By
Dr.. Pawan S.
Chandak BHMS
Parbhani, Maharashtra, India
Urticaria:
Basic Medical
Consideration:
Definition:
Urticaria (or hives) is a skin condition, commonly caused by an allergic
reaction, that is characterized by raised red skin welts. It is also known as
nettle rash or uredo.
Welts from hives can appear
anywhere on the body, including the face, lips, tongue, throat, and ears. Welts
may vary in size from about 5 mm (0.2 inches) in diameter to the size of a
dinner plate; they typically itch severely, sting, or burn, and often have a
pale border.
Aetiology:
Urticaria is
generally caused by direct contact with an allergenic substance, or an immune
response to food or some other allergen, but can also appear for other reasons,
notably emotional stress.
The rash can be
triggered by quite innocent events, such as mere rubbing or exposure to cold.
Pathophysiology & Causes
of Urticaria:
The skin lesions
of urticarial disease are caused by an inflammatory reaction in the skin,
causing leakage of capillaries in the dermis, and resulting in an oedema which
persists until the interstitial fluid is absorbed into the surrounding cells.
Urticarial
disease is thought to be caused by the release of histamine and other mediators
of inflammation (cytokines) from cells in the skin. This process can be the
result of an allergic or non-allergic reaction, differing in the eliciting
mechanism of histamine release.
Allergic urticaria :
Histamine and other
pro-inflammatory substances are released from mast cells in the skin and tissues
in response to the binding of allergen-bound IgE antibodies to high affinity
cell surface receptors. Basophils and other inflammatory cells are also seen to
release histamine and other mediators, and are thought to play an important
role, especially in chronic urticarial diseases.
Non-allergic urticaria:
Mechanisms other than allergen-antibody interactions are known to cause
histamine release from mast cells.
Neuropeptides
have been found to be involved in emotionally induced urticaria.
Dominantly inherited cutaneous and neurocutaneous porphyrias (porphyria cutanea
tarda, hereditary coproporphyria, variegate porphyria and erythropoietic
protoporphyria) have been associated with solar urticaria.
Drug-induced solar urticaria should be investigated for porphyrias. Caused by
IgG binding not IgE
Types of Urticaria:
Acute
urticaria usually
show up a few minutes after contact with the allergen and can last a few hours
to several weeks. Food allergic reactions typically fit in this category. Common
causes of reaction include consumption of shellfish, nuts, eggs, fish, acid
derivatives, dye, or a combination of these.
Chronic
urticaria refers to
hives that persists for 6 weeks or more. There are no visual differences between
acute and chronic urticaria. Some of the more severe chronic cases have lasted
more than 20 years. A survey indicated that chronic urticaria lasted a year or
more in more than 50% of sufferers and 20 years or more in 20% of them. Of
course this does mean that in almost half the people it clears up within a year
and in 80% it clears up within 20 years or less (Champion and others, British
Journal of Dermatology 1969).
Drug-induced
urticaria has been
known to result in severe cardiorespiratory failure. The anti-diabetic
sulphonylurea glimepiride (trade name Amaryl®), in particular, has been
documented to induce allergic reactions manifesting as urticaria. Other cases
include dextroamphetamine, aspirin, penicillin, clotrimazole, sulfonamides and
anticonvulsants.
Physical urticarias
are often categorized into the following.
Aquagenic:
Reaction to water (rare)
Cholinergic:
Reaction to body heat, such as when exercising or after a hot shower
Cold (Chronic
cold urticaria):
Reaction to cold, such as ice, cold air or water
Delayed
Pressure: Reaction
to standing for long periods, bra-straps, panty or thong bands, belts
Dermatographic:
Reaction when skin is scratched (very common)
Heat:
Reaction to hot food or
objects (rare)
Solar:
Reaction to direct sunlight (rare)
Vibration:
Reaction to vibration (rare)
Adrenergic:
Reaction to adrenaline / noradrenaline (extremely rare)
Related conditions of
Urticaria:
Angioedema is related to
urticaria. In angioedema, the swelling occurs in a lower layer of the dermis
than it does in urticaria. This swelling can occur around the mouth, in the
throat, in the abdomen, or in other locations. Urticaria and angioedema
sometimes occur together in response to an allergen and is a concern in severe
cases as angioedema of the throat can be fatal.
