larynx, hands, feet, genitalia,ears,and neck. These lesions may last for several days.

          In a few cases urticaria or angioedema can be associated with systemic symptoms like malaise, fever, headache, dizziness, nausea, vomiting, abdominal pain, diarrhea, arthralgia, feeling of a lump in the throat, hoarseness, wheezing, shortness of breath, and syncope, and in its most severe acute from with anaphylaxis.

Diagnosis

         Specific laboratory studies are not generally indicated. Instead a detailed personal and family case history is taken in suspected clinical cases, especially as regards to pervious attacks, and an attempt made to find out the trigger factors, through in more than half the cases no particular cause can be traced.

           In few cases a fluoroimmunoassay may help in  detection of food allergies undetected by routine examination and testing.

Differential Diagnosis

• Anaphylaxis.
• Erythema multiforme.

Treatment

                        Education on avoidance of the suspected offending allergen is essential.

       In cases of angioedema or anahylaxis, timely emergency care needs to be taken in a hospital setting, with checking of vital statistics and checking for air flow in the respiratory passage, and if needed administering oxygen. In a few cases, intubation or even tracheostomy may be required, where there is laryngeal obstruction due to angioedema.

  Homeopathic Approach to Urticaria

                  Homeopathy has maximum scope in the above condition, as modern medicine has nothing more to offer other than antihistaminics.

                  The following pattern should be observed most meticulously whilst treating the patient:

• Confirm whether the lesions fits into urticarial rash. The typical lesion should include a rosy – red, erythematous macule with edematous weals. The erythema fades on pressure.
• Time of aggravation. I have found a night aggravation more common.
• Dose urticaria alternate with any other complaint? Especially asthma or rheumatism.
• Always ask whether urticaria is preceded by any other symptoms like nausea, chill, menses, etc.
• Inquire as to which season the patients develops urticaria and at what temperature e.g. hot room, cold room, open air, near the seashore, etc.
• The most important factor that helps us to eliminate majority of the drugs is the patient’s feeling of wellbeing after an application of heat or cold.
• Try and find out which particular foodstuff aggravates the condition, especially shellfish, sweets, meat, chocolates, etc.
• Has the patient got any emotional stress?
• I have seen many patients of urticaria who have a history of worm infestation. Therefore one should inquire for any history of worms. Also history of insects bites or contact with any plants or ingestion of drugs like penicillin or salicylates.
• Sometimes physical factors especially exposure to sun, excessive physical exertion and exercise lead to urticaria.

All the above should be thoroughly scrutinized to get the maximum data. In very rare cases, patient may develop swelling of face with laryngeal obstruction. At that time the patient should be shifted to a homeopathic hospital and his airway should be kept clear with endotracheal intubation and oral drugs like chlorum, etc. should be administered

         The treatment consists of not only giving the indicated homeopathic drugs, but to eliminate the offending agent e.g. eliminative diet, withdrawal of causative drug, treatment of parasitic infection, correction of the existing physical stress. During an acute attack the patient should be kept on a bland diet- alcohol, tea and coffee are preferably avoided. Finally reassurance should be given to the patients who have chronic urticaria.

Some Important Homeopathic Remedies and Certain Important Rubrics Helpful in Clinical practice

Astacus fluviatilis, Bacillus proteus, Bombyx, Chloralum hydratum. Medusa, Santoninum, Tilia, Boletus luridus, Copaiva.

-       Urticaria wrose at night: Apis, Bov, Chlol, Cop.

-       Urticaria alternating with asthma: Apis.

-       Giant urticaria: Lyc, Stroph-h.

-       Chronic urticaria: Hygroph-s.

-       Urticaria during fever: Rhus-t.

-       Extremely giant urticaria: Antip, Bacillus no. 7, Bol-lu, Santin.

-       Urticaria associated with lot of Edema: Cortico.

Drugs for Acute Urticaria

Anthracokali: Urticaria increases with general sweat. There is intense itching, which is <night. The site of urticaria is hands, tibia, shoulders, and dorsum of feet. Eruptions always decrease with the full moon. Concomitant symptoms with urticaria are dropsy and intense thirst.

