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“A CLINICAL STUDY ON WARTS, ITS MIASMATIC

APPROACH
AND HOMOEOPATHIC MANAGEMENT”

By
Dr. ABDUL QUADEER

Dissertation submitted to the


Rajiv Gandhi University of Health Sciences, Karnataka. Bangalore.
In partial fulfillment of the requirements for the award of the degree of
Doctor of Medicine
IN HOMOEOPATHY
IN
ORGANON OF MEDICINE & HOMOEOPATHIC PHILOSOPHY

Under the Guidance of


Dr. P. SAMPATH RAO
M.D (Homoeo)

DEPARTMENT OF ORGANON OF MEDICINE & HOMOEOPATHIC


PHILOSOPHY
H.K.E.’S HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL
GULBARGA-585105, KARNATAKA.
2011

1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled “CLINICAL STUDY

ON WARTS, ITS MIASMATIC APPROACH AND HOMOEOPATHIC

MANAGEMENT” is a bonafide and genuine research work carried out by me under

the guidance of Dr. P. SAMPATH RAO, HOD & professor Department of Organon

of Medicine & Homoeopathic Philosophy H.K.E.’s Homoeopathic Medical College and

Hospital Gulbarga.

Signature of the
candidate
Date:
Place: Gulbarga Dr. Abdul Quadeer

2
CERTIFICATE BY THE GUIDE

This is to certify that the dissertation/thesis entitled “CLINICAL STUDY ON

WARTS, ITS MIASMATIC APPROACH AND HOMOEOPATHIC

MANAGEMENT” is a bonafide research work done by Dr. ABDUL QUADEER in

partial fulfillment of the requirements for the award of the degree of Doctor of

Medicine in Homoeopathy (Organon of Medicine).

Signature of the guide

Date:
Place: Gulbarga Dr. P. Sampath Rao
M.D. (Homoeo)
Principal, Professor,guide & HOD
Department of Organon of Medicine &
Homoeopathic Philosophy H.K.E.’S
Homoeopathic Medical College &
Hospital, Gulbarga

3
ENDORSEMENT BY THE HOD, PRINCIPAL/
HEAD OF THE INSTITUTION

This is to certify that the dissertation/thesis entitled “A CLINICAL STUDY


ON WARTS, ITS MIASMATIC APPROACH AND HOMOEOPATHIC
MANAGEMENT” is a bonafide research work done by Dr. Abdul Quadeer
under the guidance of Dr. P. Sampath Rao, HOD & professor Department of
Organon of Medicine & Homoeopathic Philosophy H.K.E.’S Homoeopathic Medical
College & Hospital, Gulbarga H.K.E.’s Homoeopathic Medical College and Hospital
Gulbarga.

Seal& Signature of HOD Seal& Signature of


Principal

Dr.P.Sampath Rao Dr.P.Sampath Rao


M.D (Homoeo) M.D (Homoeo)
HOD & Professor Principal & Professor
Dept. of Organon of Medicine Dept. of Organon of Medicine
and HomoeopathicPhilosophy and Homoeopathic Philosophy
H.K.E.’s Homoeopathic H.K.E.’s Homoeopathic
Medical College and Hospital, Medical College and Hospital,
Date: Date:
Place: Gulbarga Place: Gulbarga

4
COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences,

Bangalore (Karnataka) shall have the rights to preserve, use and disseminate this

dissertation/ thesis in print or electronic format for academic/research purpose.

Date: Signature of the


candidate

Place: Dr. Abdul Quadeer

© Rajiv Gandhi University of Health Sciences, Bangalore (Karnataka)

5
ACKNOWLEDGEMENT

A journey is easier when you travel together. Interdependence is certainly

more valuable than independence. No endeavor can start, continue and complete

without the blessings of almighty god. And I thank him for always being my side. I

believe without him nothing would have been possible.

I am deeply indebted to my Guide, Dr. Sampath Rao M.D (Hom), and HOD &

Professor, Department of Organon of Medicine & Homoeopathic Philosophy,

H.K.E.’s Homoeopathic Medical College and Hospital, Gulbarga, whose invaluable

help, stimulating suggestions and encouragement helped me to go ahead with my

dissertation. He has always been available when I needed his advice and has guided

me at every major phase during the preparation of this dissertation.

I owe my sincere gratitude to our Principal Dr. P.Sampathrao M.D (Hom),

Professor and HOD, Department of Organon of Medine & Homoeopathic

Philosophy, for his unflinching valuable support and advice during the course of my

study.

I express my gratitude & sincere thanks to our teacher Dr.Vijayalakshmi.B.M

M.D (Hom), for their unflinching valuable support and constant encouragement during

the course of my study.

My heartfelt thanks to our P.G. Co-ordinator Dr.Ashok Patil M.D (Hom). Prof.

& HOD, Department of Medicine.

I express my gratitude to our teacher Dr.S.S.Jambaldinni M.D (Hom), Prof.,

Department of Materia Medica.

I express my gratitude to our teacher Dr.Krishna M.D (Hom), Prof. & HOD,

Department of Repertory.

6
I express my gratitude to our teacher Dr.Rajeshwari K M.D (Hom), Prof. & HOD,
Department of Materia Medica.
I express my gratitude to our teacher Dr.Meena P. M.D (Hom), Prof., Department
of Organon of Medicine..
I express my gratitude to our teacher Dr.C.V.Padashetty M.D (Hom), Prof.,
Department of Organon of Medicine.
I express my sincere thanks to our teacher Dr.Mahadev Pasar M.D (Hom),

professor, Department of Materia Medica.


My deepest gratitude goes to my parents for their unflagging love and support
throughout my life. I am greatly indebted to my father Mr. Abdul Sattar Dandoti, who
has provided the best possible environment for me to grow up and attend school and
college and to my mother Mrs. Fatima Begum who has lovingly cared for me and
instilled strong moral values in me.
I will be failing in my duty to thank my elder sister Mrs. Shabana Begum,
Brother- in-law Mr. Abubakar Idga and My younger brothers Mr. Abdul Samee
Dandoti & Mr. Md. Nayeem Dandoti for their love, affection, encouragement &
advice during my studies.
I express my sincere thanks to all my PG colleagues, for their help & support
. I express my sincere thanks to all my Friends, for their help & support
I express my sincere thanks to librarians Mr. Deshmukh and Mr. Veeranna,
for their help & support.
I express my sincere thanks to M/s Kotli Dtp centre, Gulbarga for making this
thesis work in a reproducible manner.
Last but not the least, I thank to my patients and well wishers without whose
support this work could not have been completed.

Date: Dr. ABDUL QUADEER


Place:

7
LIST OF ABBREVIATIONS USED`

A.C.T.H. Adreno cortico thyroid stimulatin harmone

Calc. carb. Cacarea carb

C.N.S Central nervous system

D.M. Diabatic mellitus

D. N. A. Deoxy ribo nucleic acid

H.P.V. Human papilloma virus

HTN Hypertension

M.S.H. Melanocyte stimulating harmone

MI Myocardial infarction

Nat.mur Natrum mur

OA Osteoarthritis

P.C.R. Polimarase chain reaction

RA Rhermatoid Arthrites

TB Tuberculosis

8
ABSTRACT

Background:
Warts are small circumscribed, epidermal papillary elevations of skin. Various
forms of warts are described as per their shape and their predominant characteristics.
Cause of the warts is human papilloma virus.

There are different types in warts namely, flat warts, Filiform warts, Common
warts, Plantar warts.

Objectives:
1) To study the miasmatic background and its implication in warts.
2) To assess the efficacy of homoeopathic remedies in the treatment of warts.

Methods
The present study consisted 30 patients of Warts who attended the OPD, IPD of
H.K.E.’s Homoeopathic Medical College & Hospital, and Gulbarga. And OPD of
village camp, during my study period.
The cases of warts were selected on the basis of following inclusion & exclusion
criteria:

The cases were recorded according to standard case format. This format was prepared
according to homoeopathic methods of case taking.

The cases were recorded by keeping the Holistic & concept of Individualization in
mind.

The Miasmatic diagnosis was done in each and every case using different books. The
miasmatic diagnosis is done on the basis of totality of symptoms, past history and
family history.
All the cases were diagnosed according to the symptoms and signs and also with the
help of investigations like punch biopsy.

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All the cases were reviewed once in 7, 15, 30 days as the need arouse & were
followed for a period of minimum 6 months.

Results

The result of this study showed that the miasmatic background in most of the

cases where of psoro-sycotic predominantly Psora .most commonly affected age

group of 10 -19yrs ,about 10 homoeopathic remedies where evolved as efficacious

remedies in the treatment of “Warts”. Out of 30 cases, 14 cases (46.66%) recovered,

9 cases (30%) showed improvement and 7 cases (23.33%) did not show improvement.

Interpretation and conclusion


I arrive at the conclusion that Homoeopathic treatment for warts shows
remarkable results in most of the cases of my study.

After prescribing the indicated remedy patient started improving depending


upon their vital energy.
Proper treatment without external application, were found effective in bringing
significant improvement in the patient.
The Homoeopathic medicine seems to be efficacious in the treatment of warts
as it prevents further complications. It also prevents persons from the complications
associated with methods like cauterization, surgical methods.
Combination of Psoro-Sycotic miasmatic background was seen. Predominance
of psora was seen in the most of the cases.

Keywords:
Common warts; Flat warts: Plantar warts: Filiform warts; Human Papilloma
Virus

10
TABLE OF CONTENTS

Sl.No. Topic Page No.

1. Introduction 1

2. Objectives 4

3. Review of Literature 5

4. Methodology 58

5. Results 63

6. Discussions 73

7. Conclusion 77

8. Summary 78

9. Bibliography 80

10. Annexures 84

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LIST OF TABLES

Sl.No. Particulars Page


No.

1. Table showing Differential diagnosis. 32-34

2. Table showing miasmatic evaluation of warts. 49-52

3. Table showing Age Incidence 65

4. Table showing Sex Incidence 66

5. Table Showing Past History 67

6. Table Showing Family History 68

7. Table Showing Occurrence Of Different types Of Warts 69

8. Table Showing Miasmatic Diagnosis 70

9. Table Showing constitutional remedy 71

10. Table Showing Result of Treatment 72

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LIST OF FIGURES

Sl.No. Particulars Page


No.

1. Anatomy of Skin 14

2. Figure showing Common warts 27

3. Figure showing Filliform warts 28

4. Figure showing Plantar warts 28

5. Figure showing Flat warts 29

6. Chart of Age Incidence 65

7. Chart of Sex Incidence 66

8. Chart of Past History 67

9. Chart of Family History 68

Chart of Occurrences of different types of Warts 69


10.

11. Chart of Miasmatic Diagnosis 70

12. Chart of Constitutional Drugs 71

13. Figure showing Final result of treatment 72

13
Introduction

Warts are small circumscribed, epidermal papillary elevations of


skin. Various forms of warts are described as per their shape and their
predominant characteristics. Cause of the warts is human papilloma virus.

Types of warts are Flat warts, Filiform warts, Common warts, Plantar
warts.

The humble wart has undoubtedly been afflicting mankind for


many millions. A wart was generally known in Ancient Greece and Rome.
The term Verruca was used by Sennertus, meaning a steap place or height.
Sennertus applied the term to warts because they appear on the surface of
the skin like the eminence of the little hills. During the time period 1434
A.D. Aulus Cornelius Celsus described treatment for warts in his text “De
Medicina”. In 16th century, Sir Francis Bacon claims to have cured his
warts by rubbing them Oliver Cromwell also famously suffered from warts
and asked to be painted “Warts and all in portrait”. At the nineteen century
physician Joseph Payne reported developing warts on his thumb after
scraping those of young patient. The concept was not generally accepted
until 1950 however, when virus particles were actually seen using electron
microscope.

Warts occur throughout the world and although comparable figures


are largely lacking. These are clearly striking variations in incidence. The
incidence increases during school years to reach a peak age between 12
and 16 then decline sharply. Their relative frequency will necessarily vary
with the age, customs 70% common warts, 24% plantar warts, 3.5% plane
warts, 2% filiform warts, 0.5% Genital warts.

Homoeopathy considers “warts” to be because of the underlying


miasms psoric or sycotic miasm. Hahnemann observed different clinical
warts in patients having the history of suppressed Gonorrhea. The venereal

14
disease Gonorrhea when suppressed alters the susceptibility of the human
beings therefore it is said that the cause of the disease is not from outside
the patient. The true cause of the disease is in the patient himself internal
cause psora, sycosis, syphilis or of any two or of all the three of them.

Psora is a condition of physical body brought on by evil thinking


and is the prime cause of all the varied illnesses of mankind. It is that
acquired condition which is now inherent in human life-force and which
gives that life force the tendency for disease.

Gonorrhoea is a highly poisonous infection, which is acquired by


co-habitation with a woman who has already had it. It is also had by
inheritance from parents who might have had it either by direct
acquirement or by inheritance in their turn.

If Gonorrhoea is not cured according to the law of similars it


implants upon the system the great miasm of sycosis. Sycosis therefore is
not Gonorrhoea but it is that condition of the system which is bounded to it
by Gonorrhoea when it is not cured but only made to disappear either by a
course of unhomoeopathic treatment or of itself. Unhomoeopathic
treatment turns the infection inward and it then gradually attacks the more
internal organs and establishes sycosis. Hence, Psora is acquired by evil
thinking and sycosis by evil action.

“A disorganized sycotic mind suffers from disorganized clinical


state of body”.
Daily application of paints or gels containing Keratolytics such as
15 to 60% salicylic acid. Occlusions with adhesive plaster or duct tape.
Regular paring using a scalpel blade Cryotherapy with liquid nitrogen
Electro surgery (curettage and cautery) some patient has more severe local
reactions than others. Pain, injury to underlying tendons and superficial
nerves around the sides of digits, post inflammatory depigmentation,

15
scarring and recurrent 0ccurance of warts often as a ring around the treated
site. Procedure is painful

According to homoeopathic system of medicine whole man is sick


and not that any particular part of his body (organ) is sick. It is only this
that when the man is sick the sickness is expressed in the particular
physical organs like skin and as a matter of fact the man was sick long
before these expressions of diseases came. It is the patient, the sick man
that is to be treated and not the disease.

By removing the effect, you cannot remove the cause. The


destruction of the effect is not the destruction of the cause. Hence we treat
the patient as a holistic approach. Homoeopathy offers an excellent and
promising cure for warts. The beauty of the treatment is that the medicines
are to be taken orally and there is no local application. This treatment, in
turn, treats the ailment from within, for a long time and almost
permanently.

Therefore the present study is effort for the study of miasmatic


background of warts and to assess the efficacy of homoeopathic drugs in
treating warts.

16
OBJECTIVES

1. To study the miasmatic background and its implication in warts.


2. To assess the efficacy of homoeopathic remedies in the treatment of warts.

17
REVIEW OF LITERATURE

Historical prospective of warts:


The humble wart has undoubtedly been afflicting to the mankind
for many millennia. Warts were certainly well known in ancient Greece
and Rome. The wart condyloma is of Greek origin and means to knuckle
or knob. Myrmecia, a term we apply to painful, deep seated plantar warts
is derived from the Greek word for ant hill.

