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| CASE REPORT |
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| Year : 2020 | Volume
: 14
| Issue : 4 | Page : 279-286 |
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Homoeopathic treatment of viral warts with Calcarea phosphorica
Nidhi Mahajan, Ashish Mahajan, Aditi Bhinda, Sapna Salodiya
Central Research Institute of Homoeopathy, Jaipur, Rajasthan, India
| Date of Submission | 27-May-2020 |
| Date of Acceptance | 20-Nov-2020 |
| Date of Web Publication | 29-Dec-2020 |
Correspondence Address:
Dr. Nidhi Mahajan
Central Research Institute of Homoeopathy, Jaipur, Rajasthan
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijrh.ijrh_56_20
Introduction: Viral warts are the most common cutaneous infection caused by human papillomavirus. Warts can be treated by many available modalities such as cryotherapy, chemical cauterization, curettage, electrodessication and laser removal. However, most of these therapies can cause scarring. They also cause application-site reaction and recurrence. The homoeopathic literature has a plethora of medicines for the treatment of warts. Case Summary: A 4-year-old girl presented with reappearance of multiple warts on the face after a month of laser treatment. This time, the warts were on the right side of the forehead and one on the right cheek and were persisting for 8 months. The patient responded well to individualised homoeopathic treatment, i.e. Calcarea phosphorica 200 in single dose with complete recovery within 1 month without subsequent relapse. Even though the medicine is mentioned in the fourth grade against the rubric 'Face – Warts' in the Complete Repertory and is not used commonly in the cases of warts, it acted beneficially. Hence, this case emphasises the importance of individualised homoeopathic treatment based on characteristic general symptoms.
Keywords: Calcarea phosphorica, Homoeopathy, Viral warts
How to cite this article:
Mahajan N, Mahajan A, Bhinda A, Salodiya S. Homoeopathic treatment of viral warts with Calcarea phosphorica. Indian J Res Homoeopathy 2020;14:279-86 |
How to cite this URL:
Mahajan N, Mahajan A, Bhinda A, Salodiya S. Homoeopathic treatment of viral warts with Calcarea phosphorica. Indian J Res Homoeopathy [serial online] 2020 [cited 2021 Jan 20];14:279-86. Available from: https://www.ijrh.org/text.asp?2020/14/4/279/305254 |
| Introduction | |  |
Viral warts are a common skin condition, which can range in severity from a minor nuisance that resolve spontaneously to a troublesome, chronic condition.[1] These are small skin protuberances caused by human papillomavirus (HPV), are not life-threatening, but can be unsightly, embarrassing, uncomfortable and potentially contagious[2] and may be transmitted by direct or indirect contact.[3]
Common warts mainly present in children although people at any age can be affected. Warts, in general, are benign but sometimes they may become malignant and develop into verrucous carcinoma. The diagnosis of a wart is usually made on a clinical examination and physical findings.[4]
Warts need to be distinguished either clinically or histologically from other keratotic lesions on the hands or feet such as actinic keratosis, knuckle pads or more rarely, squamous cell carcinoma or focal palmoplantar keratoderma. On the feet, corns and calluses or callosities can be confused with warts.[5]
Warts may regress naturally but over a prolonged time. Recurrences are also known.[2] Recurrence rate of up to 30% has been reported with cryotherapy, probably due to lack of immune response. The viruses might remain in the skin after treatment and then lead to the growth of new warts later.[6]
Treatment of warts is especially challenging in the paediatric patient population because of the pain associated with many of the available treatments.[7] Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness. Adverse effects, such as pain, blistering and scarring, were not consistently reported but are probably more common with cryotherapy.[1] Treatment-resistant warts are a common and frustrating problem for patients, parents and providers alike. No wart treatment is uniformly effective.[8]
Much of the contemporary society is more interested in fast and impressive cures, even if these may bring side effects, whereas Homoeopathy can offer solutions with a personalised approach that requires long hours of case study by the homoeopath to find the correct personal remedy that aims to bring about positive results, which the therapy can produce in deep chronic diseases.[9]
Hence, the search for an effective, safe, cost-effective and environmental-friendly medicine that is easy to apply continues.[2]
Homoeopathic approach
Warts can be categorised under local maladies which signify those changes and ailments that appear on the external parts of the body and as mentioned in §189 and §193, local maladies cannot arise persist or even grow worse without some internal cause. So, for the treatment of these affections, an internal medicine should be selected on the basis of totality of symptoms.[10]
| Case Report | | |
A 4-year-old girl presented at the outpatient department at Central Research Institute of Homoeopathy, Jaipur, with multiple warts on the right side of the forehead and one on the right cheek for 8 months. The past history revealed that she was treated for warts on the face with laser treatment 9 months back, which gave her temporary relief for 1 month, but these warty growths reappeared.
There were 5–6 small warts, 2–5 mm of size on the right side of the forehead and 1 wart of 2 mm on the right cheek without any pain, itching or any other sensation for 8 months.
The patient had a history of fever 1 month ago for which she took allopathic treatment and recovered in 2 days. All milestones of the child were achieved on time, except late in learning to walk, but now the patient's walk was as per her age. She had been vaccinated on time with no adverse events. Pregnancy history of mother marked no significant event.
