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Spotlight on Skin
The skin is the body’s largest organ; an average person’s skin weighs 4kgs (9lbs) and covers an area of 2 square metres (22 sq feet). These figures are not so surprising when we enumerate the skin’s many functions. Some are fairly obvious: protection against chemicals, radiation, microbes etc; preserving a balanced internal environment by keeping us warm, preventing us from drying out; and the sensation of touch in all its variety. But the skin has less obvious functions: subcutaneous fat is a major reserve of energy, vitamin D is synthesised in the skin when exposed to ultra-violet light. The skin also has important social and sexual functions: it secretes pheromones which play an important role in sexual attraction, while the hair and lips play a more conscious social and sexual role.
The skin has two main parts: the superficial epidermis whose thickness ranges from 0.1mm on the eyelids to 1mm on the soles of the feet. The epidermis contains no blood vessels, its most superficial layer is the dead, dry horny layer which is constantly shed, contributing to the dust in our homes. The dermis lies beneath the epidermis supporting and nourishing it and providing immunity and other functions.
What’s more, skin problems are common: surveys suggest that 20-30 per cent of us have a skin problem which deserves medical attention, but that most of us do not see doctors about them, preferring to treat them ourselves. Skin problems are among the commonest reasons for which people, especially children, seek homeopathic treatment. Of course, as always with homeopathy, it is important to be sure that homeopathic treatment is appropriate – it is for many forms of skin disease, but there are important exceptions. The most conspicuous is malignant melanoma. This is an aggressive form of skin cancer whose incidence is increasing (although fortunately it remains rare) because of greater sun exposure and thinning of the ozone layer. The warning signs are a “mole”, which grows, bleeds or is irregular in shape or colour. It is better to be safe than sorry, and have any such skin lesion removed surgically.
Also known as dermatitis, eczema is among the commonest forms of skin disease, and it often responds well to homeopathic treatment. It affects up to 20 per cent of schoolchildren and seven to eight percent of adults. Children tend to grow out of it and the majority improve greatly by their mid-teens. It is an inflammatory condition in which patches of skin become red, inflamed and itchy. The affected areas may also be covered in small, fluid-filled blisters. There are a number of different forms of eczema.
The commonest form is atopic eczema, an inborn condition which usually starts before the age of two, and may continue to flare up throughout adolescence and adulthood. “Atopy” means an inherited tendency to allergies, including eczema, asthma and hay fever. It runs in families and is getting commoner for reasons that are not entirely clear. A currently popular theory, known as the “hygiene hypothesis” suggests the reason is basically that kids today are too clean (try telling that to the mother of an average eight year-old boy!). It is based on the observation that children who grow up on farms and the younger children of large families are less likely to be atopic. The theory is that such children are more likely to be exposed to certain kinds of bacteria and that this stimulates their immune systems to mature. But not all the scientific evidence agrees on this and the jury is still out.
Contact dermatitis is caused by contact with a substance to which an individual is sensitive, such as nickel, rubber or various plants. It can occur at any age. Nickel is one of the commonest skin sensitisers – it can usually be spotted by the areas it affects: earrings and jean buttons often contain nickel.
Seborrhoeic dermatitis occurs in adult and infantile forms. In babies it is often known as cradle cap because it affects the scalp, although it may also affect the nappy area. The adult form usually affects the face and scalp.
Finally varicose eczema occurs mostly in older people, as the name suggests it is often linked to varicose veins: the blood stagnates in the lower legs resulting in a poor supply of oxygen and nutrients. The skin becomes dark, itchy and inflamed. If left untreated the skin may break down, forming an ulcer.
This too comes in several varieties, but all involve reddened areas of skin covered in large, adherent silvery scales. The basic problem is excessively rapid division of the horny cells of the epidermis, probably provoked by inflammation whose cause is currently unknown. Psoriasis tends to run in families; it most commonly comes on in late teenage or early adult life. It can be triggered by some medicines, including antidepressant, antihypertensive and antimalarial drugs, and infections with streptococcus bacteria.
The main types of psoriasis are:
- Plaque psoriasis: the patches appear typically on the knees, elbows, lower back and scalp. Unlike eczema, the patches often appear on the extensor (outer) sides of knees and elbows. The nails may develop small pits, or more serious deformity.