The term Verruca was first used by Sennertus. Originally


meaning a steep place or height. Sennertus applied the term to warts
because ‘They appear over the surfaces of the skin like eminences of
little hills’.

In Roman Hellenistic times genital warts were referred to by the


terms ficus and thymus. Die Feigwarze(the fig wart) is a German
terminology for genital warts. The Latin term thymus (Greek thymos or
thymion) was derived from the comparison of the appearance of genital
warts with the efflorescence of certain species of thyme plant.

Aulus Cornelius Celsus, who lived during the reign of Tiberius


Caesar, in discussing wart like lesions in his classical work on medicine
(The Medicina). Mentioned three types , one kind the Greeks called
Acrochordon, where in a development of something hard and uneven
under the skin, the later retaining its natural color, it is thin towards its
extremity, but broad at its base, and of moderate size rarely exceeding a
bean in dimensions. It is seldom solitary but commonly occurs in clusters
and particularly in children. Sometimes these little tumours terminate on
a sudden but at other times they become inflamed projects considerably
from the skin, slender at the base, broad, hard and uneven and colored at
its summit.

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Myrmecia is the name given to warts dwarfer and harder than the
thymion. Their roots are deeper, they are more painful, they are broader
at the base that at the summit, they are less disposed to bleed and they are
hardly ever exceed the dimensions of a lupin in size. They are met in the
palms of the hands and the soles of the feet.

Causation of warts:

In the past, theories about the causation of warts abounded. In the


Lancet in 1849, a medical news section contain the information that; Dr.
Durr maintained, many years ago, in Hufeland’s Journal , that females
addicted to solitary habits often present with warts on the index and
middle finger.

The abundance of transference cures in folklore suggested that


lay people were cognizant of coetaneous nature of warts; the concept of a
transmissible agent being responsible for their causation was some time
in dawning on the medical fraternity. However in 1823 Sir Astley
Cooper writing on warts stated, I must observed that they frequently
secrets a matter which is able to produce a similar disease in others. He
then describes the accidental injury of a surgeon with a knife which had
been used to remove large warts, the injured part subsequently
developing warts at the site of the wound.

In 1891 Joseph Payne, recorded the contagious nature of common


warts when he described how he develop a wart under the thumb nail one
week after treating an eleven year old boy, the boy had numerous warts
on the hands and face. And Payne after the softening the warts by
salicylic and acetic acids, scraped them with his thumb nail, Payne stated
common warts appear to arise by the implantation of some contagious
material at one or more points of the skin, usually on exposed parts.

19
In 1894 Variot, inoculated warts from a child to an adult there
after Jadassohn confirmed the infective nature of warts by inoculation
experiments

The probable viral origin of warts was suggested by the


experiments of Ciuffo. Who in 1907, produced warts on his hands by
inoculating by himself with a wart extract which has passed through a
Berkfeld’s filter with a pore size.

The presence of viral particle in warts was first demonstrated by


Strauss in 1949 and 1962 Melnick classified the wart virus in the papova
virus group. With modern technique it has been possible to identify over
30 different types of human papilloma virus responsible for viral wart 1

20
Anatomy of Skin

Development of skin.

The skin-one of the largest structures in the body-is a complex


organ system that forms a protective covering for the body. The skin
consists of two layers that are derived from two different germ layers:
ectoderm and mesoderm.
The epidermis is a superficial epithelial tissue, which is derived from
surface ectoderm.
The dermis is a deeper layer composed of dense, irregularly
arranged connective tissue, which is derived from mesoderm. The
meshwork of embryonic connective tissue or mesenchyme derived from
mesoderm forms the connective tissues in the dermis. The embryonic skin
at 4 to 5 weeks consists of a single layer of surface ectoderm overlying the
mesenchyme.

Epidermis

During the first and second trimesters, epidermal growth occurs in


stages, which results in an increase in epidermal thickness. The
primordium of the epidermis is the layer of surface ectodermal cells. These
cells proliferate and form a layer of squamous epithelium, the periderm,
and a basal germinative layer. The cells of the periderm continually
undergo keratinization and desquamation and are replaced by cells arising
from the basal layer. The exfoliated peridermal cells form part of the white
greasy substance-the vernix caseosa-that covers the fetal skin. Later, the
vernix contains sebum; the secretion from sebaceous glands in the skin,
the vernix protects the developing skin from constant exposure to amniotic
fluid with its urine content during the fetal period.

The basal germinative layer of the epidermis becomes the stratum


germinativum, which produces new cells that are displaced into the layers

21
superficial to it. By 11 weeks, cells from the stratum germinativum have
formed an intermediate layer.Replacement of peridermal cells continues
until about the twenty-first week; thereafter, the periderm disappears and
the stratum corneum forms.
Proliferation of cells in the stratum germinativum also forms
epidermal ridges, which extend into the developing dermis; these ridges
begin to appear in embryos at 10 weeks and are permanently established
by the seventeenth week. The epidermal ridges produce grooves on the
surface of the palms of the hands and the soles of the feet, including the
digits. The type of pattern that develops is determined genetically and
constitutes the basis for examining fingerprints in criminal investigations
and medical genetics.

Late in the embryonic period, neural crest cells migrate into the
mesenchyme of the developing dermis and differentiate into melanoblasts.
Later these cells migrate to the dermoepidermal junction and differentiate
into melanocytes. The diffefrntiation of melanoblasts into melanocytes
involves the formation of pigment granules. melanocytes appear in the
developing skin at 40 to 50 days, immediately after the migration of neural
crest cells. The melanocytes begin producing melanin before birth and
distribute it to the epidermal cells. The relative content of melanin in the
melanocytes accounts for the different colors of skin.

The transformation of the surface ectoderm into a multilayered


epidermis results from continuing inductive interactions with the dermis,
skin is classified as thick or thin based on the thickness of the epidermis.
Thick skin covers the palms and soles; it lacks hair follicles, arrector pili
muscles, and sebaceous glands but has sweat glands. Thin skin covers
most of the rest of the body; it contains hair follicles, arrector pili muscles,
sebaceous glands, and sweat glands.

Dermis
The dermis develops from mesenchyme, which is derived from the
mesoderm underlying the surface ectoderm. Most of the mesenchyme that
22
differentiates into the connective tissue of the dermis originates from the
somatic layer of lateral mesoderm; however, some of it is derived from the
dermatomes of the somites.

By 11 weeks, the mesenchymal cells have begun to produce


collagenous and elastic connective tissue fibers. As the epidermal ridges
form, the dermis projects into the epidermis forming dermal ridges ,
capillary loops develop in some of these ridges and provide nourishment
for the epidermis. Sensory nerve endings form in others.

The developing afferent nerve fibers apparently play an important


role in the spatial and temporal sequence of dermal ridge formation.

The blood vessels in the dermis begin as simple, endothelium-lined


structures that differentiate from mesenchyme. As the skin grows, new
capillaries grow out from the simple vessels. Such simple capillary like
vessels have been observed in the dermis at the end of the fifth week.
Some capillaries acquire muscular coats through differentiation of
myoblasts developing in the surrounding mesenchyme and become
arterioles and arteries.

Other capillaries, through which a return flow of blood is


established, acquire muscular coats and become venules and veins. By the
end of the first trimester, the major vascular organization of the fetal
dermis is established.

Glands of the skin

Two kinds of glands, sebaceous and sweat glands, are derived from
the epidermis and grow into the dermis. The mammary glands develop in a
similar manner.
Most sebaceous glands develop as buds from the sides of
developing epithelial root sheaths of hair follicles . the glandular buds

23
grow into the surrounding embryonic connective tissue and branch to form
the primordia of several alveoli and their associated ducts.
The central cells of the alveoli break down, forming an oily
secretion –sebum-that is released into the hair follicle and passes to the
surface of the skin, where it mixes with desquamated peridermal cells to
form vernix caseosa. Sebaceous glands independent of hair follicles
develop in a similar manner to buds from the epidermis.
Sweat glands

Eccrine sweat glands are located in the skin throughout most of


the body. They develop as epidermal downgrowths into the underlying
mesenchyme form the primordium of the secretory part of the gland. The
eplithelial attachment of the developing gland to the epidermis forms the
primordium of the duct.

The central cells of the primordial ducts degenerate, forming a


lumen. The peripheral cells of the secretory party of the gland
differentiate into myoepithelial and secretory cells. The myoepithelial cells
are thought to be specialized smooth muscle cells that assist in expelling
sweat from the glands. Ecccrine sweat glands begin to function shortly
after birth.

The distribution of the large apocrine sweat glands in humans is


mostly confined to the axilla, pubic, and perineal regions, and areolae of
the nipples. They develop from downgrowths of the stratum
germinativum of the epidermis that give rise to hair follicles. As a result
the ducts of these glands open, not onto the skin surface as do ordinary
sweat glands, but into the upper part of hair follicles superficial to the
openings of the sebaceous glands. They secrete only after puberty.

Sebaceous gland Sebaceous gland develop about 12th week of


intrauterine life in main as budding from dxternal root sheath of hair
follicles and by 13th to 15th weeks are clear .Sweat gland appear in 5th
month of foetal life, originating from the in growing of the rete cells.
24
Development of hair.

Hairs begin to develop early in the fetal period , but they do not
become easily recognizable until about the twentieth week , hairs are first
recognizable on the eyebrows, upper lip, and chin. A hair follicle begins as
a proliferation of the stratum germinativum of the epidermis and extends
into the underlying dermis.

The hair bud soon becomes club-shaped, forming a hair bulb.The


epithelial cells of the hair bulb constitute the germinal matrix, which later
produces the hair. The hair bulb is soon invaginated by a small
mesenchymal hair papilla.The peripheral cells of the developing hair
follicle form the epithelial root sheath, and the surrounding mesenchymal
cells differentiate into the dermal root sheath.

As cells in the germinal matrix proliferate, they are pushed toward


the surface, where they become keratinized to form the hair shaft.

The first hairs that appear- lanugo hairs (L. lana, wool)-are fine,
soft, and lightly pigmented. Lanugo hairs begin to appear toward the end
of the twelfth week and are plentiful by 17 to20 weeks. These hairs help to
hold the vernix caseosa on the skin. Lanugo hairs are replaced during the
perinatal period by coarser hairs. Melanoblasts migrate into the hair bulbs
and differentiate into melanocytes.

The melanin produced by these cells is transferred to the hair-


forming cells in the germinal matrix several weeks before birth. Arrector
pili muscles, Small bundles of smooth muscle fibers, differentiate from
the mesenchyme surrounding the hair follicle and attach to the dermal root
sheath of the hair follicles and the papillary layer of the dermis.

25
Development of nails

Toenails and fingernails begin to develop at the tips of the


digits at about 10 weeks. Development of fingernails precedes that of
toenails by about 4 weeks. The primordia of nails appear as thickened
areas or fields of epidermis.2

The skin is composed of two main parts:

THE EPIDERMIS

The epidermis is the most superficial part of the skin and is


composed of keratinized stratified squamous epithelium which varies in
thickness in different parts of the body. it is thickest on the palms of the
hands and soles of the feet. There are no blood vessels or nerve endings in
the epidermis, but its deeper layers are bathed in interstitial fluid which is
drained away as lymph.

There are several layers of cells in the epidermis which extend from
the superficial` stratum corneum (horny layer) to the deepest germinative
layer. The cells on the surface are flat, thin, non-nucleated, dead cells in
which the protoplasm has been replaced by keratin.

Cells on the surface are constantly being rubbed off and they are
replaced by cells which originated in the germinative layer and have
undergone gradual change as they progressed towards the surface.

26
Figure 1.

The epidermis contains 5 layers. From bottom to top the layers are named:

ƒ stratum basale

ƒ stratum spinosum

ƒ stratum granulosum

ƒ stratum licidum

ƒ stratum corneum

There are four major layers of keratinocytes (the structural cells) in the
epidermis and one layer that is present only in certain parts of the body.
The bottom layer, the stratum basale, has cells that are shaped like
columns. In this layer the cells divide and push already formed cells into
higher layers. As cells move into the higher layers, they flatten and
eventually die. We will take a closer look at the characteristics of each of
these layers.

27
Stratum basale

The stratum basale is the bottom layer of keratinocytes in the epidermis


and is responsible for constantly renewing epidermal cells. This layer
contains just one row of undifferentiated columnar stem cells that divide
very frequently. Half of the cells differentiate and move to the next layer
to begin the maturation process. The other half stay in the basal layer and
divide over and over again to replenish the basal layer.

Stratum spinosum
Cells that move into the spinosum layer (also called prickle cell layer)
change from being columnar to polygonal. In this layer the cells start
to synthesize keratin.

Stratum granulosum
The cells in the stratum granulosum, or granular layer, have lost
their nuclei and are characterized by dark clumps of cytoplasmic material.
There is a lot of activity in this layer as keratin proteins and water-
proofing lipids are being produced and organized.

Stratum lucidum
The stratum lucidum layer is only present in thick skin where it
helps reduce friction and shear forces between the stratum corneum and
stratum granulosum.

Stratum Corneum

The cells in the stratum corneum layer are known as corneocytes. The cells
have flattened out and are composed mainly of keratin protein which
provides strength to the layer but also allows the absorption of water.

Stratum cornerium

28
The structure of the stratum corneum layer looks simple, but this layer is
responsible for maintaining the integrity and hydration of the skin - a very
important function. There are actually complex processes that are at work
in the stratum corneum and minimal disruptions of any of these processes
can cause a variety of skin problems.3

Melanocytes:

Melanocytes, derived from neural crest cells, primarily function to


produce a pigment, melanin, which absorbs radiant energy from the sun and
protects the skin from the harmful effects of UV radiation. Melanin
accumulates in organelles termed melanosomes that are incorporated into
dendrites anchoring the melanosome to the surrounding keratinocytes.
Ultimately, the melanosomes are transferred via phagocytosis to the
adjacent keratinocytes where they remain as granules. Melanocytes are
found in the basal layer of the epidermis as well as in hair follicles, the
retina, uveal tract, and leptomeninges. These cells are the sites of origin
of melanoma.

In areas exposed to the sun, the ratio of melanocytes to keratinocytes


is approximately 1:4. In areas not exposed to solar radiation, the ratio may
be as small as 1:30. Absolute numbers of melanosomes are the same
among the sexes and various races. Differing pigmentation among
individuals is related to melanosome size rather than cell number. Sun
exposure, melanocyte-stimulating hormone (MSH), adrenocorticotropic
hormone (ACTH), estrogens, and progesterones stimulate melanin
production. With aging, a decline is observed in the number of
melanocytes populating the skin of an individual. Since these cells are of
neural crest origin, they have no ability to reproduce.

29
Langerhans cells:

Langerhans cells originate from the bone marrow and are found in
the basal, spinous, and granular layers of the epidermis. They serve as
antigen-presenting cells. They are capable of ingesting foreign antigens,
processing them into small peptide fragments, binding them with major
histocompatibility complexes, and subsequently presenting them to
lymphocytes for activation of the immune system. An example of
activation of this component of the immune system is contact
hypersensitivity.

