A comparison of the conceptual understanding and management of Acne Vulgaris amongst registered homoeopaths and izinyanga in KwaZulu-Natal

Abstract

INTRODUCTION Acne vulgaris commonly known as ‘acne’ is a chronic skin disease that is caused by inflammation or blockage of the hair follicles and their associated pilosebaceous units. Acne vulgaris typically affects areas of high density of sebaceous follicles such as the face, neck and back. More than 85% of the adolescent population including 20% of adult women and men worldwide are affected by acne vulgaris. Acne vulgaris further accounts for more than 3.5 million general practitioner appointments each year, making this disease a health concern worldwide. Dermatologists are medical practitioners who are qualified to diagnose and treat acne vulgaris. In the province of KwaZulu-Natal patients suffering from acne vulgaris frequently consult homoeopathic as well as izinyanga traditional health practitioners for the alleviation of their skin ailments. However, little is known about the conceptual understanding together with the management of acne vulgaris amongst registered homoeopaths and izinyanga in KwaZulu-Natal. AIM The aim of this study was to explore and compare the conceptual understanding as well as the practice and management methods of homoeopaths and izinyanga in the treatment of patients with acne vulgaris in order to fully understand their conceptual understanding and management of acne vulgaris. METHODOLOGY An exploratory study using qualitative research techniques together with inductive reasoning processes was employed to collect data from six registered homoeopathic practitioners and six registered izinyanga traditional health practitioners in KwaZulu-Natal selected by means of judgemental sampling and snowball sampling respectively. Semi-structured interviews in a face-to-face situation were utilised to collect the primary data. The collected data was then transcribed and analysed using framework analysis. RESULTS The results showed that the homoeopath and izinyanga respondents shared similar ideas in terms of their conceptual understanding and management of acne vulgaris. Both groups of practitioners held that acne vulgaris on its own was not purely a disease but was rather a symptom of a deeper underlying cause. Furthermore, both of them prescribed their treatment based on individualisation. Homoeopaths understood the disorder as an outer expression of an inner underlying pathology that presented itself outwardly via visible signs and symptoms. Suppression of the sycotic miasm together with hormonal imbalances were the two main underlying pathologies that they believed were the cause of acne vulgaris. Homoeopaths made their medical diagnosis based on physical examinations together with the past medical history medical history of the patient. Lastly, homoeopaths managed their patients through detailed case taking, constitutional and similimum remedies. Izinyanga described acne vulgaris as isichito (a human made curse to ruin ones skin or to break up a relationship), that was placed by abathakathi (witch doctors) or jealous individuals with the intention of ruining one’s face or with the aim of separating a couple. Izinyanga used ukuhlola (the use of ancestral powers to diagnose patients). Lastly their treatment regime consisted of a combination of herbs and natural elements (collectively known as uMuthi) together with ukugquma (i.e. steaming, where one exposes the face for several minutes to steam coming from a very hot pot while covering the head with a blanket draped over the pot) and ukuphalaza (to vomit or to clear the stomach through induced emesis). There were, however, a few differences between these two medical systems. Homoeopaths believed that in addition to the prescribed treatment patients should undergo counselling. The izinyanga did not share this idea. In addition, the izinyanga believed that witchcraft was a barrier to treating acne vulgaris patients while the homoeopaths did not mention this in their responses. CONCLUSION The conceptual understanding and management of acne vulgaris amongst the homoeopaths and izinyanga interviewed appeared to be similar despite a few differences in their treatment regime. Additionally, considering the fact that acne vulgaris is a chronic disease that affects the majority of the adolescent population at large and that many of these affected individuals consult either homoeopaths or izinyanga for the alleviation of their skin ailments, a co-operative practice between these two health practitioners is paramount. Furthermore, more awareness about the treatment methods offered by homoeopaths and izinyanga should be promoted within the healthcare system.