- Guttate psoriasis, where the patches are scattered, small and roundish, may follow a streptococcal infection, typically a severe sore throat.
- Pustular psoriasis, a severe but rare type affecting mostly the palms and soles.
From the point of view of prescribing homeopathic treatment, eczema and psoriasis can be considered together. They nicely illustrate some of the principles of homeopathy: one of three homeopathic medicines will help in many cases, but the treatment must be individualised if it is to succeed. The three medicines are: Arsenicum album, Graphites and Sulphur. Homeopathy is holistic: to treat a skin problem, one has to look at the whole person, not just at their skin.
Traditionally we homeopaths classify the “whole” in three parts: the “locals” (in the case of a skin problem this means the characteristics of the skin problem), “mentals” (including the personality and psychological features of the person) and the “generals” (physical features of the person as a whole). In terms of skin symptoms Arsenicum album and Sulphur are quite similar: intensely itchy rashes which burn after scratching. Rashes likely to respond to Arsenicum tend to be in small, roundish patches and flakey, while those which respond to Sulphur typically occur in large, red areas, but these distinctions are often not clear-cut and it is often difficult to be sure which medicine is indicated on the basis of the “locals” alone.
However, there are marked differences in the types of people who respond to these medicines: the typical Arsenicum patient is tidy, fastidious, rather anxious (mentals) and feels the cold excessively (generals). Sulphur patients are the very opposite: often untidy, they tend to be extroverts who relish a good argument (mentals). They are often warm-blooded (feel the heat) and particularly have hot feet (generals). But having said that, one has to be flexible.
Graphites cases can often be recognised by the character of the rash alone: it tends to crack, and ooze clear or yellowish, sticky liquid when scratched. The rash often affects particular areas such as behind the ears or nipples, in women the eczema may get worse around the monthly period; while the mentals and generals may not be particularly marked.
There are a number of other important medicines for psoriasis and eczema: the deep acting “constitutional” (whole person) medicines include – apart from Arsenicum album, Graphites and Sulphur – Arsenicum iodatum, Lycopodium and Sepia. The two Arsenicums are typically used for guttate psoriasis: the plaques tend to be small, rounded and flakey. Arsenicum album may also be very helpful in pustular psoriasis. Arsenicum iodatum has less of the constitutional features of Arsenicum album and even may be positively hot-blooded, but these patients frequently also have severe hayfever and other allergies, affecting the eyes particularly.
In contrast to Graphites, local characteristics of skin problems which respond to Lycopodium and Sepia are not very specific and these medicines are prescribed mostly on the basis of the mental and general features. The type of person who typically responds to Lycopodium clavatum is reserved or shy, and there may be underlying anxiety or depression. They frequently have stomach problems. Odd but characteristic features include a sweet tooth and a bad period in late afternoon, feeling better later. It can be useful for a range of skin problems including psoriasis and acne.
Sepia officinalis is most often indicated for women. Typically the patient is emotionally flat, fed-up and snappy with her family and partner. She resents others prying (as she sees it) into her problems and may hide her feelings. Often, as with Graphites, the problem seems to have come on following some event of a woman’s reproductive cycle, such as the start of a girl’s periods, childbirth and menopause. There is usually loss of sex-drive. An odd feature is the temporary improvement from exercise (dancing, working out). Again it may be useful for many skin problems including psoriasis and eczema.
However constitutional homeopathy is not the only kind of homeopathy and unless one of the “pictures” described above really seems to fit, is perhaps best left to a practitioner. There are a number of “small” homeopathic medicines which work well prescribed on characteristic symptoms, sometimes called “keynotes”. These include Petroleum (made from crude oil). The keynote for this medicine is the marked deterioration in winter. It is very useful for children who get thick cracked skin of the knuckles in winter. Many patients helped by this medicine have told me that, although they have been prescribed steroid creams, they find Vaseline just as effective and use it rather than steroids. Vaseline is, of course, made from Petroleum! A favourite medicine of mine for gardeners’ contact dermatitis is Rhus venenata. Typically these are keen gardeners who get a very itchy, blistery rash, presumably from contact with a plant, although it is usually difficult to work out which one. The keynote here is that the only thing that relieves the itching is bathing the hands in very hot water.
