INTRODUCTION
Acne a common problem seen in teenage. It is seen in both girls and boys with same prevalence. Usually, acne clears by the age of 23-25 yrs, but many cases remain where it still persists and people need treatment even in thirties and fourties. Acne can sometimes affect people’s confidence and inspite of being a simple disorder can play an important role in their lives as sometimes it affects a person’s self esteem. Acne is a classic stigma of adolescence and has been viewed as a normal physiologic reaction in the skin. It is one disorder which can be very well treated by homeopathy.
In acne sebaceous glad produces excess sebum. Increase in the size of sebaceous glands and concomitant increased amount of sebum secretion during adolescence are physiological, but the inflammatory changes of true acne represent a disease which may be extra ordinarily chronic and sometimes produce severe residual physical and physiological scarring which may be lifelong.
What is sebaceous gland?
Sebaceous glands are lipid producing structures which, with the exception of palms, soles and dorsum of the feet are distributed all over the body surface. They are most numerous and most productive on the scalp and face and largest on forehead, nose and upper part of the back. The major components of sebum are triglycerides, wax ester, squalene, cholesterol esters and cholesterol.
Sebaceous glands has two auxillary actions –
- The sebum is mildly bacteriostatic and fungistatic
- Gland provides provitamin D
CAUSES OF ACNE
Inflammation of blocked pilosebaceous follicles and there are multiple causes which combine to trigger this.
- Increases sebum secretion is one of the causes considered but one has to remember that there are cases of diseases like acromegaly where there is increased sebum secretion but still there is no acne.
- Hormonal disturbance is an important factor which is associated with acne vulgaris and there homeopathy has a very good role to play in correction this disorder. Hormones from testes, ovaries and adrenals are the main hormones which stimulate the sebum secretion. In acne the sebaceous glands appear to be unduly sensitive to normal levels of these hormones.
- Acne also shows familial tendency. Acne also show increase or decrease with menstrual cycle timing in females.
TYPES OF ACNE – ACNE VARIANTS
This term incorporates special types of acneiform eruptions which need to be treated as separate entities.
ACNE NEONATRUM – Occurs around 3mnths and last till 5years of age. Lesions are on nose and adjacent parts of cheeks.
DRUG ACNE – Many drugs induce acneiform eruptions. Steroid acnes are monomorphic. Hormones in early puberty also causes acne.
TROPICAL ACNE – Severe variants of acne vulgaris. Presents with painful cysts, nodules and pustules leading to frequent scarring.
ACNE CONGLOBLATA – Found in men at late puberty. Occurs with comedones, papules, pustules, nodules and severe scarring.
ACNE EXCORIEE – In young females, rarely mild acne is accompanied by excoriations which have emotional base.
OCCUPATIONAL ACNE – Many oils and tars produce eruptions at the site of contact with skin. Seen in workers involved with machinery.
PATHOPHYSIOLOGY
DURING PUBERTY
DURING ADOLESCENCE
CLINICAL FEATURES
- Most common in second or third decade of life.
- Boys tend to have more severe acne and a little later in life as compared to girls.
- Both, the incidence and severity of disease declines to 80% of patients by their mid 20s.
- Acne is a polymorphic disease characterized by comedones, papules, pustules, nodules and cysts occurring predominantly on face and less so on back and chest.
- Nodules are particularly disfiguring and often associated with scarring.
- Various foods like chocolates, icecreams, pork fat etc have implicated to make acne worse.
- Mental stress and menstruation have known to flare up lesions.
TREATMENT AND MANAGEMENT
- Diet is believed to play an important role, following dietary changes are sometimes found to be helpful:
- Avoidance of chocolates, cola, fried food or milk products which are considered to increase acne development.
- Maintain good and healthy nutrition to equip the immune system to fight against bacterial action.
- For mild cases washing of twice with a cleansing soap so as to remove excess oil from face is found helpful.