Treatment & Management:
Urticarias can be very difficult to treat. Most treatment plans for urticaria
involve being aware of one's triggers, but this can be difficult since there are
several different forms of urticaria and people often exhibit more than one
type. Also, since symptoms are often idiopathic there might not be any clear
trigger. If one's triggers can be identified then outbreaks can often be managed
by limiting one's exposure to these situations.
While the disease is
obviously physiological in origin, psychological treatments such as stress
management can sometimes lessen severity and occurrence. Additionally, methods
similar to psychological pain management can be used to shift focus away from
the uncomfortably and itchiness during an attack.
Homoeopathic Management:
Homoeopathy offer an effective & permanent solution to Urticaria. Treatment is
directed towards signs & Symptoms, total symptomatology, Constitution of
Patient, his physical & mental make up. Many times as Allopath we concentrate on
therapeutics of Urticaria & try with specific remedy sometimes it works but
sometimes we have to face failures.
Own
Experience:
I will
give you my own experience. I was suffering from Allergic cold & cough with
breathlessness & cough < at midnight & after midnight. There was sudden change
in weather with rain during winter on 31/10/2007 and I was wet in the rain when
returning from Clinic. Since Midnight I was having itching with urticarial
rashes. In morning I had tried Rhus Tox 1 M single dose with no results till
evening then tried specific remedy Urtica urens 200 every 3 hourly till evening
no results. As I have seen in Repertory & Theraps Urtica urens is very important
medicine for Urticaria. In evening due to exposed to wet I have tried Dulcamara
with no result. Same day at 11 pm I started severe itching, burning, redness of
eyes, breathlessness, cough . Symptoms severity was very high. On considering
the above symptoms similarity I consulted Dr. Vijay Vaishnav and as per his
Scientific approach in studying Homoeopathy We can fried symptoms Urticaria with
asthmatic or cold cough symptoms alternating, midnight aggravations etc Arsenic
Album 200 three times a day has taken & cured speedily.
Hence in
studying Homoeopathy an particular disease or condition importance has been
given to patient as a whole. We can not rely just on its therapeutics or
specific remedy.
Urticaria
is not just an superficial condition which can be managed with local
applications or anti-histamines. We need an Internal malady which will help to
act through its deeper layers of manifestation & cures the person as a whole.
Repertorial Approach
Skin –
Urticaria – Common remedies are Ant –c, Apis, Antip, Ars, Bombyx, Bov,Camph,
Chlora, Cim, Cop, Dulc, Frag, Icth, Nat P, Puls, Rhus tox, Sulph, Trios, Urt.
Chronic: Anac,
Ant-c, Ars, Astac, Bov, Dulc, Lyc, Rhus tox, Sul, Urt urens etc.
Nodosa:
Bov, Urt.
Tuberosa: Anac.
Causes:
from emotion: Anac, Bov, Ign,
Kali-br.
From exertion: Con, Nat-m, Pso,
Urt-u.
With oedema: Apis.
From menstrual condition: Cim,
Dulc, Kali-c, Puls.
From shellfish, roe: Camph.
From suppressed malaria: Elat.
From Sweat: Apis, Rhus-t.
With Catarrh: Cepa, Dulc.
With Constipation, fever: Cop.
With Croup, alternating: Ars.
Alternating with Asthma: Calad.
Alternating with rheumatism:
Urt-u.
Asthmatic troubles in : Apis.
With erosion on toes: Sulph.
With itching, burning, often
scratching, no fever: Dulc.
With Liver Disturbance: Astac.
With Petechial disturbance or
erysipelatous eruption: Fragar.
With rheumatic lameness,
palpitation, diarrhea: Bov, Dulc.
