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\begin{document}

\title{Antimonium crudum in pediatric skin conditions, a classical homeopathic
case series}



\author[1]{Seema Mahesh}%
\author[2]{Tamara Kozymenko}%
\author[3]{Nataliia  Kolomiiets}%
\author[4]{George Vithoulkas}%
\affil[1]{Taylor's University - Lakeside Campus}%
\affil[2]{Kyiv Medical University of UAFM}%
\affil[3]{Center of classical homeopathy of Nataliia Kolomiiets}%
\affil[4]{Postgraduate Doctors' Training Institute}%


\vspace{-1em}



  
  \date{May 04, 2024}


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\selectlanguage{english}
\begin{abstract}
We present three cases of impetigo and one case of bullous pemphigoid
neonatorum that benefited from the homeopathic remedy Antimonium crudum,
which has a wide spectrum of dermatological applications when prescribed
according to symptom similarity. Further larger clinical studies are
necessary to establish its role in pediatric dermatology.%
\end{abstract}%



\sloppy


\textbf{Antimonium crudum in pediatric skin conditions, a classical
homeopathic case series}

Seema Mahesh\textsuperscript{1}*, Tamara Kozymenko\textsuperscript{2},
Nataliia Kolomiiets\textsuperscript{3}, George
Vithoulkas\textsuperscript{4,5}

1School of medicine, Faculty of Health and Medical Sciences, Taylor's
University, Malaysia; ORCID: 0000-0002-4765-5595

2 Private Higher Educational Establishment Kyiv Medical University,
Kyiv, Ukraine

3 Center of classical homeopathy of Nataliia Kolomiiets, Kyiv, Ukraine

4Postgraduate Doctors' Training Institute, Health Care Ministry of the
Chuvash Republic, Cheboksary, Russian Federation;

ORCID: 0000-0002-9118-8306

5International Academy of Classical Homeopathy, Alonissos, Greece

\textbf{Short Title:} Pediatric skin conditions and homeopathy

\textbf{Corresponding Author:}

Seema Mahesh,

School of medicine, Faculty of Health and Medical Sciences,

Taylor's University, Malaysia

No 1 Jalan Taylors, Subang Jaya, 47500

Selangor, Malaysia

Email: bhatseema@hotmail.com;

Tel: +60 0123809077

\textbf{Key Clinical Message}

Homeopathic Antimonium crudum may be useful in many pediatric skin
conditions if prescribed on symptom similarity. It may especially be
helpful in reducing the use of antibiotics and steroids in this age
group if proven to be effective through larger scientific studies.

\textbf{Abstract}

We present three cases of impetigo and one case of bullous pemphigoid
neonatorum that benefited from the homeopathic remedy Antimonium crudum,
which has a wide spectrum of dermatological applications when prescribed
according to symptom similarity. Further larger clinical studies are
necessary to establish its role in pediatric dermatology.

\textbf{Keywords:} pediatric dermatology, impetigo, bullous pemphigus,
homeopathy

\textbf{Background}

Impetigo (ICD 10 L01.00) \textsuperscript{1} is one of the most common
pediatric skin complaints, caused by gram positive bacteria and highly
contagious. It may occur as a primary infection of the epidermis or
secondary to any trauma or breach in the skin. While the exact
prevalence is unclear, it is estimated to account for 10\% of pediatric
skin complaints. Males and females are equally affected, and it is more
common in the 2- to 5-year-old age group. It shows a seasonal tendency
and is more prevalent in the hot/humid seasons, i.e., summer and
fall\textsuperscript{2,3}.

The causative organism is mostly Group A Streptococcus (GAS) in the
non-bullous type and Streptococcus aureus in the bullous type. Breaches
in skin integrity expose fibronectin receptors, promoting bacterial
colonization. Self-inoculation helps the lesions spread
further\textsuperscript{2,3}. Clinically, these two types show distinct
patterns. Non-bullous impetigo often appears as vesicles that coalesce
and rupture, and the purulent exudate forms the characteristic
honey-colored crust. The ruptured area exhibits an erythematous base.
Rapid spread and satellite lesions can occur, with mild regional
lymphadenopathy. Systemic symptoms such as fever are typically absent.
The bullous type almost exclusively affects infants. It usually presents
as vesicles that form flaccid bullae containing yellow or dark colored
fluid. This may rupture, exposing an erythematous base and rim.
Honey-colored crusts are not formed in bullous impetigo. Usually, no
lymphadenopathy occurs, and fever is a common
presentation\textsuperscript{2,3}.

Malnutrition, diabetes, and immune suppression predispose individuals to
the development of impetigo. It is also triggered by other viral
infections, such as herpes and varicella, and other causes of skin
breach, such as burns, trauma and insect bites \textsuperscript{3}.

Management typically involves topical and oral antibiotics.
Approximately 20\% of impetigo cases are capable of self-resolution, and
antibiotics have been shown to shorten the disease duration and avert
complications that may affect the kidneys, impact the joints or result
in acute rheumatic fever. Without treatment, impetigo will resolve in
two to three weeks; with treatment, it will resolve in 10
days\textsuperscript{3}. Some antibiotic applications have shown that
clinical clearance can occur in 5 days and microbiological clearance
will occur in 3 to 4 days \textsuperscript{4,5}.