Local examination of the skin
- Location of warts – Right side of the forehead near the hairline and right cheek
- Number of warts – 5–6 warts on the right side of the forehead and 1 on the right cheek
- Pattern of distribution – On exposed area, in group on the right side of the forehead and isolated on the right cheek
- Characteristics of warts – Flat and smooth on the right side of the forehead and fleshy on the right cheek
- Shape of warts – Round and flat
- Surface of warts – Smooth
- Pain Non-specific
- Discharge – Absent
- Itching – Absent
- Other systemic examinations were normal.
The definitive diagnosis of viral warts was based on characteristic manifestations, morphology and distribution of lesions, following the guidelines of ICD-10, code B-07.
Homoeopathic generals
Mental generals
The patient was very restless, continuously moving and unable to sit at one place. She had violent anger and bites during anger. She was mostly dissatisfied if was to remain at home. She liked to travel and go somewhere all the time.
Physical generals
The appetite of child was increased as she took food frequently. She ate two chapattis per meal and after every half an hour, again asked for something to eat. She had desire for salty food as she preferred chips, Bhujia, Kachori (salty Indian snacks), etc.
Analysis of the case
After analysis and evaluation, the characteristic symptoms were used in constructing the totality of the case. “Restlessness, desires to travel, discontented, biting in anger and late in learning to walk” were important mental symptoms in this case. Excessive appetite and desire for salty food were physical generals. Small warts on the right side of the face were the particular symptoms in this case. Miasmatic evaluation for the presenting symptoms was done with the help of The Chronic Diseases by Dr. Samuel Hahnemann,[11] which showed the predominance of Sycotic Miasm.
The selection of remedy was based on repertorisation of the case using complete repertory, version 10.0 of RADAR software [computer program]. Version 10.0. Belgium. Archibel. 2009].[12] The repertorisation chart is shown in [Figure 1] where the top five medicines were Calcarea phosphorica 22/8, Calcarea carbonica 20/8, Causticum 18/8, Sulphur 16/7 and Carcinosin 11/7.
On the basis of reportorial analysis and with the consultation of Boericke's Materia Medica,[13] Calc. phos. was selected as the first prescription, as discontentment and desire to travel was very marked in the patient, as also in Cal. phos. in comparison to Cal. Carb. and Caust. (24 October 2019) [Table 1]. After prescribing a single dose of Cal. phos. 200, good improvement was seen. Multiple warts on the right side of the forehead reduced in size and pedunculated wart on the right side of cheek slightly detached. On further visit on 20 November 2019, only placebo was prescribed, and rest of the warts fell off with no new warts or relapse till May 2020.
| Discussion | | |
Because warts is a one-sided disease,[10] efforts should be made to form the totality of symptoms based on characteristic mental, physical and particular symptoms of the patient.
Here, Cal. phos. was prescribed in 200 potency as per the totality of symptoms. Although it is not mentioned under the rubric Face – Warts in Kent's Repertory[14] and Synthesis Repertory,[15] it is found in the fourth grade in Complete Repertory.[16] The patient responded within 2 weeks of the treatment with complete remission of warts in 3 weeks which had persisted for 8 months. Previously, the patient had undergone laser treatment, but the warts relapsed after 1 month, but no recurrence was reported after homoeopathic treatment as per the last telephonic review in May 2020. In several cases, warts show spontaneous remission within 1 year,[17] but many are resistant to treatment or recur after treatment, as in this case. The warts recurred after laser therapy. The case was assessed for the likelihood of causality between the homoeopathic intervention and outcome as per Modified Naranjo criteria for Homoeopathy,[18] and the total score of outcome was 7 [Table 2]. This suggests the causal relationship between homoeopathic medicine prescribed and cure in this case. | Table 2: Monarch inventory (improved version of the modified Naranjo criteria for Homoeopathy)[18]
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 | Figure 2: Number of warts – Right side of the forehead 5–6 small warts and 1 wart on the right side of the cheek on first visit on 24 October 2019
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 | Figure 3: Number of warts – Right side of the forehead 5–6 small warts and 1 wart on the right side of the cheek on first visit on 24 October 2019. Side view
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 | Figure 4: Inflammation of wart on the cheek with reduction in the number of warts on the forehead on second visit on 5 November 2019
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 | Figure 5: Inflammation of wart on the cheek with reduction in the number of warts on forehead on second visit on 5 November 2019
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 | Figure 6: Warts disappeared from the forehead and cheek on 3rd visit on 20 November 2019
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 | Figure 7: Warts disappeared from the forehead and cheek on 3rd visit on 20 November 2019
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Thuja, Ruta, Cal. Carb., Dulcamara, Nitric acid and Caust. are the commonly used medicines for the treatment of warts[19] and have shown results in randomised controlled trials (RCT).[20] However, when the patient jumps away out of the ordinary group of remedies, it is that the treating physician has to go outside of the beaten track and find another remedy that also corresponds to the nature of disease.[21]
Interestingly, no apparent difference between the effects of homoeopathic therapy and placebo in children with common warts was found in an RCT.[22]
Although RCTs are the gold standard for evaluating the efficacy of treatment in conventional medicine, they may not be suitable for Homoeopathy at large due to the individualised nature of treatment. Moreover, these have a good internal validity, but external validity may be compromised as real-time settings are usually ignored. Therefore, due importance may be given to case reports in the field of Homoeopathy as each case is a new case with characteristic symptoms and may require any medicine from the armamentarium of homoeopathic Materia Medica and not only the specified medicines mentioned under the therapeutics for a particular disease.