With sequel from suppressed
hives: Apis, Urt.
With coming sudden & going:
Antipy
Wine from: Chlol.
Modalities:
Aggravation:
At Climacteric – Morph, Ustil.
At menstrual periord: Cim, Dulc,
Kali-c, Mag-c.
At night: Ant-c, Ars.
From bathing, walking in A.M. :
Bov.
From cold: Ars, Dulc, Rhus –t,
Rum, Sep.
From exertion, exercise: Con,
Nat-m, Psor, Urt-u.
From Open air: Nit . acid, Sep.
From wine: Chlol.
In Children: Cop.
Periodical – every year: Urt-
u.
Amelioration:
Cold water : Apis, Dulc.
Hot drinks: Chloral.
From Open air: Calc .
From warmth: Ars, Chloral,
Materia
Medica:
Antim Crud:
Excessive irritability and fretfulness together with a thickly coated white
tongue are truly guiding symptoms of Antim Crud. It is indicated for Urticaria
in which itching when warm in bed. Skin symptoms with Gastric derangements. Skin
is sensitive to cold bath.
< heat & cold bathing, evening,
acids.
> open air, rest, moist
air.
Antipyrinum:
It acts
especially on the Vaso-motor centers causing dilatation of capillaries of skin &
consequent circumscribed patches of hyperemia & swelling. It is useful for acute
erythema multiforme, intense itching. Urticaria which appears &
disappears
suddenly with internal coldness. Angioneurotic oedema. Dark blotches on skin
sometimes with oedema.
Apis Mellifica:
Acts on cellular tissues causing oedema of skin and mucous membranes. Ailments
from bee stings. Swelling or puffing up of various parts, oedema, red rosy hue,
stinging pains, soreness, intolerance of heat, and slightest touch, and
afternoon aggravation are general guiding symptoms of apis. There is extreme
sensitiveness to touch and general soreness is marked. Erysipelatous
inflammations, dropsical effusions are characteristic pathological states
corresponding to Apis. Useful for Urticaris, Hives with intolerable itching,
oedematous swellings. Netle rash after perspiration.
< by heat in any form; touch,
pressure; late in afternoon; after sleeping; in closed and heated rooms, Right
side.
> in open air, uncovering, and
cold bathing.
Bovista:
It has modified affects on skin producing ertion line eczema. Urticaria on
excitement with rheumatic lameness, palpitation and diarrhea. Blunt instrument
leave deep impression on the skin.
< walking in morning, from
bathing.
Arsenic Album:
Debility, exhaustion & restlessness with nighty aggravation are most important
theme of this remedy. Useful for Urticaria with itching, burning, swelling,
oedema worse by cold & scratching. Urticaria with burning & restlessness.
Asthma or Respiratory symptoms
alternates with Urticaria.
< wet weather, after midnight,
from cold, coold drinks, cold food, cold season.
> from heat, warm drinks.
Anacardium:
Skin symptoms f Anacardium are similar to Rhus tox. Useful for Urticaria with
intense itching with mental irritability. Itching, swelling in Urticaria,
eruption looks like that of Poison Oak.
< application of hot water.
> rubbing.
Caladium: Useful for
Urticaria in which Itching rash alternates with Asthma. There is burning
sensation and erysipelatous inflammation. Sweet sweat attracts flies in Keynote
of Caladium.
< after
sweat, after sleep in daytime.
> motion.
Bombyx:
Urticaria with caterpillar itching of whole body. This remedy is Relationship of
Astagus Fluvia.
Astagus
Fluviatilis:
Urticaria with nettle rash all over body. There is eysipleua and liver affection
with nettle rash all over body. Urticarial symptoms with Liver derangements.
Very sensitive to cold air.
<
uncovering.
Camphor:
It is useful for Urticaria in which skin is cold, pale, bleed, livid. Can not
bear to be covered.
< motion, night, contact, cold
air.
> warmth.