Merkel cells:

Merkel cells, also derived from neural crest cells, are found on the
volar aspect of digits, in nail beds, on the genitalia, and in other areas of
the skin. These cells are specialized in the perception of light touch.4

Dermis:

the part of the dermis immediately adjacent to the epidermis is less


dense in texture than elsewhere and contains the terminal capillaries of the
skin and most of its nerve endings.On its deep surface, this loose layer, the
papillary layer(stratum papillare), blends with the dense and thicker
portion of the dermis, the reticular layer. On its outer surface, the papillary
layer gives rise to numerous nipplelike projections, dermal papillae, that fit
into conical excavations on the deep surface of the epidermis. It is
particularly in the papillae that vascular loops and nerve endings are
prominent. The reticular layer of the dermijs is composed of densely
interwoven connective tissue, largely collagenous, but also containing
elastic fibers. Its varying thickness is, in most locations, responsible for
differences in the thickness of the skin.

On its deep surface, the dermis is usually connected to the underlying tela
subcutanea, commonly termed the superficial fascia. The loose texture of
this layer provides easy movement of the skin over the underlying
structures. In some locations, howege, the dermis is bound tightly to

30
underlying deep structures, either over ageneral area . or over localizaed
areas, the attachment of the skin to the tela subcutanea and deeper
structures is through connective tissue bands, the retinacula cutis. Where
these are locally well developed and are attavhed to firm, deepler- lying
tissue, they produce permanent folds and dimples in the skin.

The structures in the dermis are:

Blood vessels arterioles form a fine network with capillary branches


supplying sweat glands, sebaceous glands, hair follicles and the deeper
layers of the epidermis.

Lymph vessels. These form a network throughout the dermis and the
deeper layers of the epidermis.

Sensory nerve endings. Nerve endings which are sensitive to touch


change in temperature and pressure are widely distributed in the dermis.
There are no nerve endings in the epidermis.

The skin is an important sensory organ. It is one of the organs through


which the individual is aware of his environment. Nerve impulses which
originate in these nerve endings are conveyed to the spinal cord by
sensory, or cutaneous, nerves. From there they are conveyed to the sensory
area of the cerebrum where the sensations of touch, temperature and plain
are perceived.

Sebaceous glands

Sebaceous glands, or holocrine glands, are found over the entire surface of
the body except the palms, soles, and dorsum of the feet. They are largest
and most concentrated in the face and scalp where they are the sites of
origin of acne. The normal function of sebaceous glands is to produce and
secrete sebum, a group of complex oils that include triglycerides and fatty
acid breakdown products, wax esters, squalene, cholesterol esters, and

31
cholesterol. Sebum lubricates the skin to protect it against friction and
makes the skin more impervious to moisture.

Sweat glands

Sweat glands, or eccrine glands, are found over the entire surface of the
body except the vermillion border of the lips, the external ear canal, the
nail beds, the labia minora, and the glans penis and the inner aspect of the
prepuce. They are most concentrated in the palms and soles and the
axillae.

Each gland consists of a coiled secretory intradermal portion that connects


to the epidermis via a relatively straight distal duct. The normal function of
the sweat gland is to produce sweat, which cools the body by evaporation.
The thermoregulatory center in the hypothalamus controls sweat gland
activity through sympathetic nerve fibers that innervate the sweat glands.
Sweat excretion is triggered when core body temperature reaches or
exceeds a set point.

Apocrine and mammary glands

Apocrine glands are similar in structure, but not identical, to eccrine glands.
They are found in the axillae, in the anogenital region, and, as modified
glands, in the external ear canal (ceruminous glands), the eyelid (Moll's
glands), and the breast (mammary glands). They produce odor and do not
function prior to puberty, which means they probably serve a vestigial
function. The mammary gland is considered a modified and highly
specialized type of apocrine gland.5

Hair follicles

Hair follicles are complex structures formed by the epidermis and dermis.
(See the image below.) They are found over the entire surface of the body
except the soles of the feet, palms, glans penis, clitoris, labia minora,
mucocutaneous junction, and portions of the fingers and toes. Sebaceous

32
glands often open into the hair follicle rather than directly onto the skin
surface, and the entire complex is termed the pilosebaceous unit.

Caucasian hair follicles are oriented obliquely to the skin surface, whereas
the hair follicles of black persons are oriented almost parallel to the skin
surface. Asian persons have vertically oriented follicles that produce
straight hairs. These anatomic variations are an important consideration in
avoiding alopecia when making incisions in the scalp.

The base of the hair follicle, or hair bulb, lies deep within the dermis and,
in the face, may actually lie in the subcutaneous fat. This accounts for the
remarkable ability of the face to re-epithelialize even the deepest
cutaneous wounds. A band of smooth muscle, the arrector pili, connects
the deep portion of the follicle to the superficial dermis. Contraction of
this muscle, under control of the sympathetic nervous system, causes the
follicle to assume a more vertical orientation.6

Hair growth exhibits a cyclical pattern. The anagen phase is the growth
phase, whereas the telogen phase is the resting state. The transition
between anagen and telogen is termed the catagen phase. Phases vary in
length according to anatomic location, and the length of the anagen phase
is proportional to the length of the hair produced. At any one time at an
anatomic location, follicles are found in all 3 phases of hair growth. This is
extremely important for laser hair removal, because follicles in the anagen
phase are susceptible to destruction, whereas resting follicles are more
resistant. This explains why multiple treatments of an area may be
necessary to ensure adequate hair removal.7

33
Physiology of Skin

Physiology of sebaceous gland:


The secretion of sebaceous glands, sebum forms part of vernixcascosa.
Sebum is holocrine that is it is produced entirely by complete
disintegration of glandular cells. Sebum reaches the skin surface through
pilosebaceous canal. On the skin surface, sebum mixes with other lipid
derived as a complex mixture containing squalene, wax, sterol esters,
triglycerides, free fatty acids, mono and diglycerides, and cholesterol. The
life sebaceous cells is described into three distinct cells types they are:
a). The peripheral cells that contain ribosomes and are formed against
basement membrane that surrounds acinus.
b). The partially differentiated cells which are actively synthesizing and
storing sebum droplets within the cells.
c). The fully differentiated cells, which contain multitude of tightly packed
sebum vacuoles ready to be released upon rupture of cells.8
Cellular maturation and sebum lipogenesis represent a dynamic
process. In early stage of lipogenesis, glycogen, smooth endoplasmic
reticulum and ribosomes predominate in cytoplasm of cells. For the
cellular maturation, numerous mitochondria along with smooth surface
vesicles, ribosomes, glycogen and golgi membranes fill cytoplasmic
substance of cells. As maturation of cells is completed numerous lipid
vacuoles, smooth membranes and minimal number of ribosomes and
mitochondria appear within the cells. Smooth surfaced endoplasmic
reticulum is primarily involved in lipogenesis. The sebum thus formed in
the cells of the gland and there by the cells becomes impregnated with fats.
These maturated cells finally degenerate and break apart releasing sebum
to the excretory duct.
When excretion is not properly discharged, it lodges in the ducts as
white head the outer portion of substance may be blackened by oxidation
and constitutes black head.
Expression of sebum from duct is due to continuous pressure from behind
of disintegrating cells aided possibly compression due to contraction of

34
arrector pili muscles. Excessive amount of sebum may become impacted
in the duct and this associated with hyperkeratinisation may lead to it
being blocked to form a comedo.
Secretion of sweat gland is a colorless fluid of slightly salty taste, although
it may alkaline or acidic in reaction. It is 99.05% water with certain
organic acids and number of salts of blood. It is quite volatile, easily
evaporating.

Composition of sebum:
Composition of sebum is not fully known. Sebum has a characteristic
color. Sebum is rich in fatty acids, saponified fats, palmatin, olin, stored
cholesterol, cholesterol esters, triglycerides, wax esters and other aliphatic
components.

Control:
Sebum secretion is controlled by central nervous system, existing probably
in spinal cord and medulla. Hormonal regulation of sebaceous gland is
well established. Experimental evidences suggest that excess
administration of progesterone causes pronounced enlargement of
sebaceous glands. This has given rise to the believe that in females, acne is
insisted by progesterone formed by the corpus luteum of the ovary.
Estrogen—reduces the size of sebaceous gland. Inhibits formation of
sebum in humans. Current evidence suggest that sebum production is
stimulated primarily by androgens secreted either from adrenal gland testis
or ovaries. Contraction of arrectores pilorum helps in expulsion of sebum.
These muscles contract by application of cold, during excitement and in
response to adrenaline.

Functions of Sebum:
1). Acts as bacteriostatic agent. And as a lubricant.
2). Has property of preventing damage of epidermis during hot season and
conservation of heat during cold.
3). Keeps the skin moist.
4). Prevents too much rapid evaporation from cut surfaces.
35
Functions of sebaceous glands:

Performs excretory and secretory functions of the skin. 9


Blood supply:
The epidermis has no vascular supply, but the dermis and the
subcutaneous tissue are liberally supplied with truncal and capillary
vessels. Arterial supply is derived from subcutaneous branches. Venous
plexus accompany the arterial in all portions of the skin, merged in to
venous sinuses, which ends in subcutaneous veins.

Lymphatics;
All portions of the skin are provided with a system of lymphatic channels,
which aid in the important processor of absorption. Lymph vessels proper
are relatively few and are commonly mere appendages of blood vessels.

Nerve Supply:
The skin is well endowed with medullated and non medullated sensory
nerve fibres and via non medullated autonomic fibres supplying blood
vessels and appendages. Conspicuous nerve supply consist of plexuses in
the papillae, meissner’s corpuscles, Pacinian’s corpuscles, Merkel’s discs
and nerve endings in the basal of epidermis.

Functions of skin

The integumentary system has multiple roles in homeostasis. All body


systems work in an interconnected manner to maintain the internal
conditions essential to the function of the body. The skin has an important
job of protecting the body and acts as the body’s first line of defense
against infection, temperature change, and other challenges to
homeostasis. Functions include:

ƒ Protect the body’s internal living tissues and organs


ƒ Protect against invasion by infectious organisms
ƒ Protect the body from dehydration

36
ƒ Protect the body against abrupt changes in temperature,
maintain homeostasis
ƒ Help excrete waste materials through perspiration.
ƒ Act as a receptor for touch, pressure, pain, heat, and cold)
ƒ Protect the body against sunburn by secreting melanin
ƒ Generate vitamin D through exposure to ultraviolet light.
ƒ Store water salt, glucose, and vitamin D.
ƒ Maintenance of the body form
ƒ Formation of new cells from stratum germinativum to repair minor
injuries
ƒ
Aid in physical examination as color of the skin may indicate many
conditions e.g.it becomes yellowish in jaundice.8

Pathology of the skin.

Verrucae(Warts).
Verrucae are common lesions of children and adolescents, although
they may be encountered at any age. They are caused by human
papillomaviruses. Trasmission of disease involves direct contact between
individuals or autoinoculation.

Verrucae are generally self-limited, regressing spontaneously


within six months to two years.

The classification of verrucae is based largely on clinical


morphology and location. Verruca vulgaris is the most common type of
wart. The lesions of verruca vulgaris occur anywhere but most frequently
on the hands, particularly on the dorsal surfaces and periungual areas,
where they appear gray-white to tan, flat to convex, 0.1-to-1cm papules
with a rough, pebble-like surface. Verruca plana, or flat wart, is common
on the face or the dorsal surfaces of the hands. The warts are slightly
elevated, flat, smooth, tan papules that are generally smaller than verruca
vulgaris. Verruca plantaris and verruca Palmaris occur on the soles and
37
palms, respectively. Rough, scaly lesions may reach 1 to 2 cm in diameter,
coalesce, and be confused with ordinary calluses. Condyloma acuminatum
(veneral wart) occur on the penis, female genitalia, urethra, perianal area,
and rectum. Veneral warts appear as soft, tan, cauliflower-like masses that
in occasional cases reach many centimeters in diameter. 9
Morphology: Histological features common to verrucae include
epidermal hyperplasia that is often undulant in character (so-called
verrucous or papillomatous epidermal hyperplasia: and cytoplasmic
vacuolization (koilocytosis) that preferentially involves the more
superficial epidermal layers, producing halos of pallor surrounding
infected nuclei.

Electron microscopy of these zones reveals numerous viral


particles within the nuclei. Infected cells may also demonstrate prominent
and apparently condensed keratohyaline granules and jagged eosinophilic
intracytoplasmic keratin aggregates as a result of viral cytopathic effects.
These cellular alterations are not so prominent in condylomas; hence, their
diagnosis is based primarily on hyperplastic papillary architecture
containing wedge-shaped zones of koilocytosis.16

Pathogenesis: It is now recognized that the clinically different types of


warts just described result not solely because of the anatomically different
sites in which they arise but also as a consequence of distinct types of
HPV. More than 150 types of papillomavirus have been identified, many
of the able to produce warts in humans. The virus can be identified by
molecular hybridization and polymerase chain reaction (PCR). Warts are
generally caused by HPV types 6 and 11. In contrast, there is tendency for
lesions induced by HPV type 16 to show some degree of dysplasia. HPV
type 16 has also been associated with in situ squamous cell carcinoma of
the genitalia and with bowenoid papulosis (genital lesions of young adults
with histology of carcinoma in situ but with a biologic course of
spontaneous regression).

38
These findings are consistent with previous observations of the
association of HPV types 16 and 18 with carcinomas of the uterine cervix.
The potential relationship of papillomavirus to carcinoma is reinforced by
the rare heritable condition termed epidermodysplasia verruciformis. In
this disorder, patients develop multiple flat warts, some of which evolve to
become invasive squamous cell carcinomas. The genomes of HPV types 5
and 8 have been detected in some of these cutaneous tumors. Thus the
types of papillomavirus differ not only in the morphology of the lesions
they produce but also in their oncogenic potential.11

Histopathology.Verrucae vulgares show acanthosis, papillomatosis, and


hyperkeratosis. The rete ridges are elongated and, at the periphery of the
verruca, are often bent inward so that they appear to point radially toward
the center. The characteristic features that distinguish verrucavulgaris from
other papillomas are foci of vacuolated cells, referred to as koilocytotic
cells;vertical tiers of parakeratotic cells; and foci of clumped keratohyaline
granules.

These three changes are quite pronounced in young verrucae vulgares. The
foci of koilocytes are located in the upper stratum malphighii and in the
granular layer. The koilocytes possess small, round, deeply basophilic
nuclei surrounded by a clear halo and pale staining cytoplasm. These cells
contain few or no keratohyaline granules, even when they are located in
the granular layer. The vertical tiers of parakeatotic cells are often located
at the crests of papillomatous elevations of the rare malpighii over lying a
focus of vaculated cells. compared with ordinary parakeratotic nuclei, the
nuclei of the parakeratotic cells in verrucae vulgaris are larger and more
deeply basophilic, and many of them appear rounded rather than
elongated.

Although no granular cells are seen over lying the papillomatous crests.
They are increased in number and size in the inter vening valleys and
contain heavy, irregular clums of keratohyaline granules. Dilated

39
capillaries and small areas of heamorrahage may be seen in the thickened
horny layer at the tip of the vertical tiers of parakeatotic cells.

Common wart
Figure 2 :

Filiform warts the papillae are more elongated then in verrucae vulgaris.
Histogenesis and viral identification: No difference has been noted in
electron microscopic appearance among the virus particles in the various
types of HPV. However the quantity varies with the different types.
Frequently, Virus particles are absent in verrucae vulgaris on electron
microscope examination.

