A CASE OF ACNE VULGARIS

Author: Dr Pramod K, MD (Hom) working as Chief Medical Officer in the Dte of

AYUSH, Govt of NCT of Delhi
Key words: Acne Vulgaris, Calc.sulph.
Introduction
Acne vulgaris 1 is the formation of comedones, papules, pustules, nodules or cysts as a
result of obstruction and inflammation of pilosebacious units. It most often affects
adolescents. Diagnosis is by examination.
Etiology and Pathophysiology2
Acne occurs when pilosebaceous units become obstructed with plugs of sebum and
desquamated keratinocytes and may be infected with normal skin anaerobe
Propionibacterium acnes. Manifestations differ depending on whether P. acnes stimulate
inflammation in the follicle; acne can be inflammatory or non inflammatory.
Comedones are uninfected sebaceous plugs impacted within follicles. Comedones are
termed open or closed depending on whether the follicles dilated or closed at skin
surface.
Inflammatory acne comprises papules, pustules, nodules and cysts. Papules appear when
lipase from P. acnes metabolise triglycerides into free fatty acids(FFA),which irritates the
follicular wall. Pastules occur when active P. acne infection causes inflammation within
the follicle. Nodules and cysts occur when rupture of follicles due to inflammation,
physical manipulation or harsh scrubbing releases FFAs, bacteria and keratin into tissues,
triggering soft tissue inflammation.
The most common trigger is puberty, when surges in androgen stimulates sebum
production and hyperproliferation of keratinocytes.
Other triggers include hormonal changes that occur with pregnancy, menstrual cycle,
occlusive cosmetics, clensing agents, clothings, humidity and sweating.
Association between acne exacerbation and diet, inadequate face washing, masturbation
and sex are unfounded. Acne may improve in summer months because of sunlights antiinflammatory effects.
Classification of Acne severity2
Mild
Moderate
Severe

<20 comedones, or < 15 inflammatory

lesions or < 30 total lesions
20 to 100 comedones, or 15 to 50
inflammatory lesions or < 30 to125 total
lesions.
>5 cysts, or total comedone count >100,
total inflammatory count >50 or >125 total
lesions

Diagnosis and Differential diagnosis

Diagnosis is obvious on examination. Differential diagnosis includes rosacea in which no
comedones are seen, perioral dermatitis, acneiform drug eruptions and corticosteroid
induced acne, in which lack of comedones and pustules are in the same stage of
development.
Homoeopathic concept
Acne vulgaris is an expression of psoric miasm. Unhealthy skin, every little lesion passes
into sores. Skin dry, rough and pimply, unwashed and unclean appearances are psoric
manifestations3.
Hahnemann highlighted the following regarding the treatment of these disease
conditions. No cutaneous eruptions, of whatever kind it may be, ought to be expelled
through external means by any physician who wishes to act conscientiously and
rationally. In every case there is at the bottom a disorderly state of the whole internal
living organism. Therefore the eruptions are only to be removed by internal healing and
curative remedies which change the state of the whole. Then the eruptions which are
based on the internal disease will be cured and healed by itself without the help of any
external remedy and more quickly than it could be done by external remedies4.
Case Report:
Male patient aged18 yrs presented with pustular, indurated eruptions on face. Eruptions
are painful and occasional itching when getting warm and discharge of pus and blood.
The patient had been suffering from these complaints since 2-3 years and took various
treatments and outcome was not satisfactory. It is observed from the history that all the
comedones are turning into pustules and healing occurs with the discharge of its contents.
Personal History of the Patient:
Patient is a student, belonging to lower socioeconomic class.
No addictions
Mixed diet
Appetite and thirst normal
No marked desires and aversions observed.
Bowels are regular and satisfactory
Urine normal
Sleep well
Perspiration general
Thermal reaction- intolerance towards warmth of all kinds
Previous history shows tendency to the formation of boils in the body especially in humid
weather.

Family history: No relevant complaints

Treatment history: Took allopathic treatment but had no long lasting improvement.
Physical Examination: Moderately built and nourished no pallor, not icteric, no cyanosis,
no lymphadenopathy, BP 110/70 mm of Hg, Pulse: 72/mt.
Examination of Skin : Multiple pustules, papules and cysts on both cheeks.
Analysis
As this patient has few general symptoms, the particular symptoms are considered for the
selection of remedy.
The following rubrics were selected5
1. Skin Unhealthy skin
2. Eruption on face-acne simplex
3. Eruption on face-pustules
Homoeopathic Treatment:
The patient has been advised to wash face with soap and shampoo the hair at regular
interval. Also advised to avoid greasy cosmetics and hair oils.
Prescription & Follow up
Based on the pathological symptoms, thermal reaction and tendency to suppuration
Calc.sulph was selected and administered in 6x trituration thrice daily for 1 week and
followed by 30c and 200c. Pustules are healed and almost disappeared in a period of one
month.
Discussion
In this case, the lesions showed the signs of improvement within a week and it is more
marked when the medicine was administered in centesimal potencies.
Calc sulph, is a tissue remedy introduced by Schuessler and has been used on biochemic
theory. Many authors have high lighted its efficacy in controlling the process of
suppuration. This has to be studied further for verification to asses Calc sulphs efficacy
in centesimal potencies.
References
1. Beers, H Mark et.al (2006)The Merck Manual of Diagnosis and Therapy, Merck
Research Laboratories Publication, Eighteenth Edition, p 941
2. Beers, H Mark et.al (2006) ibid p 942
3. Speight Phyllis (1994)A Comparison of the Chronic Miasm ,B. Jain Publications,
New Delhi, p 32
4. Hahnemann Samuel (1991) The chronic disease(1991) B. Jain Publications,New
Delhi,p 174

5.Boericke E Oscar (1984), Pocket manual of Homoeopathic Materia Medica, B. Jain

Publications, New Delhi, p 744

Photograph 1(a)

Photograph 1 (b)

Photograph 2(a)

Photograph 2(b)

Photograph 3(b)
Photograph 3(a)
Photograph 1(a),(b) at the beginning of treatment.
Photograph 2(a),(b) during the course of treatment.
Photograph 3(a),(b) at end of one month.