Antimonium crudum: Dirty, unhealthy skin. Urticaria with white lump with red areola which itch. The itching is not continuous, but seems to come and go. There is marked aggravation after the ingestion of meat and when in bed. The itching makes the patient which is characterized by a thick white- coated tongue.

Antipyrinum: Chiefly between fingers and toes with troublesome itching and erythema. Urticaria appears and disappears quite suddenly and is often accompanied by internal coldness. .Also angioneurotic edema with swelling about eyes and lachrymation is seen. Urticaria associated with tinnitus.

Apium graveolens: Stomach pains and shivering before the outbreak of urticaria. Urticaria with stinging itch, rapidly changing location.

Apis mellifica: stinging and itching as if form bee sting< night. The urticaria may consist of isolated elevations, which are quite painful and tender to touch; these later become purple or livid. There is slight fever and heat of skin accompanying urticaria with burning pain. The urticaria sometimes accompanies asthmatic trouble. Change of weather, warmth and exercise cause troublesome itching and burning urticaria. Generalized anasarca as a strong concomitant to urticaria. > open air, uncovering cold bathing.

Aresenicum album: Urticaria with burning and restlessness. Useful for persistence of complaints during recession of urticaria. <Eating shell fish,< at seashore,< sea bathing.

Astacus fluviatilis: short acting remedy having a special affinity for skin producing urticaria all over the body with violent pruritus. Liver affection with nettle rash. The urticarial rash is so violent that patient may go into a mild miliaria. < Fish or shellfish.

Belladonna: violent sudden outbreaks of red, hot, painful urticaria, location- inner aspects of limbs, face. Urticaria associated with metrorrhagia.

Bombyx chrysorrhea: Hard large tubercles with a red areola. The tubercles are most marked near the joints. There is a sensation of a foreign body under the skin, with itching of the whole body. The itching gets worse in the evening but is not relived in any way. There is burning heat everywhere.

Bovista lycoerdon: Urticaria covers nearly whole body. Itching and burning <by scratching, <night. Urticaria caused by tar. The itching worse on getting warm. Urticaria with a disposition to diarrhea. Each stool is followed by tenesmum. The other concomitant symptoms are scorbutic gums, inflammation of eyes, metrorrhagia, varios mental symptoms. Urticaria on excitement, with rheumatic lameness, palpitation  and diarrhea. Urticaria < on waking in morning, < form bathing. Stupor, staring, even delirium with urticaria.

Chloralum hydratum: Characterized by its periodicity. It disappears  by day and comes on by night with such intense itching as to prevent to sleep. <wine, spirituous liquors, hot drinks. Wheals come on from a chill > warmth. Red blotches with violent stinging itching all over the body. Erythema aggravated by alcoholic drinks with palpitation; causes pains in tendons and extensors. Emotional excitability; hallucinations.

Copaiva officinalis: Hives with fever and constipation. Chronic urticaria in children. Itching < at night and during fever. Urticaria over whole body with red face. Skin dry and hot with violent itching. Severe headache with urticaria.

Dulcamara: Hives comes on at night, especially when nights are cool, with heavy dew, after a hot day or when weather changes from warn to cool and damp. Urticaria with violent cough and edema of glands. Feverish urticaria. Urticaria obliging one to scratch and burning after scratching, every eruption being preceded by sensation of pricking over whole body. Eruption of white, irregular blotches raised upon the skin, surrounded with red areola, appearing in warmth and disappearing in cold. Extremities, face, chest and back violently itching and burning after scratching. Headache, want of appetite, nausea, bitter taste, vomiting, intense aching in pit of stomach and precordial region, restlessness and sleeplessness, night sweats, turbid dark urine, diarrhea, pains in limbs. Urticaria from gastric disorders.

Ichthyolum: Chronic urticaria in patients of uric acid or tuberculous diathesis. Urticaria seen in alcoholics and especially in old people. Most important concomitant is intense appetite.

Medusa: face, arms shoulders and breasts. Oedema – face, eyes, nose, ears and lips. Burning, pricking, itching sensation associated with urticaria.

~ DR AJAY YADAV

reference from

skin homeopathy approch to dermatology from F .J MASTER

skin disease and homeopathy therapetics J.H ALLEN

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