Follow Up Management in a Case of Psoriasis

The eyes see what the mind knows, and hence the homoeopathic physician must be a keen observer and have a clear understanding of the subject, to perceive the case in totality and also see the unseen. A great amount of hard work is put into case taking and the first prescription, but what after that? Interpreting the action of the remedy and assessing the changes after that, is where the skill of the true practitioner lies.

We must carefully listen to the patient and then, along with our observation, interpret what our remedy is doing. The different possibilities after administering the remedy, like amelioration of symptoms, status quo or aggravation of symptoms are known to us, but the practical application of this knowledge is very important, especially in a chronic case. Let me use psoriasis as an example:

Patient feels he is better: meaning after a dose of the constitutional medicine, the patient is feeling better i.e. Scaling, erythema have reduced and thickness of the lesions and itching has reduced.
Do NOT repeat the constitutional medicine.

Patient says no change at all: Here one has to carefully understand the case.

• Understand the chronicity of the disease and explain to the patient the pathogenicity of the disease.
• Check if the patient is better in any of the associated complaints, and if so, then the medicine is acting in the correct direction.
• Ask the patient for any changes in the symptoms like itching, scaling etc.
• Carefully observe for signs of the disease in the patient e.g. erythema, thickness and inflammation, as these may be things the patient is not be able to appreciate in the initial stage.
• Rule out if the patient is using any local application. If so, when such a local application is abruptly stopped there can be an initial aggravation of the condition.

The eyes see what the mind knows, and hence the homoeopathic physician must be a keen observer and have a clear understanding of the subject, to perceive the case in totality and also see the unseen. A great amount of hard work is put into case taking and the first prescription, but what after that? Interpreting the action of the remedy and assessing the changes after that, is where the skill of the true practitioner lies.

We must carefully listen to the patient and then, along with our observation, interpret what our remedy is doing .The different possibilities after administering the remedy, like amelioration of symptoms, status quo or aggravation of symptoms are known to us, but the practical application of this knowledge is very important, especially in a chronic case. Let me use psoriasis as an example:

Patient feels he is better: meaning after a dose of the constitutional medicine, the patient is feeling better i.e. Scaling, erythema have reduced and thickness of the lesions and itching has reduced.

Do NOT repeat the constitutional medicine.

Patient says no change at all: Here one has to carefully understand the case.

• Understand the chronicity of the disease and explain to the patient the pathogenicity of the disease.
• Check if the patient is better in any of the associated complaints, and if so, then the medicine is acting in the correct direction.
• Ask the patient for any changes in the symptoms like itching, scaling etc.
• Carefully observe for signs of the disease in the patient e.g. erythema, thickness and inflammation, as these may be things the patient is not be able to appreciate in the initial stage.
• Rule out if the patient is using any local application. If so, when such a local application is abruptly stopped there can be an initial aggravation of the condition.

If after considering all the above possibilities, the patient is still not feeling better, then review the case and prescribe the constitutional medicine.

Patient is better but new patches are coming

• Rule out seasonal aggravation.
• Rule out any mental or physical stress that can add new patches.
• Rule out if any other medication is taken, especially anti-inflammatory, as these aggravate the psoriatic patches.

DO NOT REPEAT THE CONSTITUTIONAL.

• If the patient is better, new spots will come and slowly reduce in frequency and intensity and finally stop.
• Monitor the patient with the number of new spots every month.

Complaints are increasing continuously

Here one must ascertain whether the increasing trend of new patches is the same as when the patient started the treatment, or has the severity increased?

• If the intensity is the same, then disease is progressing in its usual course—disease aggravation
• If the intensity is increasing a lot then it can be due to medicinal aggravation.
• Sometimes sudden stoppage of allopathic medication can also cause increase in symptoms.

If it is homoeopathic aggravation, the generalities of the patient will be better and one can wait and watch.

If it is disease aggravation, then antidote the medicine and change the medicine.

Patient says he was better initially but then no change since the last few months.

• Rule out obstacles to cure like smoking, cosmetics, irregular intake of medicines.
• If patient was better initially and no change for the last 2-3 months, repeat the constitutional.
• If after repetition patient is not better, then give an intercurrent medicine.
• If there is no change, then it was a partial simillimum. Review the case and give the correct constitutional medicine.

This was just a glimpse of the various aspects to be understood in the follow up management of a chronic case.This understanding indeed helps us to make a better prescription and avoid over-medication, which itself masks the case.