The second condition, which we present here, unlike impetigo, is quite
rare. While the actual incidence has not been investigated, bullous
pemphigoid is a rare condition in the pediatric age group (ICD 10
L12.0)\textsuperscript{1}. It is an immune-mediated autoimmune disease,
exhibiting circulating autoantibodies to antigens BPA1/BP230 and
BPA2/BP180 (collagen VVII-NC16A). The initiation of the disease occurs
with the IgG recognition of BP180 antigen. Acral involvement of the
bullae is a common presentation in the infantile type and may be
diagnosed by the presence of C3 and IgG deposition in the skin biopsy.
It usually has excellent prognosis as it responds very well to
corticosteroids. The response time varies from a few weeks to a few
months, but complete resolution within one year is expected. In 2014, a
treatment algorithm was proposed that delineated the approach to mild
and severe forms of the disease. The first line of treatment is topical
steroids and in case of severe disease, involving more than 10\% of the
body surface area. A systemic steroid must be introduced, which is
withdrawn slowly upon remission. In cases of refractory disease, G6PD
deficiency must be ruled out \textsuperscript{6,7}.

We present here four patients with pediatric skin conditions that were
cured by the homeopathic medicine Antimonium crudum.

\par\null

\textbf{Case Series:}

We present 4 cases of pediatric dermatological conditions that benefited
from homeopathic Antimonium crudum. Three of these children had
impetigo, and one had bullous pemphigoid neonatorum. These patients were
treated by homeopathic physicians in Ukraine.

Case 1 (Fig. 1):

A 7-year-old Ukrainian boy presented on 7/6/2015 with rapidly spreading
lesions on the face, nose and arms. There was a crack in the left
nostril. The lesions seemed to be impetigo. This occurred after swimming
and diving in a cold pool. In one day, the left nostril was completely
blocked with honey-colored crusts, which became hard-like stones, with
pus discharging from the skin below both nostrils. More small foci
appeared on the face and body

Diagnosis: The diagnosis made by clinical features and the parents
called the homeopath.

Prescription: The first prescription was Mercurius solubilis 200C, which
had no effect. Then, one dose of Antimonium crudum 30C was given.

Follow-up: The next morning, all small crusts disappeared from the face
and nose, greenish nasal discharge appeared, and large crusts started
bleeding. Antimonium crudum 200C was given, and in one day, all lesions
healed.

Case 2 (Fig. 2):

A 5-month-old Ukrainian male infant was brought to the homeopath with
skin eruptions diagnosed by the dermatologist as impetigo
(streptodermia). The eruptions appeared at the age of 3 months in May
2014 during a cold after hypothermia, first on the chin and cheeks, then
on the neck and back of head, then on hands, nates, genitalia and heels.
The eruptions were periodical, with eruptions appearing every 2 weeks.
There was a cyclical character of the lesions as well, appearing
successively as vesicles, ulcers, crusts, and desquamations (Fig 2). The
boy was calm and smiling during the day, only crying when being washed
with cold water. However, during the night, he was very restless. The
period of the aggravation of eruptions was accompanied by constipation,
vomiting after nursing and thick, abundant saliva. The eruptions were
aggravated after bathing. The tongue was covered with thick white mucus.
No conventional treatment was given.

Diagnosis: Clinical diagnosis was made by the homeopathic physician

Prescription: On 20/7/2014, Antimonium crudum 12C once a day was
prescribed.

Follow-up: After 3 weeks, the mother noticed that the usual 2-week cycle
of the eruptions did not appear. The remedy was stopped.

After 2 months, the skin became clear completely. The child had no
problem with the skin during the 6 years of follow-up.

Case 3 (Fig. 3):

A 6-year-old Ukrainian boy presented with skin eruptions. The boy often
visited a swimming pool with heated water, but on one occasion, the
water was cold. After a few days of bathing in cold water, a wet spot
appeared inside the right hand with small pimples. Many vesicles
appeared on the face, body and arms, which opened with sticky discharges
forming thick yellow crusts (Fig 3).

Diagnosis: was made based on clinical features by the homeopathic
physician

Prescription: Graphites 30C was prescribed on 10/9/2014, and Graphites
200C was prescribed on 11/9/2014. The skin condition worsened; some
large blisters appeared on the forehead, finger, and arms. Severe
eruptions appeared around the eyes and under the right arm. He could not
open the eyes or raise the right arm. The eruptions were itching with
burning. The child peeled off the crusts during night sleep and was very
irritated. The area under the right arm looked as if scalded and was
very painful. New vesicles appeared on the left arm.

On 16/9/2014, Antimonium crudum 10 M was given

Follow-up: ~On 17/9/2014, the spreading of eruptions stopped, itching
subsided, and moist eruptions dried and developed crusts, which detached
without discharging. The face was completely clear.