Viral antigens, such as papilloma virus common antigen, can be detected


by using immunohistochemisty and HPV DNA can be amplified from the
lesions by using PCR(polymerase chain reaction) with appropriate
primers. Viral genomic material can also be identified by in situ
hybridization.

The virus particles are spherical bodies with a diameter of about 50


nanometer. Each particle consist of an electron dense nucleoid with a
stippled appearance surrounded by a less dense capsid. The wart virus
replicates in the nucleus, where the viral particles are located as dense
aggregates in a crystalloid arrangement. Eosinophilic intranuclear bodies
are very rare in verrucae vulgaris.

40
Filifom wart
Figure 3

Plantar wart
Figure 4

Verruca Plana. Verrucae planae show hyperkeratosis and acathosis but,


unlike verrucae vulgares, have no papillomamatosis, only slight elongation

41
of the rete ridges, and no areas of parakeratosis. In the upper stratum
malphighii, including the granular layer, there is diffuse vacuolization of
the cells. Some of the vacuolated cells are enlarged to about twice their
normal size. The nuclei of the vaculated cells lie at the center of the cells
and some of them appear deeply basophilic.

The granular layer is uniformly thickened, and the stratum corneum has a
pronounced basket weave appearance resulting from the vacuolization of
the horny cells. The dermis appears normal. In spontaneously regressing
warts, there is often a superficial lymphocytic infiltrate in the dermis with
exocytosis and apoptosis of the cells in the epidermis.

Histogenesis. Verrucae planae are induced by HPV 3 and HPV 10.


Electron microscopic examination reveals marked cytoplasmic oedema.10

Flat wart
Figure 5

Epidemiolgy: warts are transmitted by direct or mediate contact . the long


and variable incubation period confuses epidemiological surveys. The
examination of 2,620German soldiers aged19-21 showed an incidence of
2.82%as compared with 0.56% in civilian controls of the same age.17

Causes :
Papilloma viruses comprise a large family of small DNA viruses found in
humans and many other species. P
Papilloma viruses are highly host specific, meaning that these from one
species do not induce papillomas in heterologous species.
So HPV infect only to the humans.
42
More than 100 HPV types have been sequenced.
The degree of relatedness of their DNA. Sequence distinguishes between
HPV types.

Cutaneous (non genital ) HPV types are HPV-1, HPV-2, HPV-3, HPV-
4.15

Clinical features :
The typical history is of newly acquired, slowly expanding, persistent, and
often scaly lesions of the skin. Over several weeks to months, the
appearance of additional nearby lesion is suggestive of local spread and
the diagnosis of HPV infections.
Coetaneous lesions: Warts are described by their clinical location or
morphology. The coetaneous of warts are varied.
1).common warts (verruca vulgaris) are scaly, rough, spiny papules or
nodules that can be found on any coetaneous surface. They are often occur
as single or grouped papules on the hands and fingers.
2). Fil form warts: They appear coetaneous horns.
3). Flat warts (Verruca Plana): Are 1-4mm, slightly elevated, flat toped
papules that have minimal scale. These are most frequently occur on the
face, hands, and legs.
4). Plantar and palmar wart: These are thick, endophytic and hyperkertotic
papules which may be painful with pressure, punctuate black dots(seats)
that become evident after saving away of the keratinous surface represent
thrombosed capillaries in the paipilloma.14

Investigation:
Punch Biopsy. : Punch biopsy are performed with round disposable
knives, ranging in diameter 2-10mm but 3mm is the smallest size likely to
give sufficient tissue for consistently accurate histological diagnosis. The
punch is an ideal procedure for diagnostic skin biopsy or removing small
lesions, and often provides a better cosmetic result than a shave biopsy.
Punch biopsies can heal by secondary intention, but punches greater than
43
3mm may produce unacceptable scaring and are best closed with one or
two sutures. Punch biopsies are easily mastered by most practitioners, are
quick, and have a low incidence of infection, bleeding , non healing, or
significant scarring. With a punch biopsy owing to size, depth, or location.
Their main advantage is the amount of tissue that can be excised, allowing
for multiple studies (culture, histopathology, immune fluorescence,
electron microscopy) from one biopsy site.11

Diagnosis:

1).The clinical appearance and history of acquired, slowly enlarging


papules usually lead to the diagnosis of viral wart
2).. Histologic examination can be used to confirm the diagnosis.
3). Immunohistochemical detection can be used to detect these capsid
proteins in clinical materials,
4).PCR (polymerase chain reaction) techniques detect coetaneous or EV.
5) Highly sensitive and specific diagnostic hybridization test to identify
genital-mucosal HPV types are commercially available.12

Table - I
Differential diagnosis:

44
  SINGLE LESIONS  MULTIPLE 
LESIONS 
  Consider  Consider 
  Verruca vulgaris  Arsenical keratosis
Palms and soles  Callus, corn  Verruca vulgaris 
  Epidermal  Plamnoplantar 
inclusion cyst  keratoderma 
  Pyogenic  Psoriasis, reactive 
granuloma  arthritis.  
  Milkers nodules  Pits in basal cell 
(Palms)  nevus syndrome. 
  Orf (palms)   
     
  Rule out   Rule out 
  Amelanotic  Secondary syphilis 
acrolentiginous 
melanoma 
  Carcinoma   
cuniculatum 
     
Dorsum of hands  Consider   Consider  
and feet 
  Verruca vulgaris  Verruca vulgaris 
  Periungual  Verruca planae 
warts 
  Actinic keratosis  Actinic keratosis 
    Acrokeratosis 
verruciformes 
  Rule out   Epidermolytic 
hyperkeratosis 
  Squamous cell  Stucco keratosis 

45
carcinoma 
  Keratocanthoma  
  Tuberculosis   
verrucosa cutis 
  Fish tank   
granuloma 
     
Differential     
Diagnosis of Plane 
Warts 
FACE  HAND  TRUNK, 
EXTREMITIES 
Perioral dermatitis  Acrokeratosis  Epidermodysplasia 
verruciformis  verruciformis 
Adenoma  Lichen planus  Pityriasis 
sebaceum(mild)  versicolor 
Syringoma   Stucco keratosis  Superficial actinic 
poeokeratosis 
Flat seborrheic  Seborrheic  Seborrheic 
keratosis  keratosis  keratosis 
Actinic keratosis     
Trichoepitheliomas    
     
Differential     
Diagnosis of 
Genital warts 
  FLAT OR  NODULAR 
PAPULAR 
  Consider   Consider 
  Condylomata  Nevi 
acuminate 
  Bowenoid  Sebborrheic 

46
papulosis  keratosis 
  Sebaceous  Angiokeratoma 
glands  
  Pearly penile  Skin tags 
papules  
  Lichen planus   
  Lichen sclerosus   
et atrophicus 
    Rule out  
  Rule out   sSquamous cell 
carcinoma 
  Erythroplasia  Amelanotic 
melanoma 
  Extramammary   
  Paget’s disease   
  Condylomata   
lata of 
secondary 
syphilis.11

Complication:

ƒ Although most papilloma viruses are limited to causation of benign


lesions, but epidemiological and experimental studies document that
specific papilloma viruses genotypes have oncogenic potential.
ƒ The benign but locally obstructive verrucae in respiratory
papillomatosis, if they are treated by X-rays, often progresses to invasive
SEC.
These observations suggest that oncogenic papilloma viruses do not
induce malignant tumors directly but predisposes the infected cell to
tolerate genetic damage that, together with viral oncogenes contributes to
the malignant state.13

47
Treatment:

Cryotherapy using liquid nitrogen applied with a cotton tip.


Warts may be curetted or surgically excised.
Laser treatment.
Chemotherapeutic agents are commonly used to treat warts. 11

Prevention:

For non-genital warts, no approaches have been documented to prevent


transmission, although direct exposures to lesions or through fomites that
contain virus represent likely sources of infection.11

Homoeopathic review

Viral Infections of the Skin: Warts are noncancerous skin growths


caused by the papillomavirus. Warts are more common in children,
although they can develop at any age. Warts can spread to other parts of
the body and from person-to-person, there are many different types and
sizes of warts, due to many different papilloma virus types .
Common types of warts: The following are some of the more
common types of warts:

48
Common warts; growths around nails and the back of hands;
usually have a rough surface; grayish-yellow or brown in color.
Foot warts: Flat growths on the soles of feet (plantar warts) with
black dots (blood vessels feeding them); clusters of plantar warts are called
mosaic warts and may be extremely painful.
Flat warts: Small, smooth growths that grow in groups of 20 to 100
at a tune; most often appear on children’s faces.
Genital warts: Grow on the genitals, are sexually transmitted; are
soft and do not have a rough surface like other common warts.

Filiform warts: Long, narrow, small growths that usually appear on


the eyelids, face, neck, or lips.20

Kent.J. T. says that Psora is the cause of all contagion. The


majority of the cases of Gonorrhea are acute, that is there is period of
prodrome, a period of progress and period of decline, being thus in
accordance with the acute miasm. The acute really and truly be called a
gonorrhea, because about all these is of it is this discharges23

Close Stuart says that Into this wilderness of conflicting names,


theories and classifications Hahnemann began to blaze his way, guided by
the compass of logic encased in the inductive method of Bacon. His search
was now directed to the discovery of the fundamental causes of the
non-venereal diseases. Having found that so large a number of symptoms
and diseases had a venereal origin in syphilis and sycosis, it occurred to
him that it might be possible to find a common, general or primary
cause for all, or at least a great part of the remaining symptoms of disease,
and thus to make a final generalization.

To this end he directed his efforts. Rejecting existing


classifications; searching, collecting, comparing, grouping similar and
naturally related symptoms in the light of history, logic and experience;
tracing the relations between similar diseases and their antecedents, and
tracing recognized proximate causes to their antecedent causes as far back
49
as possible, he gradually narrowed the field of general causation until
he arrived at one primary cause, which accounted for an explained the
greater part, if not all of the phenomena with which he was working.

Hahnemann's keen mind had detected its relation to many evil


consequences following the suppression of the primary discharge by local
treatment. He had also observed the evils arising from the topical and
mechanical treatment of the anomalous venereal condition variously
known as Sycosis, or the "fig wart disease," condylomata, ficus marisca,
atrices and warts. (London Medical Dictionary, 1819.)

Condylomata were not regarded as having any connection with the


large number of peculiar constitutional symptoms which are present in
many cases. Hahnemann made extensive researches in the phenomena
presenting in such cases and came to the conclusion, first, that they
constituted a definite and distinct infectious, constitutional venereal
disease, clearly distinguishable from syphilis on the one hand, and the
simple, non-specific urethritis on the other; and second, that it was due to
the presence of specific, living micro-organisms.
To this newly recognized pathological form he applied the
generic name Sycosis, using the Greek term commonly employed in
his day to designate the typical physical manifestation, the
"figwart."24
Allen J. H. says that, there are many ways by which the life force
might be disturbed that would bring forth an abnormal growth, such as a
suppression of a discharge, injury to a part, suppression of disease states,
such as eruptive diseases, pain ulcerations or any marked disease process.
Any stasis of disease or miasmatic suppression may produce an abnormal
growth.
When a miasm is acting along certain lines, say in a chronic or sub
acute state, producing simple external expressions, as popular eruptions,
warts and such like, the system is through these simple mediums
eliminating from itself all that is necessary of the effects of miasmatic
poison.
50
The more profound the suppression the greater and deeper the new
manifestation or new process. So without this knowledge hits with some
specific remedy, or some suppressive ceasure every inhibitory point that
manifests itself, thus cutting off all avenues of elimination of the disease .
it is in this way abnormal growths develops.18

Roberts H. A. says that, Sycosis is generally understood to be the


gonorrheal poison. We should make the distinction clear between
gonorrhea and sycosis. Gonorrhea is the acute infection of the gonococci,
which takes from five to ten days to develop a urethritis after an exposure.
During this incubation period it is purely an infection; then the local
manifestations are thrown outward by Nature at the point of attack as a
resentment of the vital energy to the infection. If the gonorrhea is
thoroughly and completely cured, practically no sycosis ever develops.

Sycosis is established after a suppressed gonorrhea, when the acute


infection is driven in upon the vital energy by external methods of
suppression, and it then becomes a systematic stigma, permeating every
living cell of the organism, and transmitting its deadly destructive forces to
the offspring as well as retaining the full destructiveness of its power in
the original individual, and impregnating the mother of the child.

The suppressed gonorrheal infection is very apt to first show itself


in attacking the blood and producing an anaemic condition, and a general
catarrhal condition is set up. These are the symptoms that are first
produced after a suppression, showing that the whole organism is involved
and in the grip of this destructive force.
When some external manifestation occurs, such as a catarrhal
condition, a leucorrhoea, or even the return of the menstrual period, there
is a general amelioration of the mental condition. The mental condition
may be much ameliorated when warts or fibrous growths appear; they are
always ameliorated in general from the return or breaking open of old
ulcers or old sores, and markedly ameliorated by the return of acute
gonorrheal manifestations.
51
Sycosis never gives a true ulcer; the sycotic manifestations are
more overgrowth of tissue than destructive of tissue. There are many warts
and warty growths these are sycotic sign posts.19

Kent J.T. says that, we know in sycosis , which is a constitutional


miasm, that we have venereal warts or gonorrheal warts; that we have
another sycotic state that comes upon the female in cauliflower
excrescences. They are all due to one cause, and some day this cause will
be demonstrated to be latent sycosis. Gonorrhea will someday be known to
be the true offspring of this sycosis. It is the contagious part of the
sycosis. It is the means by which the disease is handed from generation to
generation.

Now, I say that gonorrhea and all of these latent conditions of the
body are one and the same thing; that primarily they date back to one and
the same source of course, the books will tell you that gonorrhea will
produce warts, and gonorrheal rheumatism, and will last throughout life,
and children be brought into the world with the same disease. Symptoms
of a latent gonorrhea are unknown to the books. you will find nothing of it.

It is only known to such observers as have been able to make two


out of two times one-by putting things together. By and by I shall have a
complete chain of evidence to show that gonorrhea is a constitutional
disease and can be handed down from father to son, as can syphilis. It is
one of the chronic miasms, and is one that very little is known about. If
this be true, it is as dangerous to suppress as syphilitic chancre before its
time. You will never know if you go on treating these constitutional
Miasms by suppressing the primary manifestations-you will never
know the harm you are doing. I have observed this, that there are two
kinds of gonorrhea –one is a simple urethral discharge, which, when
stopped by injection, will not produce a constitutional taint, because that is
not a sycosis, and the other form is the sycotic gonorrhea, which, if
suppressed with injections, will appear in constitutional symptoms.22
52
Aphorism 79 says, Sycosis (the condylomatous diseases), equally
ineradicable by the vital force without proper medicinal treatmint, was not
recognized as a chronic masmatic disease of a peculiar character, which it
nevertheless undoubtedly is, and physicians imagined they had cured it
when they had destroyed the growths upon the skin, but the persisting
dyscrasia occasioned by it escaped their observation.26

Causes of warts

Fundamental cause (5, 72, 78, 80, 204, 206)

Sarkar B. K. says that, Aphorism. 5 .tells that Useful to the


physician in assisting him to cure are the particulars of the most probable
exciting cause of the acute disease, as also the most significant points in
the whole history of the chronic disease, to enable him to discover the
fundamental cause, which is generally due to a chronic miasm.
In these investigations, the ascertainable physical constitution of
the patient, his moral and intellectual character, his occupation, mode of
living and habits, his social and domestic relations, his age, sexual
function,& c., are to be taken into consideration.