HOMEOPATHIC TREATMENT: Acne is rightly treated by homeopathy by a remedy given based on totality as acne is usually associated with underlying causes. Acne during puberty can be treated by homeopathy by consideration of cause and covering total picture including physical and mental makeup of the person. The benefit is when a patient is treated for acne with a constitutional remedy, not only acne will get better acutely but tendency to acne is decreased or removed and the underlying cause is treated. In addition to this, remedy based on type of acne also gives results in few cases but our main guiding line for curative line of result shall always be totality.
Few Homeopathic Remedies for acne which can be helpful for local or mild acne are given below in Therapeutics section but it will be helpful only if the symptoms match with the patient
THERAPEUTICS
- APIS – For pimples, vesicles and pustules. Sensitive to cold bathing. Thick, hard, honey colored scabs. Dry skin. Scaly, pustular eruptions with burning and itching getting worse at night.
- BELLADONNA – Pustules on face. Dry hot skin. Boils and acne rosacea. Alternate redness and paleness of skin.
- BERBERIS AQUIFOLIUM – Pimply, dry, rough and scaly. Eruptions on scalp extending to face and neck.
- BOVISTA – Pimples cover the entire body, worse from bathing. Very good remedy for acne or eruptions after use of cosmetics. Has been found very helpful in our clinical practice at our clinic.
- CALCAREA SULPH – Many little matterless pimples under the hair, bleeding when scratched
- EUGENIA JAMBOS – Acne simple and indurated. The pimples are painful for some distance around.
- GRAPHITES – Unhealthy skin, every little injury suppurates. Pimples and acne. Eruptions oozing out a sticky discharge.
- HEPAR SULPH – Unhealthy, suppurating skin, even slight injury suppurate. Pustular eruptions or afflicted with boils that are very sensitive. Putrid ulcers, surrounded by little pimples. Great sensitiveness to slightest touch.
- JUGLANS REGIA – Comedones and acne of face. Itching and redness of small red pustules.
- KALI ARS – Acne pustules worse during menses. Intolerable itching worse from warmth.
- KALI BICHROMICUM – Popular eruptions with punched out edges, with tendency to penetrate and tenacious exudation. Pustular eruptions resembling small pox with burning pain.
- NATRUM MUR – Skin dirty, dry, withered, unhealthiness in general, all varieties of eruptions, but especially the vesicular form. Itching eruptions on margin of hair and nape of neck. Large blotches like hives that itch terribly. After great body exertion nettle rash appears with terrible itching. Very good results when given based on totality.
- PULSATILLA – Acne at puberty aggravated after rich food.
SULPHUR – Dry scaly skin, every injury suppurates. Pimples, eruptions, pustules with itching and burning worse scratching and washing. Skin affection after local medication. Avoid giving based as a specific, will give results only when based on totality. A girl with recurrent acne came with major presentation of disease as acne and tension headaches. On further questioning her menses were regular but when investigated her ovaries showed polycystic appearance. Her detailed case taking was done and major symptoms presented were acne before menses, anxiety, headaches due to anxiety, craving for fish, thermal : hot, emotionally she was a sensitive individual and an important feeling state was she doesn’t look nice as compared to other girls. This was inspite of the fact that she was a very smart girl, very good in studies, liked by teachers, and doing very well in career. On evaluation of her mental state on BDI scale for depression she was found to be mild depressive. Based on totality presented above of physicals, and a symptom was taken as her delusion that she looks wretched Natrum Mur was prescribed. Natrum Mur deceased her acne gradually and her tendency to headaches, she was on Trptomar before she came to homeopathy for her headaches and depression and she was able to get off all the medications. Natrum mur 30 was continued for 5-6 months starting with BD and then shifting to TDS and then QID based on follow ups and then 200 was given in one dose. Every 15 days for few weeks. Her acne got completely resolved and her depression was also reduced to level of mild mood disturbance. So if a remedy is given based on totality overall improvement can be seen in cases.
About the Authors:
Dr Geeta Rani Arora
Dr Arti Goyal
Dr Noorie Raghavan
Published in Homeopathy for All, October 2019