In 1925 COCA introduced the term "Atopy" meaning "Out Of Place" or "Strange" to signify the heriditory tendency to develop allergies to food and inhalent .
     It is also known as Asthma Eczema Syndrome. Family history or personal history of collateral allergies like asthma, eczema and hay fever etc. are normally present or the same may alternate. It is characterised by a selective flexural distribution , extreme chronicity with acute excacerbations from time to time a familial and personal allergic predisposition and a very sensitive emotional nature . The eczematous process is usually the result of endogenous sensitisation , but exogenous allergies may play a part. Besides allergens ; emotional stresses and parental attitudes can also cause this condition. Parents are usually the anxious type, and the patient is usually very sensitive and highly strung but often very intelligent. Homoeopathic medicines has an important role to play in its treatment.
Atopic Dermatitis may be divided into 3 stages namely : Infantile atopic dermatitis, Occurring from 2 months to 2 years of age., Childhood atopic dermatitis from 2 to 10 years , and Adolescent and Adult stage atopic dermatitis.
     The entity undergoes a clinical and histologic evolution from an acute eczematous eruption in early life to a characteristic lichenified dermatitis seen in older patients.
Infantile A.D.
     In infancy it usually begins as itchy erythema of the cheeks . In the erythematous patches minute epidermal vesicles develop, rupture and produce moist crusted areas. The eruption may rapidly extend to other parts chiefly the scalp(Cradle) , neck ,forehead, wrists and often extremities . The eruption may become generalised involving buttocks and diaper area with erythroderma and considerable desquamation . Moist type _ Is most common. The lesions show polymorphism . Exudation may be marked and there are many secondary effects from scratching , rubbing and infection : Crusts ,pustules and infiltrated areas . The infiltrated patches eventually take on a characteristic lichenified appearance. Itching is severe and main symptom.
     Dry type _ There is excessive dryness and Xerosis, which with pruritis predisposes to eczematisation . This is seen especially in older children in whom antecubital and popliteal fossae are invloved .
     In most infants who suffer from this disease , the skin symptoms disappear towards the end of the 2nd year . The patients are able to eat without bad effects of foods which previously caused disturbance. Exacerbations are observed after immunisations (Mez,Thuja),colds(Alum,Petr,Psor). Partial or complete remissions of the dermatitis in summers and relapse in winters are usually seen, aggravated wool irritation and low humidity. The role of food allergy in infantile and childhood atopic dermatitis is still a debated point. Foods most commonly testing positive were Egg, Peanut, Milk, Fish, Wheat and Chicken.
Childhood A.D.
     Through out childhood less acute lesions in the same areas may recur. Such lesions as occur are apt to be less exudative, drier and more papular. The classic locations are the antecubital and popleteal spaces (Selen, Sep),the wrists ,eyelids, face (Carb.ac, Crot.t, Psor, Sulph)and about the neck. Pruritis is a constant feature. Itching is of compelling paroxysmal type with inability to feel the pain during the paroxysms (disseminated neurodermatitis). During childhood there is decrease in frequency of sensitization to non ingested substances particularly wool, cat hair, and pollens. Feather sensitivity also has its onset in childhood.
Among the aetiological factors are emotional and allergies. For allergies Scratch and Patch Tests can be done. It should be impressed upon the parents for the patient that he has an inborn weakness of the skin and unstable emotionally sensitive nature and that he should learn to live with this weakness avoiding stresses as far as possible. It is a chronic but not a serious disease though cosmetically it looks repulsive, therefore patient should not get depressed. It has been seen that anger, resentment and frustration aggravates the whole problem (Ign, Staph, Sul, Ph.Ac.).
The patient usually presents with symptoms:-
     Pruritis ,Typical morphology and distribution i.e flexural lichenification in adults and facial and extensor involvement in infancy, Tendency towards chronic or chronically relapsing dermatitis , Blood count shows Eosinophilia.
