A Case Of Urticaria And Atopic Dermatitis

A female 27 years, has been suffering from atopic eczema since 8 months of age. She used to take creams with corticosteroids and now the eczema appears only during winter.  In 2015 she weaned off hormonal pills and then severe urticaria has developed. It appeared for the firs time in the evening but since then it occurs mostly in the morning after waking up, especially when she has drunk some alcohol the evening before. When the urticaria appears, it is a very severe type with great swelling (3) affecting large portions of the skin. She loves sun and is ameliorated by it. After withdrawing from hormonal pills she perpires more on her feet and in axilla and the perspiration is sometimes offensive (2). For long periods of time, she feels worse regarding her energy, especially in the afternoon but there is no particular time. Sometimes she has troublesome sleep but it happened only twice in the last month. She had suffered from epistaxis in the morning until 13 years of age, when it disappeared after some injection.

Analysis of the case and the questioning

Since the very beginning it has become evident that the urticaria is the main complaint. Eczema is still there during winter but it is suppressed. We don‘t know the origin of the urticaria, but it is possible that the hormonal system is involved as this problem is linked to withdrawl from hormone pills. One of the remedies we think of when seeing urticaria with very strong swelling is Apis mellifica but here it is contraindicated as the patient is ameliorated by sun which is the exact opposite of Apis, which is very aggravated when exposed to sun. Another possibility is Rhus toxicodendron which is very ameliorated by sun and has the urticaria as well but there were no other confirmatory symptoms like stiffness, joints problems, strong desire to milk, aggravation from cold and dampness or restlessness. I also thought of Sepia due to the possible hormonal origin of the main complaint and amelioration from the sun, but I could not find any confirmatory symptoms as well.  She also noted the need to sleep with a light on whenever she is alone at home but if there is somebody in the house there is no problem sleeping in a dark room. This is very typical for Lycopodium but again, I asked about keynotes of Lycopodium but this remedy could not be confirmed.

On the one hand I realized the present symptomatology was confusing but on the other hand I recalled the symptom which she does not have for very long, but which was very clear when she used to have it. It does not mean that the old symptoms which are not there anymore always lead us to the correct remedy but sometimes it can give us the idea of the remedy which we have not thought of and which can be further confirmed. Simply said, in some cases we are not able to see the picture from the present symptomatology alone, because it lacks characteristic symptoms. But sometimes (not in every case) when we combine this present symptomatology with some old symptoms, it creates a clear picture which we can further confirm by careful questioning. This is going to happen only in cases where the level of health is good enough to keep one remedy indicated through more stages of the disease (the patient needs the same remedy now as in the past).

The symptom I meant was the epistaxis in the morning, because she used to have it very often and for very long period of time. I opened the rubric: NOSE – EPISTAXIS – morning

There are 72 remedies in the Synthesis repertory in this rubric but only 6 remedies are listed in the 3rd degree. I looked at those six and one of them was Bovista (in 3rd degree) which impressed me the most as I knew that this remedy has very strong urticaria in its symptomatology. I thought: my god, is that possible? Is it possible that this is a case of Bovista? I dont know but I tried to ask her for its keynotes. One of the very important keynotes of Bovista is awkwardness of hands, especially before menses. The patient is in a kind of  irritable state before menses and in that state this akwardness is most pronounced.

So I asked: have you ever experienced awkwardness of your hands? She replied: “Yes, every month there are one or two days that I have the state of inner irritability in which I want to put e.g. sugar into a cup but I put in on the table instead or I want to put some papers into a box but I miss and put it on the ground instead, etc.”

I was thinking: okay, when she has it once a month, maybe it is associated somehow with the menses, so I asked: “Did you notice any connection between those states and menses?” She replied: “I dont know, I have never thought this way, so I can´t say..”

Well the next thing I wanted to find out was how old this symptom is, because if it is new one, it has much greater value as it would belong to the uppermost layer, so I asked: How long have you had this awkwardness, and she said: “Since I withdrew the hormones”, which means that this symptom began at exactly the same time as the urticaria and both are the keynotes of Bovista as well as the old symptom which makes her prognosis much better.

It was all I had at that moment but to be sure I opened Boericke‘s materia medica to study skin symptoms of Bovista more in depth. We know that when urticaria appeared the first time, it was after bathing and then always in the morning. In Boericke’s chapter on skin we can read: ” Urticaria on waking in the morning, worse from bathing.” And that was my final confirmation of this remedy.

Prescription: Bovista 200C single dose

1st Follow-up (5 months after the remedy)

She took the remedy five months ago and she does not remember if there was any aggravation initially but since then the urticaria has never come back again. Her eczema that was suppressed has worsened and now it covers the same areas as in her childhood which are bends of elbows, both legs and the back of her hands. She has it the same as in childhood, in both arms (in bend of elbows) on her whole legs. She is less irritable and episodes of awkwardness are gone. The eczema is very aggravated by washing (3). She can even sleep at home in a dark room when nobody is there. She told me that last week she had little pieces of blood in mucus when blowing her nose and complained of bruiuses that appear spontaneously on her skin. This is an old symptom but now it is much stronger.

Analysis of 1st follow-up

Although we lack the information about the initial aggravation, there are several factors that show us that the remedy acted correctly, like disappearance of the main complaint and reappearance of old (suppressed) symptoms which is an eczema in this case. In eruptions which are aggravated by washing we have to think of remedies like Sulphur, Psorinum, Mezereum and Antimonium crudum, but I was not able to confirm these remedies sufficiently. I asked her to show me her arms and I spotted that the eruptions cover exactly the same places, creating the same shapes on both sides. This kind of (symmetrical) eruptions is a keynote of Arnica as well as ecchymoses which is now much sronger than in the past.

Prescription: Arnica 200C one single dose

2nd Follow-up (4 months after Arnica)

There were no initial aggravation after the remedy but within 2 weeks itching after washing disappeared as well as bruises. It was the summer which is the part of the year in which the eczema is almost gone (it used to be like this in the past) but on the other hand, itching disappeared very quickly and bruises also and that cannot be explained by the summer. The only thing that remains is the perspiration which is stronger. She has neither eczema nor urticaria and feels less irritable and the awkwardness and bruises are gone.

Analysis of the 2nd follow-up

All complaints disappeared and she feels better generally. The perspiration itself is not sufficient for the remedy prescription and her state which is much better generally shows that the remedy is still working and therefore it is neccessary to wait.

Prescription: wait