Aphorism 72.tells that among chronic diseases , artificially


produced in allopathic treatment by the prolonged use of violent heroic
medicines in large and increasing doses, by the abuse of mercurial
ointment, nitrate of silver, iodine, and its ointment& c. whereby the vital
force is sometimes weakened to an unmerciful extent, sometimes, if it do
not succumb, gradually abnormally deranged in such a way that, in order
to maintain life against these inimical and destructive attacks, it must
produce a revolution in the organism and either deprive some part of its
irritability and sensibility, or exalt these to an excessive degree, cause
faulty organic alteration in the interior or the exterior.

53
Aphorism 78 the true natural chronic diseases are those that arise
from a chronic miasm which when left to themselves, and unchecked by
the employment of those remedies that are specific for them always go on
increasing and growing worse notwithstanding the best mental and
corporeal regimen, and torment the patient to the end of his life with ever
aggravated sufferings.27

Aphorism. 79 tells that sycosis (the condylomatous disease),


equally ineradicable by the vital force without proper medicinal treatment,
was not recognized as a chronic miasmatic disease of a peculiar character,
which it nevertheless undoubtedly is, and physicians imagined they had
cured it when they had destroyed the growths upon the skin, but the
persisting dyscrasia occasioned by it escaped their observation.

Aphorism 80 tells that Incalculably greater and more important


than the two chronic miasms just named, however, is the chronic miasm of
psora, which, while those two reveal their specific internal dyscrasia, the
one by the venereal chancre, the other by the cauliflower-like growths,
does also, after the completion of the internal infection of the whole
organism, announce by a peculiar coetaneous eruption, sometimes
consisting only of a few vesicles accompanied by intolerable voluptuous
tickling itching (and a peculiar odor), the monstrous internal chronic
miasm - the psora, the only real fundamental cause and producer of all the
other numerous, I may say innumerable, forms of disease1,

Aphorism. 204 most the remainder of chronic diseases result from


the development of these three chronic miasms, internal syphilis, internal
sycosis, but chiefly and in infinitely greater proportion, internal psora,
each of which was already in possession of the whole organism, and had
penetrated it in all directions before the appearance of the primary,
vicarious local symptom of each of them (in the case of psora the scabious
eruption, in syphilis the chancre or the bubo, and in sycosis the
condylomata) that prevented their outburst; and these chronic miasmatic
diseases, if deprived of their local symptom, are inevitably destined by
mighty Nature sooner or later to become developed and to burst forth, and
54
thereby propagate all the nameless misery, the incredible number of
chronic diseases which have plagued mankind for hundreds and thousands
of years,

Aphorism 206 Before commencing the treatment of a chronic


disease, it is necessary to make the most careful investigation1 as to
whether the patient has had a venereal infection (or an infection with
condylomatous gonorrhoea); for then the treatment must be directed
towards this alone, when only the signs of syphilis (or of the rarer
condylomatous disease) are present, but this disease is very seldom met
with alone nowadays.

If such infection have previously occurred, this must also be borne


in mind in the treatment of those cases in which psora is present, because
in them the latter is complicated with the former, as is always the case
when the symptoms are not those of pure syphilis; for when the physician
thinks he has a case of old venereal disease before him, he has always, or
almost always, to treat a syphilitic affection accompanied mostly by
(complicated with) psora, for the internal itch dyscrasia (the psora) is far
the most frequent fundamental cause of chronic diseases.

At times, both miasms may be complicated also with sycosis in


chronically diseased organisms, or, as is much more frequently the case,
psora is the sole fundamental cause of all other chronic maladies.26

Ghatak says that : It is that acquired condition which is now


inherent in human life force and which gives that life-force the tendency
for disease.28

Close Stuart says that Life : Life is the incisibe, substantial,


intelligent, individual, so-ordinating power ans cause directing and
controlling the forces involved in the production and activituy of any
organism possessing individuality

Health : health is that balanced condition of the living organismin


which the integral, harmonious performance of the vital functions teends
55
to the presergation of the organism and and the normal development of the
individual.

Disease: disease is an abnormal vital process, a changed condition


of life , which is inimical to the true development of the individual and
tends to organic dissolution.24

Totality of symptoms.

Kent J. T. says that the removal of the totality of the symptoms is


actually the removal of the cause. It may not be known that causes are
continued into effects but it is true that all ultimates to a great extent
contain the cause of the beginnings. And since cause continues into
ultimates and things in ultimates shadow forth cause, the removal of all the
symptoms will lead any rational man to assume that the cause has been
removed.

Hahnemann as to the cure of disease, which means permanent


removal of the totality of the symptoms, thus removing the cause and
turning disorder into order, and as a consequence the results of disease are
removed. The totality cannot be removed without removing the cause.

But when the disease is annihilated the health is restored ; and this
is the highest, the sole aim of the physician who knows the true object of
his mission, which consists not in learned sounding prating but in giving
aid to the sick.

The totality of the symptoms means a good deal. it is all that is


visible and represents the disease in the natural world to the eye, the touch
and external understanding of man. It is all that enables the physician to
individualize between diseases and between remedies.23

Individualization.

Kent J. T. says that the substitution of one remedy or another


cannot be thought of, or entertained in homoeopathy. Without the generals

56
of a case no man can practice homoeopathy, for without these no man can
individualize and see distinctions. After gathering all the particulars, one
strong general rules out one remedy and rules in another.

Each medicine produces particular effects in the body of man, and


no other medicinal substance can create any that are precisely similar.23

Concept of cause and effect (relation)

Close Stuart says that in considering the succession of two


different states of the same living body, such as health and disease, the law
of causation teaches that no internal effect can arise without an external
cause, and that the effect itself may in turn become a cause of further
changes.

The law of vis inertia teaches that all internal changes of bodies in
nature are the results of an external cause, for without 'this all bodies
would remain in the same state in which they were placed. The state of the
body must be known before any change in it can be known. The cause or
reasons of the state of the body, therefore, are the conditions under which
it can be changed by any external cause.

In Medical science and especially in therapeutics, rigid


discrimination must be made between the two relations of state and
changes according to these two laws (causation and vis inertiae) since the
action of the curative agents introduced into the body as external causes,
for the purpose of changing a state of disease into a state of health, can
only be determined by paying due regard to the conditions of age, sex,
constitution, predisposition, etc., as manifested by symptoms or
phenomena.24

B.K. Sarkar says that According to Hahnemann, the perceptible


pathological changes in the body are neithet the exciting or maintaining

57
causes of disease but they are the end- results of the morbid vital process,
which is disease perse.
The disease process is manifested primarily by “dynamic
alterations of the sensations and functions of our organism.27

Dhawale M. L. says that “Remove the effects and you remove the
disease, the cause of the effects”. Cessat effectus cessat causa. Empiric
medicine guesses, recommends, tries, hits and misses misses and hits
again. Scientific medicine like any other scientific art compares effects,
sensation and motion with corresponding effects, corresponding sensations
and motions.
It has Hahnemann, who paid sufficient attention, in considering the
cause of disease, to both the:
a. Soil or constitution of the patient and 

b. The seed such as germs or worms as we know it now, but


which was designed by him as ‘miasms’, acute and chronic. With his keen
analytical mind, phenomenal intuition, logic and reasoning powers, shook
off the crude materialistic idea regarding miasms as he perceived the
spiritual dynamic character of the vital principle.

Useful to the physician in assisting him to cure do the particulars of


the most pronanle exist cause of disease, as also the most significant points
in the whole history of the chronic disease, to enable him to discover its
fundamental cause, which is generally due to a chronic miasm.25

Concept of susceptibility.

Hahnemann says that “ the inimical forces, partly physical, to


which our terrestrial existence is exposed, which are termed morbific
noxious agents, do not possess the power of morbidity deranging the
health of man unconditionally; but we are made ill by them only when our
organism is sufficiently disposed and susceptible to the attack of the
58
morbific cause that may be present, and to the altered in its health,
deranged and made to undergo abnormal sensation and functions hence
they do not produce disease in every one nor at all times.26

Dhawale says : “Susceptibility is an inherent capacity in all living


things to react to stimuli in the environment and represents a fundamental
quality that distinguishes the living from the non-living.”
”Digestion, assimilation, repair, excretion, metabolism and
catabolism as well as disease process arising from contagion depend upon
the power of the organism to react to specific stimuli.”25

ROBERTS H.A.says “Susceptibility primarily as the reaction of


the organism to external and internal influences.”

Susceptibility varies in degree in different patients, and at different


times in the same patients. A homoeopathic application of a remedy is an
illustration of meeting the susceptibility and filling the vacuum that is
present in the sick individual.

Human beings are susceptible to infection and contagion in varying


degrees. Pne man will become infected in contact with diseased
individuals while another will experience no ill ffects whatever.
One person is made ill ny noxious plants while another man can
handle the with impunity. Certain people are capable of making a
wonderful proving of a drug, whereas others will show no reaction
whatever.
Contagious diseases thrive in childhood because of the extreme
susceptibility of the miasmatic influence; this susceptibility has an
attractive force which draws to itself the disease which is on the same
plane of vibration and which tends to correct this miasmatic deficiency.19

59
CLOSE STAURT ; “Susceptibility we mean the the general
quality or capability of living organism of receiving impressions: the
power to react to stimuli.”
It is well-known fact that the living organism is much more
susceptible to homogeneous or similar stimuli than to heterogeneous or
dissimilar stimuli.24

KENT. J. T . In contagion (and consequently in cure)there is


practically but one dose administered, or at least that which is sufficient to
cause a suspension of influx. When cause ceases to flow in a particular
direction it is because resistance is offered for causes flow only in the
direction of least resistance and so when resistance appears influx ceases,
the cause no longer flows in.
Now in the beginning of disease, i.e., in the stage of contagion,
there is this limit to influx, for if man continued to receive the cause of
disease (if there were no limits to its influx)he would receive enough to
kill him, for it would run a continuous course until death.
But when susceptibility is satisfied, there is a cessation of cause,
and when cause ceases to flow into ultimate, not only do the ultimate cease
but cause itself has already ceased.23

Susceptibility and health:

DHAWALE says :An organism in perfect balance represents


health. This fine balance, even in the presence of adverse environmental
factor, is a resultant of different processes that are going on within and
which maintain the optimum condition. This fine regulation is feasible
only as long as a predetermined response follows a given stimulus. This is
possible only when a cell –the unit of life- exhibits what we call normal
susceptibility.

60
Normal susceptibility leads to a state of good health characterized
by good nutrition and a healthy outlook on life. Abnormal susceptibility,
on the other hand, affect them in the first instances and interferes with the
process of adaptation and there by leads to development of disease. The
normal susceptibility may be increased, decreased or exaggerated in the
disease.

Susceptibility and cure


Restoration to normal susceptibility, therefore, is a prerequisite to
cure. This is done by satisfying the susceptibility by the similimum.
The law of direction of cure was discovered by Hering on the basis
of his experience during treatment of chronic cases, the direction of cure
takes place from above downwards, from within outwards’ more important
to less important organ, in the reverse order of their coming.25

Pathological concept in homoeopathy

Kent. J.T. The derangement of the immaterial vital principle is the


very beginning of the disorder, and that with this beginning there are
changes in sensation by which man may know this beginning, which
occurs long before there is any visible change in the material substance of
the body.23
Table - II

Miasmatic evaluation of warts.


Banerjee S. K. writes as follows:

Psoric Sycotic skin Syphilitic Tubercular


skin skin skin
Itching Warty excrescences: Ulcer and Urticarea and herpes.
without which come out after putrefaction of all
pus or vaccinations. Moles, tissues but devoid of
discharge. warts, uine coloured pain and itching
patches and other .eruptions slow to

61
manifestations of heal are psora-
unnaturally thickened syphilitic stitch
skin abscess

Sensation Herpes, erysipelas, all Leprosy in which Recurrent and


of burning, sorts of warts and liquefaction has obstinate boils with
scaly excrescences, barber’s already started (is profuse pus and
eruptions itch. Skin eruptions tubercular) but fever, which heal
and occur in circumscribed syphilis is with difficulty.
tendency of spots, exfoliating predominating.
recurring eczemas. The fish
skin scale eruptions are tri-
diseases . miasmatic.

Warts in face, Nails: Irregular, thick, Nails : spoon shaped Leprosy.


arms, and pale. Stitching pains and paper like thin
hands. and sensitiveness. nails with binding,
Recurrent Panaritium. tearing easily.
small boils. Thick, ridgy and Whitlow are psora-
corrugated. Nails syphilitic as are the
ridged or ribbed other periosteal
inflammations.29

62
(

63
Phyllis Speight writes as follows:
psora Pseudo-psora syphisis sycosis
Eczema-papular Emzempustule.
eruptions. Herpes. Syphlis Sycosis
Urticaria Condylomata will Warts and warty
Anidrosis. Hyperidrosis and reveal the presence of growths.
Psoriasis variola Bromidrosis. both Skin lesions in
have a syco- Anidrosis. SYPHILIS and tertiary stage, warty
psoric nase. Abscess and ulcers. SYCOSIS, also eruptions or
Freckles. verruca accuminata, Growths-verruca
Fine, smooth, clear Pointed papillary filiformis, verruca
skin. growths, coxcomb and vulgaris, verruca
Goose flesh. warts. plana.
Verruca vulgaris
Abscess and found in children,
ulcerations after suffer from
injuries. Bee or bug hereditary SYCOSIS.
affect these patients Verruca filiformis
badly. comes as a tertiary
Impetigo. lesion in an acquired
The patients often form ofSYCOSIS.
have benign or Verruca plana is
malignant tumours. another hereditary
form, found more or
In tubercular and less upon the backs
syphilitic patients we of hands and faces of
see much scarring and children and young
increase in cicatricial people.
tissue. The filiformis
Leprosy. appears in adults
Th the lymphatic with acquired
temperamint we see SYCOSIS who have
the malignancies –we had it suppressed.