     It should be differentiated with Seborrhoeic dermatitis, Irritant or allergic eczematous contact dermatitis, Scabies , Psoriasis (Palmo plantar), Dermatitis Herpetiformis .
While managing a case one should take care that any external irritation - sudden change of temperature, excessive bathing ,vigorous rubbing, insufficient cleanliness especially in diaper region, local infections, irritating secretions or even medicated oils are to be avoided. Attacks may be induced by teething also. One of the first consideration is prevention from scratching the parts affected and mechanical restraints may be resorted to as cardboard splints over elbow to prevent the child's hands from reaching his face. As soap and water may aggravate the disease olive oil on absorbant cotton may be used for cleansing. Particular attention should be given to genitals, and buttocks, diapers should be changed whenever soiled. Parts cleaned with vegetable or mineral oil and powdered with corn starch .In cases where specific food allergies are implicated dietary restrictions are in order. The food substitutes for wheat are oat, rice (puffed rice, boiled rice) ,when milk is eliminated souyabean emulsion gives adequate nourishment.
Homoeopathically :
     Commonly used and found effective medicines are : Alumina, Ars Alb, Ant.Crud, Bov, Canth, Cic.V, Clem, Calad, Chrysobin Ac, Crot. Tig, Dul, Flour Ac, Graph, Hep, Hydrocotyl, Ign, Kali Ars, Merc, Mez, Med., Nat.Mur, Nux V, Opium, Petr, Phos, Puls, Psor, Pyrogen, R.T, Rhus Ven, Sep, Skookam Chak, Staph, Sulph, Thuja and Tuberculin. etc.
Case 1:
Master V 1yr old was brought to me for the consultation and treatment with both of his hands gloved and tied with waist. As can be seen in the slide for the complaints of : Terrible itching all over the body and head,<sweating. Oozing of sticky offensive discharge from the skin lesions. Scales on the skin peel off. Oozing of the thick offensive discharge from behind the ears.
H/O Overdue delivery by 8 days of due date.
Loose stools 6-7 very offensive yellowish, blackish, brownish.
Dry Cough with occasional vomitings.
Lymph nodules palpable at post Auricular and cervical chain region.
Sleeplessness due to profound itching with marked restlessness and irritability.
Teething started at 3rd month only.
Initially he was given Graphites 1M by some other doctor with no substantial relief.
Next he was given Sulphur 30 which brought some change in his case, the offensiveness and watery stools got checked , but the cough reappeared with increased discharge behind the ears. Patient was given Placebo later on he showed further signs of improvement. Suddenly one day \very offensive smell was noticed from the whole body of the child with oozing of the discharge all over the body. Child was given Pyrogenum 1M single dose followed by S/L within 2 days the offensiveness and the smell disappeared and the skin became much clear all over the body.
Now the face is clear , head is clear only few skin lesions are visible on the legs and arms that too are drying up.
No more scaly skin and the skin looks much healthier with absolutely no itching and the child is able to sleep peacefully and comfortably.The other medicines which were used in this case were - Ant Cr, Podo, Merc Sol, and Puls, and H.S at time to time. The slides of the patient at different stages are evident of his progressive cure.
Case 2:
Baby G.G. 3 months old was brought to my consultation chamber on 20th Feb 1988 with complaints of itching ,rashes all over the body since birth. Slide
H/O Mother had drug allergy during pregnancy .
Delivery was conducted by induced labour and mother had allergy at the time of delivery.
Dry scales on the face, neck, hands, hips and legs.
Itching with dryness , bleeding on scratching. More in evening and night.
Cough loose with occasional vomitings.
Stools whitish hard balls like, changeable stools .
Redness of the anus on straining for the stools , flatus.
Hiccoups < after feed.
P/H Had Measles 1 month ago .
F/H Father allergic cold.
(Disharmony in the parents - though both mother and father are working , and the child is being brought up by maternal grandparents)
The remedy Pulsatilla cured the case, the other remidies used were Sul
ph, Calc.C, Graph, and Cheli.
Slides of the patient at different stages of progress in testimonials.