The ultimate wart treatment would resolve all, or a great percentage, of warts, be painless, create no scarring, offer HPV immunity for a lifetime and be available to all patients,[23] as observed in this case treated with Homoeopathy in a painless way, without scarring.
| Conclusion | | |
Individualised, constitutional homoeopathic medicine plays a very important role in treating patients. This is a single case report to serve as an evident role of Calc. phos. as constitutional medicine, which otherwise is not commonly used for the treatment of warts. Further study may be considered in evaluating the role of this remedy in viral warts. Therefore, further prospective study of Calc. phos. is suggested in the cases of aforementioned viral warts to confirm its scientific validation.
Declaration of patient consent
The authors certify that they have obtained written consent, duly signed by the patient's maternal grandmother (as patient is minor) and she has even given consent for the photographs and other clinical information to be reported in the journal. The maternal grandmother of the patient was made to understand that the name and initials of the patient will not be published and due efforts will be made to conceal the identity of the child.
Financial support and sponsorship
Nil.
Conflicts of interest
None declared.
| References | | |
| 1. | KwokCS, GibbsS, BennettC, HollandR, AbbottR. Topical treatments for cutaneous warts.Cochrane Database Syst Rev2012;12CD001781.  |
| 2. | |
| 3. | |
| 4. | Zandi S, Ahmad Zadeh R, Yousefi S, Gharibi F. Promising new wart treatment: A randomized, placebo-controlled, clinical trial. Iran Red Crescent Med J 2016;18:e19650. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27761268. [Last accessed on 2020 Apr 15]. |
| 5. | SterlingJC, GibbsS, HaqueHussain SS, MohdMustapa MF, Handfield-JonesSE. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014.Br J Dermatol2014;171696-712. Available from: https://onlinelibrary.wiley.com/doi/10.1111/bjd.13310. [Last acessed on 2020 Apr 23]. |
| 6. | |
| 7. | |
| 8. | |
| 9. | VithoulkasG. Can Homeopathy, a Particularly Mild Therapeutic Approach, Survive and Grow in a World of Violence?Homeopathy2020;109179-81. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32408371. [Last accessed on 2020 May 05]. |
| 10. | Hahnemann S. Organon of Medicine. 6 th ed. New Delhi: B Jain Publishers; 2002. p. 227-8. |
| 11. | Hahnemann S. The Chronic Disease, their Peculiar Nature and their Homoeopathic Cure, Translated from Second Enlarged German Edition of 1835, by Prof Louis H Tafel with Annotations by Richard Hughes, edited by Pemberton Dudley. 13 th Impression. New Delhi: B Jain Publishers; 1998. |
| 12. | |
| 13. | Boericke W. Pocket Manual of Homoeopathic Materia Medica and Repertory. 9 th Reprint ed. New Delhi: B Jain Publishers; 2007. p. 152-3. |
| 14. | Kent JT. Repertory of the Homoeopathic Materia Medica. Enr. Indian ed. New Delhi: B Jain Publishers (P) Ltd; 2006 |
| 15. | Schroyens F. Synthesis: Repertorium Homoeopathicum Syntheticum. 9.1 th ed. New Delhi: B Jain Publishers (P) Ltd.; 2014. |
| 16. | Zandvoort R. The complete Repertory. 1 st ed. Leidschendam: IRHIS Publishers; 1996. |
| 17. | BrugginkSC, EekhofJA, EgbertsPF, vanBlijswijk SC, AssendelftWJ, GusseklooJ. Natural course of cutaneous warts among primary schoolchildren: A prospective cohort study.Ann Fam Med2013;11437-41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24019275. [Last accessed on 2020 Apr 29]. |
| 18. | Lamba CD, Gupta VK, van Haselen R, Rutten L, Mahajan N, Molla AM, et al. Evaluation of the modified naranjo criteria for assessing causal attribution of clinical outcome to homeopathic intervention aspresented in case reports. Homeopathy 2020;109:191-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32215892. [Last accessed on 2020 May 05]. |
| 19. | |
| 20. | |
| 21. | Kent JT. Lectures on Homoeopathic Philosophy with Classroom Notes and Word Index. 7 th ed. New Delhi: B Jain Publishers; 2007. |
| 22. | |
| 23. | Kuykendall-Ivy TD, Johnson SM. Evidence-based review of management of nongenital cutaneous warts. Cutis 2003;71:213-22. Available from: https://pubmed.ncbi.nlm.nih.gov/12661750/. [Last accessed on2020 May 12]. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2]
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