Importance of Observation in Dermatology

Some of our best prescribers" wrote Dr. Elizabeth Hubbard "stress the importance of objective symptoms which cannot lie”. All doctors know the importance of minute observation, for diagnosis and prognosis of sensing through odour, gait, skin texture etc., the deep processes going on of which the patient is often unaware. Although it is possible to prescribe Homeopathic medicine on the basis of general symptoms but still the importance of proper diagnosis and therapeutic prescription based thereupon can not be denied.

Without the knowledge of disease symptoms we cannot differentiate between pathognomic symptoms (disease symptoms) and non-pathognomic symptoms (individual symptoms). We cannot decide the management and prognosis of case unless and until we know the diagnosis of case. Like in case of vitiligo we have to inform the patient that the patch will change from white to pinkish and then to skin color; this can only be known if we diagnose the case properly.

It also helps us in determining the effect of medicine prescribed by differentiating homeopathic aggravation from disease aggravation. The importance of observation in Dermatology can be summed up under following headings:

Observation for diagnosis: Since most of the skin diseases are diagnosed just by Naked-eye examination. So Observation plays an important part in this respect especially in determining the morphology of eruption. Whether it is macule, papule or vesicle can only be decided by proper observation. Sometimes the thin demarcation between two diseases can only be made by close observation, like recognizing the cases of contact dermatitis.

Observation for patient’s individual symptoms: As we all know that homeopathic medicines are not prescribed on disease symptoms but on individual symptoms. It is the responsibility of physician to decide which symptom is patient’s and which one belongs to disease. For e.g well defined, erythematous, scaly plaques are disease symptom of Psoriasis but excessive itching along with these scales becomes patient’s individual symptom.

For management of case: A perfect diagnosis and management of case based on it also forms an integral part of observation in dermatological OPD. We know that if a patient comes to us with itching between fingers and mite burrows in the area, it is a case of Scabies and it requires strict hygiene maintenance.

For determining response to treatment: As discussed above we can only decide our case is progressing or not if we observe the course of disease. If on giving medicine the disease stops its progress and starts healing then only it means our medicine is benefiting the patient.

There are cases where physical symptoms are not useful in the analysis and their description occupies no more than a line or two; sometimes there are no modalities or characteristic symptoms among those of the presenting complaint and here we pay more attention to the general symptoms.

Always consider modalities, the effect of air, cold, exertion, food, heat, lack of sleep, occupation, perspiration, season, time, touch, undressing, washing, effect of hot and cold water, weather, wool, scratching.

Emotional modalities:admonition and reproaches, anger, effect of expression, effect of suppression, anticipation, anxiety, consolation, contradiction, excitement, mental exhaustion, weeping, stress

Thus we see that a keen observation and an open mind help the physician in his practice at Dermatology clinic. So to help our homeopathic brethren in this endeavor we present the September Issue of Homeopathic Horizon on SKIN-SCAN. This comes out as a sequel of August Issue on Homeopathy and Dermatology wherein we covered the scope of Homeopathy in common skin diseases. In this Issue we have dealt with Difficult yet not so uncommon cases in Homeopathic Dermatology Clinic. Here we have tried to discuss the approach limitations of homeopathy in these cases. Hoping we have come up to your expectations.