Management of Recurrent Vulvovaginal Fungal Infection with Concomitant Digital Dermatitis with Homoepathy.

A 30-year-old female patient [Patient ID –54632] presented with complaints of intense itching around the vulva, accompanied by whitish vaginal discharge and burning during micturition, which had been ongoing for the past two months. The symptoms had a gradual onset, initially manifesting as vulvar itching, which later progressed to abnormal discharge. She also complained of fungal-type lesions on the left index and middle fingers, involving the distal and middle phalanges, triggered by exposure to detergents and washing soaps. The finger lesions were intensely itchy, with scabs and hyperpigmentation. The patient described the vulvar itching as severe, while the discharge was mild but persistent.

Past Medical History – The patient had suffered from typhoid and had undergone vocal cord surgery. No other systemic illness was reported.

On Examination, Hyperpigmentation and scabbing were noted on the affected fingers, while the vulvar area showed mild erythema with excoriations due to scratching. No systemic signs of infection or other dermatological involvement were observed.

Physical Generals – The patient had an average body build, moderate appetite, and no specific cravings or aversions. Bowel and urinary habits were normal. She had a high fluid intake of 2–3 liters/day, profuse sweating, and a thermal tendency toward heat. Sleep was sound.

Menstrual History – Menarche had occurred at age 13, with a current regular 25-day cycle. The last menstrual period had occurred 3–4 days before presentation.

Mental Generals – Mentally, the patient was calm, gentle, confident, affectionate, and expressive, though she occasionally experienced irritation if household work was delayed. She had a well-supported social and family life, living with her spouse, who worked in the GST department, and a 5-year-old daughter.

Past Treatment – Previous treatment had included oral itraconazole 200 mg once at bedtime for three days, Fentosa 600 mg vaginally on alternate nights for two doses, and Surfaz-SN cream (beclometasone + clotrimazole + neomycin) applied locally twice daily for seven days. Lactacyd perineal wash was used twice daily for one month. These treatments had provided temporary relief; however, recurrence occurred if medications were stopped prematurely.

Follow-ups:

• During the first follow-up on 04/07/2024, the patient had significant improvement in itching and burning. However, symptoms recurred within 2–3 days of stopping medication, highlighting the chronic and recurrent nature of her condition.
• On 14/08/2024: Mild white discharge occurred once every 3–4 days; daily itching continued but at a reduced intensity. Redness and burning sensation were no longer present, indicating partial improvement in inflammation.
• On 25/09/2024: The overall condition had improved by 60–70%. Itching was significantly reduced, and redness occurred only occasionally, 2–3 times per month. Burning during micturition was markedly better. However, whitish vaginal discharge had increased over the previous 20–25 days, necessitating 3–4 panty changes per day due to wetness.
• On 07/11/2024: The patient experienced no fresh complaints. Redness and burning were minimal, and whitish discharge was slightly reduced. Itching had improved considerably. Panty changes remained at 3–4 per day due to residual wetness.
• Last follow-up taken on 18/12/2024: The patient remained asymptomatic for the past two months without any medication. No episodes of itching, burning, or discharge had occurred, indicating sustained recovery. Overall improvement was assessed at over 80%.

Conclusion:

The patient showed gradual and sustained recovery from recurrent vulvovaginal candidiasis and mild dermatophytic lesions, with marked reduction in itching, discharge, and burning, achieved through symptomatic treatment with homeopathy.

• Case study written by – Dr. Shreya Hedaoo, an associate Doctor to Dr. Rajesh Shah, MD (Hom.)