Clinical Cases

A Case of Atopic Dermatitis

Homeopath Petr Zacharias presents a case of atopic dermatitis in a 3 year old boy. This is a perfect teaching case with a number of important lessons.

First visit –June 19, 2014

A 3-year-old boy arrives with his parents because of atopic dermatitis, which he developed half a year ago and which is localized on his buttocks, legs, and abdomen. The eczema is not very itchy, it does not react to water and the boy can sleep at night without problems. He also suffers from frequently recurring laryngitis occurring once or twice a month. He tends to have rather higher fevers, 38.5°C. Psychologically he is very dependent on his mother and he does not tolerate the presence of strangers (3). When he comes into contact with strangers, he hides behind the mother. When he was younger, he cried every time somebody leaned over his bed. His mother had to take him out of the kindergarten as he did not tolerate being there alone. He isolates himself and does not want to play with other children much. He started walking at 18 months of age, his speech developed normally, fontanelles closed in time, height and weight are normal, and he has no complaints with teeth. His head is bigger than usual, compared to his body size. Perspiration is normal. Observation: he is hiding behind the mother and he speaks about himself in the feminine gender.

Analysis of the case and investigation of the information:

The first thing that I observed during the interview with the boy was that he avoided direct contact. He did not want to talk and he hid behind the mother and kept staying very near to her. Although it was my first impression, the mother confirmed this to be very characteristic for the boy. Therefore, the first remedy that came to my mind was Baryta carbonica, which has these symptoms as keynotes and at the same time, it is one of the main remedies for frequently recurring colds, when the symptoms agree, of course.

Here, the reader might ask why we are discussing all these things, but not eczema itself, which represents the main problem of the child. It is necessary to realize that in each case where the main complaint manifests locally (e.g. eczema), these local complaints only represent final consequences of what is going on within the organism. If eczema exhibits some prominent characteristic or peculiar symptoms, then these symptoms can be very important, especially when they are very rare. If there are no such peculiar local symptoms like in this case, it is not an obstacle, especially when we see some general symptoms. These generalized symptoms (so-called generals) have much higher value for us than local symptoms (except the very peculiar local ones) because they show us the way the organism works as a whole and thus individualize the case the most. In this way, generals enable us to see a more complete picture of the disease, whereas the local symptoms show us only a small part. For this reason, the local symptoms have the least value during the selection of the remedy (unless they are very peculiar or intense).

When I was questioning about other confirmatory symptoms of Baryta carbonica, I was not able to find any further confirmation. However, considering the symptoms I observed, Baryta carbonica was the only remedy which covered the above-mentioned symptoms as keynotes.

Depth of the disturbance:

The complaints of this child manifest partially in the physical body (skin and recurrent laryngitis) and partially on the psychological level. On the other hand, eczema is not serious from the medical point of view and the other complaints the child suffers from are not of a serious type either.

Prognosis and level of health:

Frequency and course of acute diseases belong to the main parameters through which we are able to determine a person’s level of health1. As acute diseases of this child are very frequent, sometimes even several times a month, and they need treatment, it is probable that the child’s organism belongs to the level B61. The fact that the child develops high fevers is favorable for the prognosis, but on the other hand, complaints on his psychological plane make the prognosis worse.

Choice of the remedy, potency, and dosing:

Because there were very few symptoms in the case (or more precisely, I was not able to find more) and all of them were keynotes of Baryta carbonica, I recommended this remedy in a single dose. With regard to the child’s level of health, I chose 200C potency.  It is possible to start with a much higher potency in the level of health B6, namely 1M, but since the picture of the remedy was not absolutely clear (I could not find any more confirmatory symptoms), I opted for the 200C potency.

Recommendation: Baryta carbonica 200C single dose

Follow-up 1, August 28, 2014

The boy took the remedy 2 months ago. After the remedy, his eczema got worse for about 2 weeks and then it got better. However, his psychological state has worsened. He constantly wants to be with his mother and he is afraid of strangers. Both these symptoms were worse than before the remedy (3).

Analysis of the first follow-up and investigation of the information:

A reaction of this type is something that no homeopath likes to see. In spite of the short initial aggravation which occurred shortly after the remedy, further development shows with certainty that the remedy has had a suppressive effect and thus, it was incorrect. Amelioration of local symptoms and aggravation (or emergence) of deeper complaints, in this case, psychological ones, shows that the remedy has caused a suppression of eczema into deeper structures of the organism. The question remains what to do in such a situation.