Chloralum:
Urticaria worse from Spirituous liquors, hot drinks. Erythema aggravated by
alcoholic drinks with palpitation causes pain in tendons & extensions. Intense
itching with surface of body cold. Wheal come on from a chill,
< after hot drinks, stimulants,
night
> warmth.
Cimicifuga:
Urticaria from suppressed menses.
Dulcamara:
Hot days & cold nights towards the close of summer are especially favourable to
the action of Dulcamara. Urticaria in which Diarrhoea alternates with skin
symptoms. Urticaria from change of weather when weather suddenly becomes cold,
damp cold weather, before menses. Urticaria in which red spots brought on by
exposure on sour stomach. There are humid eruption on face, genitals, hands etc.
Anasarca.
< at night, from cold in
general, damp, rainy weather.
> from moving about, external
warmth.
Fragaria:
Useful for Urticaia rashes just like Strawberry Anaphylaxis. Urticaria from
eating strawberry. There are petechial and erysipelatous eruption, swelling of
whole body.< strawberry.
Grindelia: Urticaria
in which skin rash look like rosacea with severe burning & itching. In poisoning
from Poison oak Grindelia could be used locally as wash.
Ictholum:
Useful for
chronic hives, Urticaria, There is itching, heat and irritation.
Ignatia:
Useful for Urticaria from Grief & worry. It is especially adapted to nervous
temperament , women of sensitive, easily excited nature, dark, mild disposition,
quick to perceive, rapid in execution. Urticaria during fever with itching,
nettle rash all over body. < draft of air, morning, open
air.
Natrum mur:
Oversensitive to all sort of influences. Useful for urticaria with itching,
burning worse by eating salt, at seashore. Urticaria, wheal, Hives itching after
exertion. < at seashore, mental exertion,
heat.
> open air, cold bath.
Natrum Phos:
Useful for Urticaria in which ithching in various parts especially ankles. Skin
is smooth, red, shining.
Burning pain < night.
Pulsatilla:
It is an preeminently a female remedy especially for mild, gentle, yielding
disposition. Changeability of symptoms are marked.
Useful for Urticaria after
eating rich food. Urticaria with Diarrhoea. Urticaria from delayed menses. <
undressing.
< from heat, rich fat food,
after eating, towards evening, warm room.
> open air, motion, cold
application, cold food & drinks.
Rhus tox:
Urticaria from over exertion, getting wet while perspiring. Urticarial eruption
are red, swollen, intense itching < during sleep, cold, wet rainy weather, after
rain, at night, during rest, drenching when lying on back. > warm, dry weather.
Sulphur:
Sulphur is an great Hahnemannian Anti-psoric. It is having an elective affinity
for skin producing heat & burning with itching < heat of bed.
Urticaria with itching, burning
< scratching & washing.
< warmth, evening, spring time,
damp weather.
> dry, warm weather.
Urtica Urens:
Urticaria returns at the same time every year. Violent Itching, blotches,
burning heat with formication. Consequence of suppressed nettle rash. Rheumatism
alternates with nettle rash.
Useful for Urticaria nodosa.
Also for Urticaria with angioneorotic odema. < snow air, water, cool moist
air, touch.
References:
A.P.I.
Medicine 6th Edition
Homoeopathic
Materia Medica & Repertory by Willium Boericke
Homoeopathic
Repertory By Dr. Kent
Allen's Key
Notes by H.C. Allen.
Article Presented by
Dr. Pawan S. Chandak
‘Shradha’ Vishnu nagar,
Basmat Road, Parbhani 431401
Maharashtra, India
Cell: 9422924861
Email:
pavanchandak498@gmail.com
Website:
http://www.modernhomoeopathy.com
Nenhum comentário:
Postar um comentário
Seu comentário é muito importante para que possamos melhorar o blog. Sugestões e críticas construtivas são muito bem aceitas e sempre que possível incorporadas a nosso trabalho. Felicidades para você e muito obrigado pela visita e pelo comentário. + English English English English >>>
Your comments are very important to us. They help us making the blog better. Thank you and come other times!