64
find here rich soil for Usually appear on
gonorrhea and sexual organs, trunk
syphilis. The of body-small in
tubercular patients we diameter, one-eighth
have so much of an inch long, often
difficulty in shorter, brownish or
eradicating acquered grayish, pointed with
syphilis or gonorrhea. spindle- like
attachments.
Gonorrhea runs to
gleety discharge and
strictrres, pockets and
metastasis forms, or
we have metastasis to
ovaries, broad
ligaments, tubes,
uterus, rectum and all
such complications. 30

65
Evaluation of warts:
Miasm is a dynamic energy, which cannot be seen, maism is
hostile to the life preserving vital force. It is dynamic, as it affects the
dynamic plane and there by dynamically deranges the life preserving
energy of any living creature. The basic pre-condition of a miasmatic
infection is susceptibility. After entering in the body, it tends to join the
fundamental miasm already existing in the body.
There is ample evidence both in the literature of allopathy as well
as homoeopathy, which says that the skin disorders are nothing but
expression of disturbances in the internal dynamics. The cause for this
disturbance is invariably a miasm, as it had been put-forth by Hahnemann
in ‘Chronic Diseases.37

Psoric warts:
Speight Phyllis says about psoric skin, the skin is dry, rough, dirty
or unhealthy looking as an uneasy appearance, very little suppuration in
psoric skin.30
Benerjea S. K. says :dirty, dry, harsh skin itching without pus or
discharge, sensation of burning, scaly eruptions and tendency of recurring
skin diseases. He writes warts in face, arms, and hands comes under psoric
miasm.29

Patel Raman lal:All coetaneous warts comes under psoric miasm,


examples Warts, bleeding; Warts, brown; Warts, dry; Warts, flat; etc.,31

Kent J.T.writes :Psora is the cause of all contagion. The majority


of the cases of Gonorrhea are acute, that is there is period of prodrome, a
period of progress and period of decline, being thus in accordance with the
acute miasm. The acute really and truly be called a gonorrhea, because
about all these is of it is this discharge.23

66
Robert H. A.says Gonorrhea is the acute infection of the
gonococci which takes from 5-10 days to develop a urethritis after and
exposure, during this incubation period it is purely an infection; then the
local manifestations are thrown outward by nature at the point of attack as
a resentment of vital energy to the infection. If the gonorrhea thoroughly
and completely cured, practically no psychosis ever develops. Psychosis is
established after a suppressed gonorrhea. When acute infection is driven in
upon vital energy by external methods of suppressions.19

Close Staurts writes :The discovery of the fundamental causes of


nonveneral diseases. Having found that so large a number symptoms and
diseases and had a veneral origin in syphilis and sycosis, it occur to him
that it might be possible to find a common general or primary cause for all.
And thus make a final generalization. Gonorrhea as a constitutional
disease was but little known, but Hahnemann’s keen mind had detected its
relations to many evil consequences following the suppression of the
primary discharge by local treatment.24

Hahnemann’s theory from the stand point of bacteriology


pointed out, first, that we have inherited from preceding generations, a
false and misleading interpretation of what Hahnemann really thought in
regard to psora as the cause of chronic non venereal disease.26
sycosis:

Banerjea S. K.writes In psychotic disease the skin shows scaly,


patchy and in circumscribed spots. There is a warts and warty growths skin
lesion in tertiary stage shows warty eruptions or growths --- Verruca
filiformis, Verruca vulgaris, Verruca plana. Verruca vulgaris found in
children suffer from hereditary psychosis. Verruca filiformis comes as
tertiary lesions in an acquired form of psychosis. Verruca plans is another
hereditary form found more or less upon the backs of hands and faces of
children and young people. The filiformis appears in adults with acquired
psychosis who have had it suppressed.

67
Syphylis:

Condylomata or veneral warts will reveal the presence of both syphilis and
psychosis also Verruca acuminate, pointed papillary growths, Cox comb.
And also gangrene or gangrenous spots could be tubercular and in dry
gangrene syphilis is always present.
Psychosis the miasm which we put in second place was well
recognized by Hahnemann for its characteristic production of
neoformation with dented or pedunculated growth resembling figs.25

Management of warts:

No role of local application.

Roberts H. A. Local manifestations were but an outward


expression of the inward and spiritual force, which when disturbed
expressed itself in external signs; that if these external manifestations were
removed by local treatment, that disease was not cured, but driven into
some more centrally located organ, there to express itself in some graver
form.

It is neither beneficial in acute local diseases or rapid growth nor in


those of long standing, to use a remedy externally as local application to
the diseased part, even if the medicines were specific and purity in that
form.

External application is entirely objectionable, not only in local


affection dependent on psora, but also in local symptoms arising from
syphilis and from psychosis, because the local application of a medicine,
simultaneously with its internal use, results in great disadvantages.19

68
Sarkar B.K. writes : Removal of local symptoms of local affection
by tropical administration of unhomoeopathic external remedies leads to
rousing up of the internal disease and other symptoms that previously
existed in a latent stage side by side with the local application.27

Homoeopathic Therapeutics:
Kent’s Repertory enumerates 92 Homoeopathic remedies in the
chapter on Skin under Rubrics and sub-rubrics of ‘Excrescences’ and
‘Warts’, which display a spectrum reflecting all the three miasms.21

Anacardium : Warts are present on hands, especially dorsum and


eyebrows, there is sensation of intense itching in the warts which is worst
on scratching.

Causticum: Warts are present on nose eyebrows, face, lips, near


the nail, tips of fingers, upper limbs. They are large, horny, broad, fat and
hard, moist and pedunculated, they tend to bleed easily.

Dulcamara: Warts are present on face, hands, fingers, close to the


nails,:the warts are smooth, hard.

Lycopodium: Lycopodium has two types of warts, first isolated


warts and second warts in crops. Warts are situated especially on face,
upper limb, and fingers and they are associated with terrible itching. They
are large and pedunculated.33

Causticum: Old warts on nose and eyebrows, on face, nails and


fleshy tips of fingers.

Sepia: Horny excrescences in centre: Small, flat, hard and itching


warts on hands and face.

69
Thuja: Broad, conical warts easily splitting from their age on their
surface.34

Dulcamara: Warts on face and hands, smooth, sometimes nearly


transparent, coming in crop.

Sepia: Horny excertions in center: Small, flat, hard and itching


warts on hands and face.

Thuja: Broad, conical warts easily splitting from their edge and on
their surface. 35

Thuja: It is often situated to old cases of pneumonia, in such


individuals as have suppressed gonorohhea, fig wart gonorhhea.36

70
METHODOLOGY

This clinical study was undertaken at H.K.E. Society’s


Homoeopathic Medical College & Hospital, Gulbarga, from 01.10.2009 to
30.11 2011. .

Patients attending the following OPD’s and admitted in the


IPD of H.K.E. Society’s Homoeopathic Medical College & Hospital,
Gulbarga, were taken up for the study.

1) HKES Homoeopathic Medical College and Hospital, Gulbarga.


2) Govt. Homeopathic & Ayurvedic Hospital, Near Tirandaz
Theatre, Gulbarga.
3) HKES Sangameshwar Homeopathic OPD Near Bus stand
Gulbarga.
4) Homeopathic MayaMandir OPD, Near Prakash Theatre,
Gulbarga
5) Homeopathic OPD Gunj, Gulbarga.
6) Rural Homeopathic OPDs (6)
7) HKES Homeopathic OPD Gazipur, Gulbarga.
Thirty warts patients chosen by simple random sampling technique
were studied.
The cases were recorded keeping the individualistic & Holistic
concept in mind. The data was collected by interrogation & physical
examination of the patient.
Case taking was done according to the Case Proforma in
Annexure-I with special emphasis to ascertain the following points.

1. Preliminary data: The names, age, sex, religion,


occupation, address, socioeconomic status of the patient with date of first
consultation were recorded.

71
2. Chief complaints with duration: The chief or presenting
complaints of the patient were recorded in brief in chronological order.

3. History of presenting complaints: The complaints with


exact duration have been recorded with emphasis upon their probable
causative factor, mode of onset, modalities and concomitants.

4. Past history: The past medical history was recorded in detail


in the chronological order with nature of treatment taken. Past medical
history was recorded mainly to understand the miasmatic background,
suppressions, factors responsible for warts, and other relevant details. In
the childhood disorders, eczema, allergy, nutritional deficiency, tonsillitis,
meningitis, primary complex, cauterization, external application any other
ENT diseases and other respiratory disorders were emphasized. In the
adulthood diseases, Koch’s, HTN, DM, any respiratory diseases, allergies,
any surgery, trauma to head, immune deficiency syndrome, malignancies,
dental infections were enquired.

5. Family history: Detailed family history was recorded to


know the hereditary tendencies. History of Gonorrhea, TB, allergies, DM,
ENT diseases, malignancy in the family was stressed.

6. Personal history: All the generalities of the patient were


recorded with special reference to constitution, relation with heat and cold,
desires and aversions, thirst, bowel, appetite, etc. and more importantly
history of occupational exposure to dust, pollen or dust was enquired.
Mental state of the patient was also recorded.

7. Life space investigation: Life space of the patient was


studied in detail. The order of birth, parent’s occupation, financial status
of parents, childhood life including childhood illnesses and
maladjustments, primary school life, high school life, college life,
employment, marital life, major illnesses during adolescence, setback in
life, and other relevant information were noted.
72
8. General physical examination: The positive findings of the
built, nourishment and vital data were recorded.

9. Local examination: The warts were examined to


differentiate different types of warts.

10. Systemic examination: systemic examination of skin was


done.

11. Laboratory investigations:


a) Punch biopsy

12. Probable diagnosis:


1).The clinical appearance and history of acquired, slowly
enlarging papules usually lead to the diagnosis of viral wart
2).. Histologic examination can be used to confirm the diagnosis.
3). Immunohistochemical detection can be used to detect these
capsid proteins in clinical materials,
4).PCR (polymerase chain reaction) techniques detect coetaneous
warts.

13. Homoeopathic management:

The following steps were followed for homoeopathic prescription.


i. Analysis and evaluation: After detailed case taking, the
symptoms of the patient were grouped into various categories like mental
generals, physical generals and particulars. After analysis, the symptoms
were evaluated according to the order of their importance like mental
general I grade, II grade, III grade, and particular I grade, II grade and III
grade.

73
ii. Repertorization: The symptoms were then taken for
repertorization and were repertorized according to raman lal patel, J. T.
Kent repertories.

iii. Miasmatic Diagnosis: Was done from the family history, past
medical history of the patient, and by miasmatic repertorization using
Ramanlal Patel’s ‘Repertory of Miasms’,Subrata Kumar Banerjea’s
miasmatic diagnosis and Phyllis speight’s a comparison of the Chronic
Miasms.

iv. Selection of the remedy: The selection of the remedy was done
based upon Constitution, Causation, Suppressions, and PQRS/Keynote
symptoms of the patient.

vi. Constitutional remedy: Constitutional remedy was selected


from the totality of the characteristic symptoms of the patient i.e., mental
generals, physical generals and characteristic particulars keeping in mind
and the miasmatic background.

vii. Dosage:
Indicated medicine was prescribed in the 200th potency initially, it
was repeated in plus potency when there was no further improvement or
when there was a relapse of symptoms. Higher potencies were considered
when the lower potencies failed to give relief.
b. Auxillary measures:

• Do not use other’s towel


• Take balanced and nutritional diet

14. Follow up: All cases were reviewed once in 7/15 days and
on as needed basis over a period of six months.

15. Parameters:

74
The following parameters were fixed according to the type of
response obtained after the treatment.

• Recovered: Patients showed general wellbeing and


complete relief of symptoms.
• Improved: Feeling of general wellbeing with slight
improvement in the intensity of the symptoms.
• Not improved: No response even after a sufficient period of
treatment.

75
RESULTS

The data obtained from the observation in the treatment is as


follows. The study showed maximum incidence in 10-19age group in 14
cases i.e (46.66). 10 Cases (33.33%) in 20-29 year age group, where as 06
cases (20%) in 0 – 9 year age group.
The data obtained from the observation in the treatment. The
incidence of sex showed the maximum incidence in female sex group is 19
i. e. (63.33%)., Male sex group is 11 i.e. 36.66%.
Out of 30 cases, 06 cases (20.00 %%) gave past history of
cauterization, 04 cases (13.33%) gave past history of vaccination, 04 cases
(13.33%) gave past history of eruptions. And 04 cases (13.33%) gave a
past history of chemical application.

Out of 30 cases, 04 cases (13.33 %) gave a family history of


diabetic mellitus, 04 cases (13.33%) gave a family history of
Hypertension, 03 cases (10.00%) gave a family history of Gonorrohea, 03
cases (10.00%) gave a family history of Tuberculosis and 03 cases
(10.00%) gave a family history of Osteoarthritis.

30 cases presented with different types of warts.18 cases i.e. (60%)


showed common warts. 4 cases i.e. (13.33%) showed flat warts. 01 cases i.
e. (3.33 %).Showed filliform warts. 7 cases i. e. (23.33%)showed plantar
warts.

Psoro sycotic miasmatic background shows the highest incidence


in 27 cases (90%) and psoric miasmatic background in 3 cases (10%).

The constitutional remedies were indicated in 30 cases. Thuja in 5


cases (!6.66%), Antimoniuc crudum in 3 cases (10.00%), Dulcamara in 6
cases (20.00%), Causticum in 5 cases (16.66%), Sepia in 2 cases (6.66%),

76
Calcara carb in 3 cases (10.00%), Lycopodium in 3 cases (10.%), Nitric
acid in 3 case (3.33%),

Lastly the observation of results is as follows, The outcome of this


study was that out of 30 cases, 14 cases (46.66%) recovered, 9 cases
(30%) showed improvement and 7 cases (23.33%) did not show
improvement.

77
Table – III

Table showing incidence in age groups

Sl.No. Age Group Total No. of Cases Percentage


(In years)

1. 0-9 6 20%

2. 10-19 14 46.66%

3. 20-29 10 33.33%

The above table shows the incidence in age groups. The study showed
maximum incidence in age group i.e. 14 cases (46.66%) in 10-19 year age group,
where as 10 cases (33.33%) in 20-29 year age group and 6 cases (20%) in 0-9 year
age group.
Chart showing incidence in age groups

78
Table – IV
Table showing sex incidence in the treatment

Sl.No. sex incidence Total No. of Cases Percentage

1. Male 11 36.66%

Female
2. 19 63.33%

Total 30 100%

79
The above table shows the incidence of sex taken in this study, Out of 30
cases, 19 cases (63.33%) have female sex and 11 cases (36.66%) have male sex.

Table – V
Table showing the past history of the patients

Sl.No. Past History Total No. of Cases Percentage

1. Cauterization 06 20.00%

2. vaccination 04 13.33%

3. Eruptions 04 13.33%

4. Chemical application 04 13.33%

The above table shows the past history of the patients. In this study, Out of 30
cases, 6 cases (33.33%) gave past history of Cauterization. 4 cases (22..22%) gave
past history of vaccination, 04 cases (22.22%) gave past history of Erutions and 04
cases (22.22%) gave a past history of Chemical

80
application.

Table – VI
Table showing the family history of the patients

Sl.No. Family History Total No. of Cases Percentage

1. Diabetes Mellitus 04 13.33%

2. Hypertension 04 13.33%

3. gonorrhoea 03 10.00%

4. Tuberculosis 03 10.00%

5. Osteo arthritis 03 10.00%

81
The above table shows the family history of the patients. In this study, Out of
30 cases, 04 cases (13.33%) gave a family history of Diabetes mellitus, 04 cases
(13.33%) gave a family history of Hypertension , 03 cases (10.00%) gave a family
history of Gonorrhoea. 03cases (10.00%) gave a family history of Tuberculosis and
03 cases (10.00%) gave a family historyof Osteo arthritis.

Table VII
Table showing different types of warts
Sl no. Different types of Total no of cases percentage
warts
1 Common warts 18 60%
2 Flat warts 4 13.33%
3 Filliform warts 1 3.33%
4 Plantar warts 7 23.33%
5 Total 30 100

The above table shows the different types of warts. In this study, Out of 30 cases, 18
cases (60%) show common warts, 4 cases (13.33%) shows Flat warts , 01 cases
(3.33%) shows Filliform warts. 7cases (23.33%) shows Plantar warts.