We know from practice that a partially similar remedy can act in two ways, that is, positively or negatively. In the first case (the positive), original symptoms get stronger after a partially similar remedy and/or they are joined by some new ones which, together with the original ones, create a clearer picture of symptoms compared to the state before the administration of the remedy. In such a case, it is necessary to prescribe on this new (clearer) picture of symptoms. In the second case (the negative), the remedy changes the symptoms and these new symptoms do not clearly point to a remedy. In such a case, it is necessary to study the original symptoms and to find a better suited remedy based on the original (clearer) picture of symptoms.

In this particular case, I did not observe any new symptoms, but some important symptoms of Baryta carbonica became stronger. However, Baryta carbonica had a suppressive effect. The first thing that came to my mind was that I must have overlooked something important in the case or that I did not ask about something crucial. There might be a remedy which also has the boy’s symptoms as keynotes (apart from Baryta carbonica) and I either did not consider it or I do not know it. In any case, the reaction clearly shows that Baryta carbonica was not the correct remedy and it is necessary to look for another one, based on the original set of symptoms. Some of the original symptoms have become more prominent after giving Baryta carbonica. It is favorable that there has not been any change of character of the symptoms after the remedy. The ability to maintain the same symptoms in spite of the influence of a partially similar remedy points to a strong organism.

When going through the original case record, I noticed that the mother

spontaneously said this: “Already as a small child he started crying every time when somebody leaned over his bed.”

This is a very important symptom, which can be interpreted as aggravation from being approached. The corresponding rubric in the Synthesis2 repertory is MIND – APPROACHED by persons; being, agg.  Although this rubric contains 7 remedies, only one of them has this symptom as the main keynote, namely Arnica montana. Arnica is known for its aggravation from being approached by others, which can be the reason for the boy’s behavior and aggravation in the presence of people, especially strangers.

Symptoms of Arnica often (although not always) develop as a consequence of an injury, especially head injury. Little children can experience such an injury during birth, for instance. My first question was, therefore, aimed at the details  of the course of the child’s delivery. Te mother reported that the boy developed a cephalohematoma during the delivery and it took half a year to get absorbed.  To my question about the time when his aggravation from being approached started, the mother replied: “He did not tolerate when somebody

tilted towards him or got closer to him already as a small child.” He started crying every time he saw somebody coming near to him and he still does not

tolerate being approached or when somebody is close to him nowadays.”All these symptoms are keynotes of Arnica which also has a very specific symmetrical appearance of eczema, creating identical shapes of the same size on both sides of the body. However, the eczema of this child was not symmetrical. This does not exclude Arnica, though, provided that we are able to find some keynotes of this remedy in other areas, in this case, in the psychological area and the personal medical history of the child (cephalohematoma).

Intense symptoms:

  1. Hiding behind mother
  1. Fear of strangers
  1. Head injury in the personal medical history

Peculiar symptoms:

  1. Aggravation when being approached

Repertorization in RADAR with Synthesis 9.1 repertory

The repertorization has been made using the technique of summary of symptoms with consideration of their intensity (For Radar users: Sum of symptoms and degrees – intensity is considered)

 

112341MIND – HIDING – himself – children – mother; behind1
212342MIND – FEAR – strangers, of20
312341HEAD – INJURIES of the head; after43
412343MIND – APPROACHED by persons; being – agg.7
arn.con.phos.ign.lyc.stry.bry.bar-c.kali-p.sil.
1914121010109877
11
222111211
33122
42131112

 

Differential diagnosis:

Arnica is a remedy which covers most of the symptoms of the totality as keynotes. This remedy can be found in the rubric “Fear of strangers”, together Baryta carbonica, but there is one essential difference between these two remedies. Baryta carbonica is not aggravated from being approached, but it is a very shy remedy and it can, therefore, look similar. However, in the personal history of the child, we can find strong reactions to situations where somebody approaches him, and this symptom that cannot be found in Baryta carbonica. The history of the head injury is another important symptom. Of course, it is important to keep in mind that the possible link between the head injury and the child’s current complaints has not been proven. However, both the history of the head injury and current complaints are keynotes of Arnica. In other words, the current symptoms, as well as the symptoms from the past, are covered by one remedy, which makes the prognosis of the case significantly better. Fear and aggravation from being approached by others can be perceived as an essence of this remedy.

None of the other remedies that have come up in the repertorization has this symptom, which is very prominent and long-lasting in this child, as a keynote and that is why Arnica is the remedy of the first choice. It corresponds not only with this symptom and covers it as a keynote but it also covers the history of the head injury and fear of strangers. Therefore, we can say that Arnica covers the totality of symptoms, keynotes, the possible aetiology and the essence.