Most teenagers have some acne and it can cause great emotional distress at an age when many are very self-conscious; it is much less common in other age groups. Linked to androgens, male sex hormones, that are present in both boys and girls, acne vulgaris, as this type is known, affects particularly the face but may also appear on other areas, especially the upper back, chest, shoulders and neck. It is caused by the overproduction of a natural grease called sebum, which is secreted by glands in the skin. Sebum normally drains into the hair follicles and flows out through the follicle openings on the skin surface, lubricating the skin and keeping it supple. But in acne, excess sebum blocks the follicles by hardening into plugs. Bacteria multiply in the blocked follicles, causing the surrounding tissue to become inflamed.
Less common forms of acne include occupational acne, which may result from exposure to certain industrial oils; and drug-induced acne, often caused by steroids. Rosacea is a related condition occurring most often in middle aged women. The main problem is dilatation and instability of the blood vessels. It does not usually cause black- or white-heads.
Two of the most commonly indicated homeopathic medicines are Sulphur and Silica. And again it is illuminating to compare and contrast the local, mental and general features. We looked at the Sulphur type before. The main local feature of acne which responds to Silica is that the pustules never seem to discharge: they sit under the skin for weeks without bursting, often forming cysts. The Silica constitutional type is very different from the Sulphur, like the Arsenicum type they are usually chilly and feel cold even in a warm room. They tend to be pale and thin, with fine hair and weak, ridged nails. They will often mention that their hair has changed, becoming finer and falling out since they have been ill. Their hands and feet are cold yet clammy. Mentally they complain of feeling tired and washed out and yet are stubborn and “niggly” even sometimes obsessional.
Pulsatilla is another medicine which may be very helpful in acne, particularly (but by no means exclusively) in girls when crops of spots develop in the premenstrual period. It is prescribed mostly on constitutional grounds – the characteristics of the person rather than the name of the disease. Typically Pulsatilla types are mild tempered or sweet-natured, and indecisive. They are often weepy, crying when they talk about their problems, but quickly cheered up by a few reassuring words (unlike Sepia patients who may also be weepy when talking about their problems, but they resent probing and discussion – the best thing is to move on to another topic). Strangely, although the Pulsatilla type easily feels cold, she likes fresh air (provided she is well wrapped up) and hates stuffy atmospheres.
Other medicines which may help in acne include Kalium bromatum; with this medicine the sufferer complains of poor sleep, often disturbed by bad dreams. They may be mentally slow, have difficulties with memory and thinking and be fidgety. Calcarea sulphurica has large yellow pustules which are slow to heal, as with Sulphur they may be itchy. Acne spots which respond to Hepar sulph are very sensitive to touch or painful as they erupt.
Lachesis is the most commonly indicated homeopathic medicine for rosacea. Typically the rash is dusky red and worse in hot atmospheres. The onset may be associated with the menopause, but if before the menopause, it usually gets worse before the period and eases quite abruptly when the bleeding actually starts. The typical Lachesis patient is talkative and may be suspicious or jealous. An odd symptom is that they hate tight clothes, especially round their necks – polo necks, scarves etc.
As usual with homeopathy, individualisation of treatment needs a skilled practitioner. However, I am against being too precious about this: the use of a homeopathic complex consisting of several of the homeopathic medicines most likely to be indicated is often helpful and very unlikely to do any harm. The most commonly used “complex” for acne, well worth a try if a good homeopath is not available, is Sulphur, Silica and Carbo vegetabilis, combined in a single pill often known as SSC.
As a general rule, all these medicines should be started in a dose of two pills of the 6c dilution, twice daily. “Aggravations” – a temporary flare-up of the problem at the beginning of treatment – are quite common with homeopathic treatment of skin problems. They are generally considered a good sign, indicating the treatment is provoking a reaction. If you get an aggravation you should stop treatment until it has completely settled down, don’t be in a rush to restart. You may get another aggravation on restarting, but normally it will be less severe and will die out altogether after three or four stop-start cycles. In terms of creams and other topical applications, Calendula (marigold) cream is often used by homeopaths for eczema, it has a gentle soothing action. It is often helpful in “weaning off” steroid creams, gradually substituting Calendula for them.
Peter Fisher MA MB BChir FRCP FFHom is the Clinical Director, Royal London Homoeopathic Hospital, editor of Homeopathy and is Homeopathic Physician to Her Majesty The Queen.