82
Table – VIII

Table showing incidence of miasms

Sl.No. Miasms Total No. of Cases Percentage

1. Psoro - Sycotic 27 90%

2. psora 03 10%

The above table shows the incidence of miasms. In this study, miasmatic
background Psoro-Sycotic showed the highest incidence 27 cases (90%); followed by
Psora miasmatic background in 03 cases (10%).

83
Table – IX
Table showing the constitutional drugs used

Sl.No. Constitutional drugs No. of Cases Percentage


1. Thuja 05 16.66%
2. Antimonium crudum 03 10.00%
3. Dul camara 06 20.00%
4. causticum 05 16.66%
5. sepia 02 6.66%
6. Calcarea carb 03 10.00%
7. Lycopodium 03 10.00%
8. Nitric acid 03 10.00%
Total 30 100%

84
The constitutional remedies were indicated in 30 cases. Thuja in 05 cases
(16.66%), Antimoniuc crudum in 3 cases (10.00%), Dulcamara in 6 cases (20.00%),
Causticum in 5 cases (16.66%), Sepia in 2 cases (6.66%), Calcara carb in 3 cases
(10.00%), Lycopodium in 3 cases (10.00%), Nitric acid in 3 case (10.00%).

2.5

1.5
1
0.5 No. of Cases
0 Percentage

85
Table – X

Table showing results of treatment

Sl.No. Result Total No. of Cases Percentage

1. Recovered 14 46.66%

2. Improved 09 30%

3. Not Improved 07 23.33%

Total 30 100%

The above table shows the results of treatment. The outcome of this study was that out
of 30 cases, 14 cases (46.66%) recovered, 9 cases (30%) showed improvement and 7
cases (23.33%) did not show improvement.

86
Graph showing Results of Treatment

16
14
14

12

10 9

8 7

0
Recovered Improved Not Improved
Result

DISCUSSION

Warts are noncancerous skin growths caused by the


papillomavirus. Warts are more common in children, although they can
develop at any age. Warts can spread to other parts of the body and from
person-to-person, there are many different types and sizes of warts, due to
many different papillomavirus types .
Common types of warts: The following are some of the more
common types of warts:
Common warts; growths around nails and the back of
hands;usually have a rough surface; grayish-yellow or brown in color.
Foot warts:Flat growths on the soles of feet (plantar warts) with
black dots (blood vessels feeding them);clusters of plantar warts are called
mosaic warts and may be extremely painful.
Flat warts: Small, smooth growths that grow in groups of 20 to 100
at a tune; most often appear on children’s faces.
Genital warts: Grow on the genitals, are sexually transmitted; are
soft and do not have a rough surface like other common warts. Filiform

87
warts: Long, narrow, small growths that usually appear on the eyelids,
face, neck, or lips.
The subjects of the study were selected from those patients
with selected from those patients with sciatica attending the OPD and
village camps of H.K.E.’s Homoeopathic medical college Gulbarga as per
inclusion criteria.
A total of 30 cases were selected and presented in standardized
case record. All the cases were diagnosed based on the clinical history.
The result s of various observations is discussed below under
different headings.

Age incidence:
This study establishes that the incidence of warts was more
from the first decade onwards. The study showed maximum incidence in
age group i. e. cases (46.66%) in 10 – 19 year age group, where as 10
cases (33.33%) in 20-29 year age group and 06 cases (20%) in 0-9 year
age group.

Sex incidence
There is no correlation between the sex of the patient and the
incidence of Warts. In the present study, females accounted for 19 i.
e.63.33% and males accounted for 11 i.e. 36.66% each.

Past history of the patient:


In this study of 30 cases, 6 cases i.e.20.00% of the patients had
past history of Cauterization. 4 cases i.e 13.33% patient had vaccinosis. 4
cases i.e. 13.33% had Eruptions and 4 cases i.e. 13.33% had past history of
application of external agents.

Family history
It is observed in the present study 04 cases i. e.13.33 % have the
family history of diabetis mellitus, 04 cases i. e. 13.33% have the family
history of hypertension. 03 cases i.e. 10.00 % have the family history of

88
gonorrhea. 03 cases i. e. 10.00 % have the family history of tuberculosis.
03 cases i.e. 10.00% have the family history of osteoarthritis.

Miasmatic background:
According to Dr. T. P. Chatterjee,’Miasm is a sort of taint
hereditary or acquired which lies dormant in the human system but is
reactivated by circumstantial pathogens and helps to bring about
disequilibrium in vital force which in general parlance is called disease. It
acts by prolonging the disease and or by obstructing the process of cure,
even though a true Similimum has been prescribed.
In the present study, Psoro-sycotic was the predominant miasm in
maximum numbers of cases (27) i.e. 90% and followed by psoric miasm in
3 cases i. e. 10%.

Constitutional remedies.

Dr. Elizabeth wright writes Homoeopathy regards acute disease as


an eliminative explosion if handled in the proper homoeopathic manner
leaves the body in a health their condition. This does not mean that the
acute disease should be allowed to run its course, for if the symptoms are
met at its inception, by the similimum the disease will be aborted and yet
the economy will be purified.

Chronic disease is not self-limited and shows no tendency to


ultimate recovery if untreated. This is the unique sphere of homoeopathy.
Practically everyone has some symptoms of latent chronic disease and to
the homoeopath chronic disease is the basis of susceptibility. By taking
the totality of the symptoms from birth on, a deep acting, chronic
constitutional remedy can be chosen which will aid in finding off future
acute disease and remove many inherited and acquired encumbrances to
the vital force.

89
When the action of a well indicated constitutional remedy gets
blocked and the patient fails to respond to further medication, the obstacles
to cure have looked for. When this analysis pointed to a miasmatic block,
an anti-miasmatic prescription has cleared the way for the constitutional
medicine to act in many of the cases.

Indicated constitutional remedies in the study.

Though the constitutional remedies are prescribed, strictly on


individual constitutions, the following medicines were found to be the
miasmatic background and the regional affinity.

The constitutional remedies are dulcamara, nitric acid, thuja, calc.


carb. causticum, sepia, lycopodium.
The following are the intercurrent remedies.
Tuberculinum, thuja,,psorinum.
Result of treatment
As mentioned in the section of methods, 3 parameters were used to
assess
the resuts.
1) Recovered  

2)  Improved  

3) Not improved. 

It has been observed that out of 30 cases of warts, 14 cases


i.e.46.66% have recovered. There was a remarkable improvement in the
mental, physical and symptomatic plane. 9 cases i.e.30% have improved.
There was considerable amelioration of the symptoms. In 7cases
I.e.23.33%, there was no improvement.

90
CONCLUSION

The present clinical study on warts of 30 cases was undertaken to


evolve the miasmatic background, efficacy of homoeopathic remedies and
to arrive at a group of remedies commonly indicated in warts.

The results of this study have shown that the miasmatic


background was predominantly psoro-sycotic in majority of cases.

Secondly homoeopathic remedies have rendered benefit to


the people suffering from the warts. Homoeopathy by addressing all
aspect of the individual and their complete set of symptoms through the
constitutional and holistic approach is superior to all methods of treatment
especially in chronic diseases like warts.

91
Homoeopathic treatment essentially based on “The
constitutional Approach” targeting the root cause and restoring the
deviated immunity back to normal, there by cure the disease.

Warts are the chronic miasmatic disease, and by


antimiasmatic remedies it is effectively treated. In the present study group
of remedies are evolved for the treatment of sciatica.
Homoeopathic remedies in warts to begin with reduce
intensity of symptom, reduce the relapse and chances of recurrence and
there by relive the suffering, & reduce the dependency over allopathic
drugs.

The group of Homoeopathic medicines which were


efficacious in treating warts includes constitutional remedies namely;
Thuja, Antimonium crudum, Dul camara, causticum, sepia, Calcarea carb,
Nitric acid, Lycopodium.

Summary

In health all the expressions of vital force may be expressed by


perfect function of all parts the body and sense of general well being.
The humble wart has undoubtedly been afflicting mankind for
many millions.
Homoeopathy can provide miraculous relief from this
overgrowth, without any side effects by controlling the inflammation and
infection of skin. Homoeopathy offers some of the most effective remedies
for the disorder on any level, physiological, psychological etc.

Most of the patients predominantly carry psoro sycotic in


background.

92
The objectives of the study are as follows:
1. To understand the miasmatic background of “warts”.
2. To know the efficacy of the homoeopathic drugs in treating
warts.
The 30 cases of warts were treated on the basis of inclusion
and exclusion criteria. The cases were recorded keeping the holistic
concept in mind.
The study was primarily aimed to understand “A clinical
study on warts its miasmatic approach and homoeopathic management”.
The facts found in the present study summarized below:
Study comprises of 30 different cases of warts.
The patient comprise of both the sexes.
Study showed warts has maximum incidence in above 10 years of
age.
Study showed female predominance in development of warts.
In the present study psora-psycotic was the predominant miasm in
maximum number of cases 27 (90%), followed by psoric miasm in 3
(10%) cases.
Among constitutional remidies Dulcamara, Nitric Acid, Thuja,
Causticum, Sepia, Calcarea Carb happened to be the constitutional
remedies. Tuberculinum, Thuja, are the inter-current remedies
commonly found indicated.

Out of 30 cases, 14 (46.66%) patients fully recovered, 09(30%) patients


improved, & no improvement in 07(23.33%) patients.

I arrive at the conclusion that most of the patients in my study


showing psoro sycotic miasmatic background. And the constitutional
treatment is very helpful in the treatment of warts.
Homoeopathic medicines when given on constitutional basis
would bring beneficial results in the treatment of warts.

93
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97
ANNEXURE I

CASE PROFORMA :

H.K.E. SOCIETY’S HOMOEOPATHIC MEDICAL COLLEGE &


HOSPITAL, GULBARGA

PRELIMINARY DATA

NAME OF THE PATIENT :


AGE :
SEX ;
MARITAL STATUS :
RELIGION :
OCCUPATION :

98
EDUCATIONAL STATUS :
SOCIO ECONOMIC STATUS :
ADDRESS :
DATE :

1. PRESENTING COMPLAINTS WITH DURATION :

2. HISTORY OF PRESENT COMPLAINTS


a). probable cause :
any significant incident before the onset/ use of a particular clothing/ any
infection/ any associated diseased condition

b). mode of onset and progress of the lesion (with duration of onset) :

c). site of onset:

d). site of skin affected:

e). nature of the lesion: dry or moist

f). any discharge:


g). odour of the discharge:
h). general nature of the skin ( dry./oily/ dark/ fair) :
i). itching; present /absent
j). scaly flakes: present/ absent.
k). crust formation: present/ absent.

99
l). pain: present / absent. if yes which type of pain.
m). associated with hair fall: yes / no.
n). lesion – generalised /localised.
o). erythema: present/ absent.
p). sensitive to touch: yes/ no.
q). progress of symptom:
r). modelities:
s). concamitant:

Past history:
• Intrauterine life:
• Milestones of life:
• Vaccinations:
• Childhood disorders:
[Eczema / allergy / nutritional deficiency / tonsillitis / congenital deformity /
meningitis / primary complex / any other ENT diseases / other respiratory
disorders / others]

• Adolescent disorders:
[Koch’s / Exanthematous diseases / HTN / DM / any respiratory disorders /
allergies / prolonged medication / any surgery / trauma to head / immune
deficiency syndrome / malignancies / dental infections etc.]

FAMILY HISTORY:

PERSONAL HISTORY :
a). Diet : veg/mixed.
b). Appetite: normal/decreased/increased.
c). Thirst: normal/decreased/increased.
d). Dietetic error : present/absent.
e) Bowels: regular/ irregular.

100
satisfactory/unsatisfactory.
character of stools :
frequency ;

f). MICTURITION : D/N :


colour :
Any other:

g). PERSPIRATION :
site :
character :
odour :
moderate : profuse/ scanty.

h). DESIRE :
Sweat/salty/bitter.
Pungent/sour/bland.
If any other specify:

i). AVERSION :
sweat/salty/bitter
pungent/sour/bland.
IF ANY OTHER SPECIFY.

j). DISAGREES:

k). SLEEP: sound/disturbed


Any details

101
l). DREAMS:

m). HISTORY OF PICA: YES/NO.


IF YES (SPECIFY):

n). HABITS:

o). THERMAL STATE:


Bath: luke warm/cold/hot.
Covering prefers: yes/no.
Season prefers: cold/warm/ hot.
Fanning: far distance/near distance.
Prefers: open air/warm air room.
In general: chilly/ hot/ ambhithermal.

p). MENSTRUAL HISTORY:


Age of menarche:
Cycles: regular/irregular.
Flow: profuse/scanty/moderate.
colour : red/dark/pale.

Character:
Yes no if any other specify.
Staining:
Water:
Stringy:
Clots:
q). CONCOMITANTS:

102
r). OBSTETRICS HISTORY:

G PLAS
Any details sepcify :

s). ABNORMAL DISCHARGES (IF ANY) :

t). SUPPRESSION OF ANY TYPE OF DISCHARGES:

u). SEXUAL HISTORY:

DEVELOPMETAL LAND MARKS:

GENERALITIES
a.GENERAL MODALITIES :
1. Time of the day
2. Season
3. Meteorological (moon, phases etc)
4. Effect of external impression (light, heat of sun, fire place, bathing,
pressure of clothing, touch, noise, music, odour etc.)

b. AILMENTS FROM
Mental:
Physical:
c.NEVER WELL SINCE

d. THERMAL STATE :

e. EFFECT OF VARIOUS POSITION/MOTION:

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f. GENERAL SENSATION AND COMPLICATIONS:

LIFE SPACE DEVELOPMENT:

Living environment and family set up (social, financial, spiritual atmosphere


of family); early childhood, relation in work area and society.

EXAMINATION

A.GENERAL PHYSICAL EXAMINATION:


1. Vital signs:
Pulse:
b.p. :
Respiration rate:
Weight:
2. General built (frame)
Small / medium / large.
3. Nutrition or nourishment;
Good / fair / poor.

4. Height:

5. Weight:
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6. Anemia/ pallor:
Present / absent.

7. Gyanosis:
presnt / absent.

8. Icterus:
presnt / absent.

9. Clubbing:
Present / absent.

10. Pedal oedema:


Present / absent.

11. Lymphadenopathy
Present / absent.

12. Scalp;

13. Hair;

14. Eyes;
Conjunctiva sclera.

15. Ear:
External pinna : hearing :
External acoustic canal:
If any other specify:

16. Face:

17. Vision:
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18. Nose:
Yes / no if any other specify.
Dns :
Any discharge
Smell;

19. Mouth:
Tongue:
Lips:
Oral cavity:
Teeth:
Gum:
Basal mucosa- pink pale

20. Neck:

21. extremities-
A). upper limbs:
Oedema: yes / no
Pigmentation: yes / no
axillary lymphadenopathy : yes / no
Any other details:
b). lower limbs:
Oedema: yes / no
Pigmentation yes / no
axillary lymphadenopathy :
popliteal / inguinal : yes / no.
Any other details:
c). joints

22. Chest and abdomen:

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B. LOCAL EXAMINATION / CUTANEOUS

1. MORPHOLOGY OF LESION:
Localised / generalised / papules / follicles / vesicles / large
patches, dry / moist, with scales/ without scales, oozing / without oozing,
crust formation / without crust formation, oedema / without oedema,
associated with hair loss / with out associated with hair loss. erythematous /
without erythema, itching/ non – itching, infected/ non infected, greasy / non
greasy, pustules / small pustules, swollen / not swollen / fissures / ulen
formation. Exudation / papulo vesicles / waxy.

