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CASE REPORTS OF THE USE OF MEDORRHINUM IN THREE PATIENTS SUFFERING FROM EXFOLIATIVE DERMATITIS AND ONE PATIENT WITH PORPHYRIA

O. B. ABDEL-HADI,  C. O. KENNEDY, M. D. JENKINS.  (BHJ. VOL. 69, 2/1980)


         Three cases of patients with the Erythroderma syndrome are reported in this paper.  All three apparently responded to homœopathic treatment.  A fourth case of a patient with a severe dermatitis complicating  coproporphyria is also reported.


Introduction


         The Erythroderma syndrome is a serious dermatological complication which may occur as a result of a reaction to drugs such as Sodium aurothiomate (Myocrisin), or as a generalized spreading of a pre-existing dermatitis such as Psoriasis or Atopic dermatitis.  It may also occur in association with a Lymphoma or Leukaemia or as a manifestation of internal malignancy.  A primary idiopathic form, Pityriasis rubra, is also described.


         Whatever its cause, exfoliative dermatitis presents with as generalized erythmatous scaling eruption involving the whole skin surface.  Itching is a variable symptom.  Patients with this syndrome may develop a negative nitrogen balance, oedema and hypoalbuminaemia   with a loss of muscle mass.


         Prognosis is variable.  In one study, approximately 60 percent of patients with Erythroderma recovered in 8-10 months, about 30 percent died and the remaining 10 percent were left with persistent skin disease unresponsive to treatment.  The prognosis of the idiopathic type is the worst, the disease usually progressing to a fatal termination in two to three years.


Case Reports


         Patient 1:  B.S. Aged 35, Female.

         This patient presented in OPD in July 1978 with an 18-year history of Psoriasis.  Previous treatments had included Betnovate, Dithranol, and Methotrexate.  At that time she had typical psoriatic lesions on the scalp and elbows and psoriatic nail involvement.  The local symptoms she described were that the lesions were very itchy, tended to be worse in cold weather, and were markedly improved by sea bathing.  Hot sunny weather had on different occasions both relieved and aggravated the skin condition.  The first homœopathic prescription was for Staphysagria 200, one dose followed by placebo.  This was prescribed on the mental symptoms of a marked intolerance of injustice and a tendency to throw things when angry.  Ung. Emulsificans was prescribed.  There was an initial slight improvement and placebo therapy was continued.  However, the patient was admitted from Out Patients in October 1978 with generalized erythroderma which had started on her return from a seaside holiday in Spain. Initial treatment with  Apis 200 and Hamamelis ointment had little effect.  A singles dose of Medorrhinum 30 given on these third day of admission also had little or no effect.


         On the 5th Day of her admission also was given 3 doses of Medorhhhinum 10M and began to improve almost immediately.  The Hamamelis ointment was continued.  The Medorrhinum 10M, one dose,  was repeated 2 weeks later.


         The patient was discharged home and remained well until 4 months later when her Psoriasis began to break out again.  Treatment was therefore recommended.


         Patient 2: N.C Aged 57.   Female

         This patient had an 18 year history of rheumatoid  arthritis.  For the last 3 years she had been having Sodium aurothimalate (Myocrisin) injections 10 mg monthly which had controlled her arthritis.  She was admitted with two-week history of rapidly progressive exfoliative dermatitis which started on the trunk and spread to involve the whole body including the scalp.  She had not had any previous skin, renal or haematological evidence of gold toxicity.  A skin biopsy showed non-specific picture of a dermatitis with hyperkeratosis and subepithelial infiltration, mainly mononuclear but with a few eosinophilis.  Haemoglobin, full blood count, EWSR, urea and electrolytes, liver function  tests  and skin swabs were all normal.  She was initially treated with Sulphur 6 qds for week and then Aurum 30 qds for 4 days without benefit.  She  was extremely anxious, irritable, worse from heat and gave a history of a general feeling of well being while at the seaside.  On this basis she was given Medorrhinum  30 tds for one day with some improvement of the skin in  reasonably of good condition.  The ony topical skin application used was ung. Emulsiticans.


         Patient 3: D.A Aged 28 Female

         This patient was admitted to the hospital in August 1978.  She had Asthma and Eczema since early childhood.  She is known to be sensitive to house dust and Cat fur.  She also suffers from Hay fever.  Seven months before admission she of her own accord, stopped her topical Steroid (Betnovate).  Her Eczema initially became markedly worse but then improved considerably whilst taking a seaside holiday in Italy.  On returning to this country her Eczema became steadily worse until it involved the whole skin.  She was seen by a homœopathic physician and given one dose of Sulphur 30, which coincided with an aggravation of the situation.  On admission to hospital she was given 3 doses of Medorrhinum 10M with dramatic improvement in the appearance of the skin over the next 3 days.  The itching of the skin was however not relieved.  This symptom was partially relieved by Phosphorus 6x tds and Phenergan 25mg. nocte.  Calendula cream was used topically.  One week later the skin was almost normal but still somewhat itchy.  She was then given 3 doses of House dust 200 and discharged.


         Her improvement has been maintained for 7 months.


         Patient 4: G.R.  Aged 26.  Female

         This patient had a history of Eczema and Asthma since infancy.  These had in recent years been controlled with Betnovate and a Ventolin inhaler respectively.  She had however stopped using the topical Steroids for several months during which time her Eczema had become considerably worse.  She had been on a large number of homœopathic remedies (from a lay practitioner), but to no avail.  There were also considerable psychosexual and depressive elements underlying the illness.  She had made at least two suicide attempts.  Both her father and her brother had committed suicide.  Her mother and maternal grandmother had Eczema and Asthma.  In addition she had had Amenorrhoea for 6 years associated with marked breast enlargement.


         On admission the skin lesions involved the face, neck and upper chest and upper arms.  She also had a stye on the right upper eye lid.  Investigation revealed that she suffers from Porphyria of the Coproporphyria type.  She was also found to have an abnormally raised plasma prolactin level.  Plasma Testosterone levels were normal.  She was treated with Medorrhinum 10M (3 doses) with rapid initial improvement of her skin condition.  This was repeated two weeks later when she did not appear to be improving any further and there was again a further improvement in the skin condition.  Shortly after this she had a normal period, the first for 6 years.  Another repetition of the Medorrhinum 10M had no effect and the treatment was changed to Sepia 12 bd. with sustained improvement.


         When seen one month later she was well, her skin was clear and she was on no treatment.


Discussion


         Medorrhinum is a homœopathic  remedy said to be made by potentization of a sample of urethral discharge from a patient with Gonorrhoea.  There are no live bacteria in the final preparation.  The remedy is usually used in the higher homœopathic potencies.  In these cases there was no evidence of any aggravation of the skin condition with the high potencies used.


         The main indication in all the patients described was either a general symptom of feeling much better by the seaside, or that the local skin condition had clearly improved at the seaside.  There were however, other features present in these cases which supported the use of Medorrhinum  as the treatment of choice.


         These were heat intolerance in all four cases, particularly intolerance of the heat of the bed; a marked desire for sweet things was recorded in patients 1 and 4  and a salt craving in patient 3.  two of the patients, 3 and 4, had associated Asthma and Eczema of long standing.


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