On 20/9/2014, only light crusting on left upper limb and armpit
remained; other areas were clear.

On 27/9/2014, all skin eruptions disappeared, and the skin became clear.

Case 4 (Fig. 4)

A 10-day-old female Ukrainian infant living in the USA with bullous
pemphigus neonatorum was seen by a homeopath. On the 7th day after
birth, yellow blisters appeared in the left armpit, which then opened
and became wet on the surface with a yellow sticky discharge (Fig 4). In
the hospital, the patient was diagnosed with ``bullous pemphigoid
neonatorum'', and immediate introduction of intravenous antibiotics for
sepsis prevention was recommended. Meanwhile, patients consulted the
Ukrainian homeopath via video consultation. The infant had thick white
mucus on the tongue that was similar to candidiasis. The general
condition, sleep and appetite were normal, and the baby was not
vaccinated.

Prescription: One dose of Antimonium crudum 30C was given on 30/3/2018.

Follow up: Immediate changes were appreciated, averting the need for
antibiotics.

On 6/4/2018, purulent discharges were completely reduced, and no further
spread of eruptions was observed.

On 13/4/2018, all skin eruptions disappeared, but some pigmentation
remained.

On 8/8/2020, the child was clear of the complaint with no relapses so
far.

\textbf{Discussion}

Classical homeopathy approaches any condition in a holistic,
individualized manner. This means that it takes into consideration the
hereditary predisposition, circumstantial stress, diseases suffered in
the past, immune response characteristics, drugs given, responses to
these drugs and the current diagnosis with detailed symptomatology to
choose a remedy \textsuperscript{8,9}. The homeopathic pharmacopoeia
includes many drugs that have an action predominantly on the
skin\textsuperscript{10}, and many disparate conditions have shown
excellent response clinically to them \textsuperscript{11-14}. Nwabudike
in 2016 published a homeopathic case report of impetigo in an elderly
man\textsuperscript{15} who benefited from a different homeopathic
medicine, Hepar sulphuricum.

Antimonium crudum, the black sulphide or native sulphide of antimony, is
another such medicine that has an effect on skin
conditions\textsuperscript{16,17}, prepared homeopathically according to
Class VII of Indian pharmacopeia \textsuperscript{18}. The semiotic
similarity between the symptoms produced during proving of Antimonium
crudum and those produced in the patient gives us the indication about
which dermatological conditions the medicine will be serviceable
homeopathically in \textsuperscript{16}. The action of this homeopathic
preparation has been proven to be beneficial in murine leishmaniasis
through a distinct promotion of B cell activity \textsuperscript{19,20}.
The medicine exhibited immunomodulating activity where it promoted Th1
predominance and helped control the infection
process\textsuperscript{21}.

In the cases we have presented, the first three were infections, and the
last one was an autoimmune condition. The indications for homeopathic
medicine, however, do not stop at diagnosis. The same remedy may be
indicated in infections or autoimmune conditions because of the other
associated symptoms, especially those that do not seem to be a direct
consequence of the pathology. For example, patients requiring Antimonium
crudum usually have a very thick milky white coating on their tongue.
They also have an unexplainable craving for
cucumbers\textsuperscript{16,22}. The common line running in the above
cases was aggravation at night and aggravation from cold bathing. Such
peculiarities may seem insignificant, but to homeopaths, they are of
paramount importance. The idea is that in a diseased state, it is not
just the local organ or system that is affected but rather a general
affection occurs, altering many faculties of the being. Considering this
entire profile alone indicates to the right medicine. This idea is no
longer far-fetched, as studies show the systemic nature of inflammation,
immune response and sickness behavior \textsuperscript{23,24}. While
these are being studied in a generalized manner by conventional medicine
to understand the common changes in the whole spectrum of disease,
homeopathy considers these changes at the individual level and has
treated so since the last two centuries. In these cases, such an
approach was proven to be beneficial.

\textbf{Conclusions:}

The homeopathic medicine Antimonium crudum was beneficial in the four
cases of pediatric skin conditions presented here. The relevance of this
drug in homeopathic potencies to dermatological conditions needs to be
investigated further with scientific studies.

\textbf{Statements}

Statement of Ethics Ethical approval was not sought as the report is
from treatment results and not a trial. The patients' parents were
explained about the publication and they have provided written consent
for publication.

\textbf{Consent for publication:} Written consent was obtained from
parents for publication of their wards' case details and photographs.

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

Funding Sources

No funding was obtained for this work

Author Contributions

TK and NK were the primary physicians who treated the patients, obtained
the data and analyzed them for the study. SM wrote the manuscript and
obtained the references. GV was the guide, final approver and guarantor
of the work. All authors have read and approved the final version of the
manuscript

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\textbf{Figure Legends}

Fig. 1. Case 1 presentation and treatment result

Fig. 2. Case 2 presentation and treatment result

Fig. 3. Case 3 presentation and treatment result

Fig. 4. Case 4 presentation and treatment result\selectlanguage{english}
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