2. SITE OF LESION:

ADULT TYPE:
scalp / eyebrows / super orbital region / thighs / pubic areas/ eye
lids / nasolabial folds or creases / lips / palms / soles / ears / post curricular
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areas / sternal area axillae / submammary folds/ inter scapular region /
umbilicus groins / gluteal crease / glabella / checks / paranasal areas / beard
areas / checks / retro-auricular / genitalia.

INFANT TYPE:
Scalp / frontal hairline / face/ forehead / eyebrows / eyelids / nasolabial
folds / pinna / neck / external ear / axillae/ anogenital area / groins.

3. COLOUR OF LESION :
Pink / yellow / dull red / red- brown/ erythematous / brown.

4. DISTRIBUTION AND DESCRIPTION:


Margins defined / ill defined / symmetrical / sharply marginated/
non-marginated / inflammatory / circinate / gyrate / petal form / psoriasiform
/ discoid bilateral ipsilateral.

5. SECONDARY CHANGES:
SUPER INFECTIONS

6. EXTEND OF SPREAD:

7. APPENDAGES: HAIR / NAILS:

8. EXAMINATION OF PALMS AND SOLES:

9. OTHER MANIFESTATION (IFANY):

10. TESTING FOR SENSATIONS:


PAIN / TOUCH / TEMPERATURE

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SYSTEMATIC EXAMINATION-

RESPIRATORY SYSTEM –

CARDIO-VASCULAR SYSTEM-

CENTRAL NERVOUS SYSTEM-

GASTRO INTESTINAL TRACT-

GENITOURINARY SYSTEM-

INVESTIGATIONS

BLOOD-
Hb%
TC :
DC :
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OTHERS
SKIN:
BIOPSY

ANY OTHER INVESTIGATIONS-

ANALYSIS AND EVALUTION OF SYMPTOMS-

CONSTITUTIONAL TOTALITY-

REPERTORIAL TOTALITY-

RESULTS OF REPERTORISATION-

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MIASMATIC ANALYSIS

MIASMATIC REPERTORISATION TABLE


MENTAL SL. SYMPTOM P.N PSOR SYC SYP
GENERAS NO. S O. A O HI
1.
2.
3.
4.
5.
PHYSICAL 1.
GENERALS 2.

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3.
4.
5.
6.
PARTICUL 1.
AR 2.
SYMPTOMS 3.
4.
5.
6.
TOTAL

SELECTION OF REMEDY AND DOSAGE

ACUTE-

CHRONIC-

MIASMATIC-

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GENERAL MANAGEMENT-

FOLLOW ---UP CRITERIA REMEDY AND INTERPRETATION

Date General Treatment Instructions


condition

ANNEXURE II 
                                                    MASTER CHART 
 
 
 
 
 
 
 
 
 
 
 

113
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

114
 

115
 

116
 

117
 

ANNEXURE III 
                                                       
                                                 SYNOPSIS OF CASES 
 
1)A patient by named Miss. R.S. aged 9 years, consulted for 1 to 2
warts on face since 1 year. It appeared on dorsum of hands ,she has applied
chemicals locally and also got them cauterized, but they came back in larger
number each time. Past history of chicken pox in early childhood. Family
history of gonorrhea. From the history, clinical features case was diagnosed
as common warts. miasmatic analysis showed predominant miasm as psoric
background. The remedy given was dul camara 1dose given considering the
individuality of the case. The case was recovered.

2) A patient by named Miss C.S. female aged 16 years ,consulted for


common warts on left hand since 8 months. She had tried other system of
medicine but they had came back family history mother suffering with
osteoarthritis. Past history cautrisation.From the history, clinical features,
case was diagnosed as common warts. miasmatic analysis showed
predominant miasm as psoric background. sConsidering the acute clinical
picture, , Dul camara1 dose was given. The case was recovered.

3) A patient by named Miss M.K. aged 18 years, consulted for warts


on both hand since 1 year. Past history of cauterization. Family history of
diabetic mellitus, tuberculosis.From the history, clinical presentation , and
family history the case was diagnosed as common wart. Miasmatic analysis
showed predominant miasm as psoro-sycotic.Since considering the
individuality of the case Sepia was given. the case did not improved

4) A patient by named Miss.M.I. female aged 8 years, consulted for


small warts on face, neck and chest more on right side. Past history of
cautrisation. Family history HTN, asthma From the history, clinical
features, case was diagnosed as flat warts. miasmatic analysis showed

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predominant miasm as psoro-sycotic background. causticum 200was given
as the constitutional remedy. The case was recovered

5) A patient by named Miss. K.Y. female aged 14 years, consulted


for warts on both the hands since 8 months. Gives a past history of jaundice.
There was family history of warts, bronchial asthma and hypertension,From
the history, clinical presentation and family history, the case is diagnosed as
common warts. Miasmatic analysis showed predominant miasm as psoro-
sycotic. Lycopodium 200 was given as the constitutional remedy,
considering the individuality of the case. Case improved finally.

6) A patient by named Miss V.G. female aged 15 yearsconsulted for


hard wart on hand since 7-8 months..family history of rheumatic arthritis,
bronchial asthma, DM, eruptions on the body. Past history of eruption on the
body.From the history, clinical features, case was diagnosed as common
warts. miasmatic analysis showed predominant miasm as psora background.
Antimonium crudum was given as acute remedy, The case recovered finally.

7) A patient by named Mr. S.S. ,male aged 28 years, hailing from a


middle class family, student by occupation, in Gulbarga city, consulted for
wart on both hands since 5 months. . Associated complaints of dandruff ,.
Initially tried external applications. There was family history of warts ,
allergic rhinitis, bronchial asthma and HTN,gonorrohea. There was a past
history of tonsillitis, frequent cold and cough.On the basis of history,clinical
features and family history this case was diagnosed as common warts.
Miasmatic analysis showed predominant miasm as psora background.
Causticum was given as the constitutional remedy, considering the
individuality of the case. The case recovered finally.

8) A patient by named S.K. aged 20 years, consulted for multiple


warts on palms and foot, since 6 months. Warts were hard , tender. There
was a family history of bronchial asthma, HT and myocardial infarction.
Also past history of eruptions. From the history, clinical presentation and
family history, the case is diagnosed as plantar warts . miasmatic analysis

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showed miasmatic background was psora. Dul camara 200 was given as
acute remedy Case did not improved

9) A patient by named Miss A.E. aged 16 years, consulted for


warts on the dorsum of the hands and on the face since 1 year. Family
history of asthma. Past history of erruptions, acne, From the history, clinical
presentation , and family history the case was diagnosed as common wart.
Miasmatic analysis showed predominant miasm as psoro-sycotic.Based on
the individualization dulcamara was given as constitutional remedy. The case
was did not improved finally.

10) A patient named K.E. ,female aged 26 years, came with


complaints of w art on the face since 3 years . Gave a family history of
bronchial asthma, HTN, TB, and cervical spondylosis. Gave a past history of
tylphoid.On the basis of history,clinical features and family history this case
was diagnosed as flat warts. Miasmatic analysis showed predominant miasm
as psoric background. Since the disease was having the acute clinical picture
and dul camara was given as constitutional remedy. The case recovered
finally.

11) Patient named K.W. aged 28 years, consulted for multiple warts
around mouth and nose. family history of asthma, diabetic mellitus . past
history of cauterization. From the history, clinical presentation and family
history, the case is diagnosed as flat warts . miasmatic analysis showed
miasmatic background was psro-sycotic.He was prescribed Nitric acid 200,as
constitutional remedy considering the individuality of the case .The case
improved

12) Patient named M. Z.female aged 13 years , consulted for warts


on her face, warts.there was a family history of bronchial asthma and uterine
fibroid.she also gives past history of recurrent attacks of Tonsillitis and
Pharyngitis.On the basis of history,clinical features and family history this
case was diagnosed as flat warts. Miasmatic analysis showed predominant
miasm as psoro-sycotic background. Dulcamara was given as the

120
constitutional remedy, considering the individuality of the case . The case
recovered.

13)Patient named D.O. aged 8 years, was consulted for hard warts
on right foot since 6 months. He had applied salicylic acid locally, but they
had come back. Past history of eczema. family history of strong tendency for
gonorrhea
From the history, clinical features case was diagnosed as plantar
warts. miasmatic analysis showed predominant miasm as psoro-sycotic
background.
The remedy given was antimonium crudum 200,1dose was as
constitutional remedy. The case was recovered.

14)Patient named miss S.E. female aged 24 years. consulted for warts
on his left hand since 8 months. Family history of tuberculosis. Past history
of external application of chemical .From thehistory, slinical presentation ,
and family history the case was diagnosed as common wart. Miasmatic
analysis showed predominant miasm as Psoro-sycotic. On the basis of
constitution calc. carb. 200, 1 dose was given. . The case did not improved
finally.

15) Patient named S.V. aged 25 years ,came with warts on right
finger since 2 years . And gives family history of bronchial asthma, allergic
rhinitis, HTN .and gaves a past history of using some external application
undergone cauterization once with recurrence of the warts . On the basis of
history,clinical features and family history this case was diagnosed as
common warts. Miasmatic analysis showed predominant miasm as psoro-
sycotic background. Since the disease was having the acute clinical picture
lycopodium.was given as the constitutional remedy considering the
individuality of the case. Case recovered finally.

16) Patient named miss V.J. female aged 9 years , consulted for
wart on his right foot since 2 years . . There was a family of allergic rhinitis,
bronchial asthma, HTN and T. B.. There is past history of vaccination, On

121
the basis of history,clinical features and family history this case was
diagnosed as plantar warts. Miasmatic analysis showed predominant miasm
as psoro-sycotic background. Thuja was prescribed as the constitutional
remedy .The case recovered finally.

17) Patient named P. S. aged 24 years, came with warts on his upper
lip and around the mouth since 2 years. family history of gonorrohea. And
past history of cautrization.On the basis of history,clinical features and
family history this case was diagnosed as fillifom warts. Miasmatic analysis
showed predominant miasm as psoro-sycotic background.Causticum was
given as constitutional remedy considering the individuality of the case.
Case recovered finally.

18) Patient named N.S. female aged 24 years,,complaints of warts


on left foot, since 1 year , there was family history of erruptions. and gave a
past history of chemical application From the history, clinical presentation
and family history, the case is diagnosed as plantar warts . miasmatic
analysis showed miasmatic background was psro-sycotic. Sepia was given
as constitutional remedy. Case improved finally.

19) Patient named S.K. aged 10 years, consulted for warts on the
hands since 9 months. Family history of asthma. Past history of vaccination
From thehistory, slinical presentation , and family history the case was
diagnosed as common wart. Miasmatic analysis showed predominant miasm
as psoro-sycotic.Based on individualization thuja 200 was given as
constitutional remedy. The case was did not improved finally.

20) Patient named M.I. aged 9 years, consulted for a wart on the left
index finger since 2 years..family history of T.B. Past history of
eruptions.From the history, clinical presentation and family history, the case
is diagnosed as common warts . miasmatic analysis showed miasmatic
background was psro-sycotic.Cal. Carb was given as a constitutional remedy
considering the individuality of the case. Case was improved finally.

122
21) Patient named M.H. male aged 9 years, consulted for wart on
the lower limb since 1 year. Family history bronchial asthma. Past history
jaundice.From the history, clinical features, case was diagnosed as common
warts. miasmatic analysis showed predominant miasm as psoro-sycotic
background. Lycopodium was given as constitutional remedy . Then
tuberculinum was given as intercurrent remedy. The case was recovered
finally.

22 ) Patient named M. A. aged 18 years, consulted for warts on his


hands, sides of the fingers since 8 months . Family history of gonnohorea.
Past history of bad effects of vaccination and typhoid.From the history,
clinical presentation , nd family history the case was diagnosed as common
wart. Miasmatic analysis showed predominant miasm as psoro-sycotic.
Based on the constitution thuja 200 was given as constitutional remedy.
Sulphur was given as intercurrent remedyThe case did not mproved finally.

23)Patient named R.T. aged 21 years, consulted for warts on right


hand since 2 years. Family history of osteoarthritis, past history of external
application of other system of medicine, From the history, cliinical
presentation , and family history, the case was diagnosed as common wart.
Miasmatic analysis showed predominant miasm as psoro-sycotic.Since
considering the individuality of the case Nitric Acid, was given as
constitutional remedy The case improved finally.

24) Patient P.B. aged 11 years consulted for a big warts on the fingers
of both the hands for one year. .family history of osteoarthritis, hyper
tension. Past history of worms since childhood, vaccination. From thehistory,
slinical presentation , and family history the case was diagnosed as common
wart. Miasmatic analysis showed predominant miasm as psoro-sycotic. On
the basis of constitution calcarea carb was given constitutional remedy. The
case improved.

123
25)Patient named R.S. male aged 24 years, consulted for wart on the
left foot since one year. there is family history of, bronchial
asthma,hypertensive, R.A .gives a past history of chicken pox ,cauterisation.
On the basis of history,clinical features and family history this case was
diagnosed as plantar wart. Miasmatic analysis showed predominant miasm as
psor-sycotic background. Antimonium crudum was prescribed as the
constitutional remedy. The case recovered finally.

26) Patient named R.G. male aged 16 years consulted for warts
on the right foot since 2 years . family history of , Tuberculosis. Past history
of cauterization of warts. From the history, clinical presentation , and family
history the case was diagnosed as plantar wart. Miasmatic analysis showed
predominant miasm as psoro-sycotic. Thuja was given as the constitutional
remedy on the basis of individualization .tuberculinum was given as
intercurrent remedy.The case did not improved finally.

27) Patient named R.O. female aged 12 years, consulted for warts on
the right foot since 7 months. Family history T.B.. Past history diarrhea,
cholera.
From the history, clinical features, case was diagnosed as plantar
warts. miasmatic analysis showed predominant miasm as psororo-sycotic
background. Thuja 200 was given as constitutional remedy considering the
individuality of the case.
The case was recovered.
28)patient named S.D. ,female aged 15 years ,consulted for warts on
hands . Family history of asthmatic attack . past history of
vaccination.From thehistory, slinical presentation , and family history the
case was diagnosed as common wart. Miasmatic analysis showed
predominant miasm as psoro-sycotic. Based on the individualization Nitric
acid was given as constitutional remedy. After failure thuja was given as
intercurrint remedy.The case was did not improved finally.

29) patienat named B.S.male, aged 14 years, consulted for number of


warts on right leg since 2 years. . Family history of tuberculosis, HTN. past

124
history of bad effects of vaccination. From thehistory, slinical presentation ,
and family history the case was diagnosed as common wart. Miasmatic
analysis showed predominant miasm as psoro-sycotic. On the basis of
individualization causticum. 200 was given constitutional remedy.. The case
improved finally.

30 ) patient named A.P. female, aged 15 years, consulted for warts


on left leg since 2 years. family history of peptic ulcer. Past history of
eruptions. From the history, clinical presentation , and family history the case
was diagnosed as common wart. Miasmatic analysis showed predominant
miasm as psoro-sycotic.Based on individualization causticum was given as
constitutional remedy. The case was did not improved finally.
 

125