Recommendation: Arnica 200C single dose

Follow-up 2, September 12, 2014 (via e-mail)

“Hello, it has been 2 weeks since the administration of Arnica. My son’s psychological state has improved. He started going to the kindergarten. So far, he has been there alone twice for about an hour, including a snack break. It is a significant improvement that he does not cry anymore. Although he tends to cover his eyes, turns away, does not want to talk, he goes to play. He can say when he needs to go to the toilet. He comes with the other children to the lunchroom and has a snack. His teacher says that he plays nicely. Last night, he complained about a stomach ache. He woke up frequently during the night, gagged as if he was about to vomit (the whole night), but he did not vomit. He did not complain about the stomach ache anymore then. In the early morning, he developed some coryza and he started coughing. His cough is barking and wheezing. His colds usually used to start like that. He always used to have nightly aggravation with such a cough. Within a few days, he used to start expectorating. There is almost no cough during the daytime and he only has a runny nose.”

Analysis of the second follow-up and investigation of the information:

The child has improved psychologically without any noticeable initial aggravation and he currently has an acute disease. We know from the original analysis that the child gets ill very often and belongs to the level B6. When we give a remedy to such a child, we can determine the correctness of the remedy from the course of an acute disease that appears after the remedy (taking into consideration changes in the child’s general state, of course). In patients from group B, we do not usually observe an immediate decrease in the frequency of recurrent acute diseases after a remedy, however, the immune system should start functioning better which should manifest as a decrease in the frequency of acute diseases and the acute episodes should last shorter. However, the course of the acute diseases can be more violent in the sense that the symptoms can be more intense and fevers can be higher. Nevertheless, their overall course must be less serious than before the homeopathic treatment.

Considering the psychological improvement which continues, it is possible that the remedy was correct, but as it has only been 2 weeks, we do not know whether the improvement is long-lasting. On the other hand, we can use the current acute disease to assess whether the remedy is acting correctly and whether it has influenced the child’s immune system to some extent. Because the acute disease has only started a few hours ago and its course is not serious, it is best to wait a few hours and watch the further development. Therefore, I advised the mother to inform me about further progression in 1-2 days and 2 days later, I got the following message through e-mail:

“Nightly cough was somewhat worse than usually in the sense that he vomited more than he used to. However, the whole episode had a quicker course. Yesterday, his uncle came to visit us. In the past, it took my son a few hours to get used to him and to stop being ashamed, but this time, it was not a problem. He immediately communicated with him and they played together.”

At this point, we have two important pieces of information at our disposal, namely the persisting psychological improvement and faster but somewhat more intense course of the acute disease. Both these pieces of information together point to the fact that the remedy is acting correctly and it is necessary to wait without any intervention.

Recommendation: wait

Follow-up 3, October 22, 2014

The psychological level has still been getting better. The boy likes to play outside, he does not have acute diseases, there was a strong aggravation of eczema for a few weeks and it subsequently started improving. Now his skin has a much lighter color. He does not have any coryza or a cough, which was unthinkable before. He also stopped using the feminine gender when talking about himself.

Analysis of the third follow-up:

It has been one month since the last follow-up and the boy’s psychological state has improved further. The mother also reports that when the improvement of the psychological level set in, eczema appeared again for some time but it has been improving recently. This is crucial information for us because the eczema was suppressed by Baryta carbonica and the psychological level got worse then. The psychological level should improve and eczema should reappear after a correct remedy (according to Hering’s law “from within outward”) and it should then subside (in accordance with another Hering’s law “from above downward”, thus from face towards lower extremities). Apart from this information, the mother tells us that the boy has not had any acute disease since the first episode and he stopped talking about himself in the feminine gender.

Recommendation: wait

Follow-up 4, March 9, 2015 (via e-mail)

“My son had a coryza with a cough in December. He had a 37.6°C fever and the disease lasted shorter than in the past. Since then, he has been healthy apart from a very mild coryza in January. About a month ago, his eczema got much worse on his buttocks and one leg and it also appeared on the abdomen and one hand. It was very red, but it is currently getting paler. The skin is still dry and rough. His psychological level has still been getting better. He has become more communicative in the kindergarten and he has even made some friends. He gradually starts getting involved in collective activities and he tries new toys. He has no problem telling me goodbye. He is less shy when we have visitors. He takes part in parlor games.”

Analysis of the fourth follow-up:

Apart from one short episode of a coryza with a cough, the boy has not had any acute disease for the whole time and his psychological state has been getting even better. The aggravation of eczema one month ago could mean a beginning of a partial relapse, but as the general improvement continues and his eczema started improving spontaneously, it means that the organism succeeds in dealing with the situation by its own means. For this reason, it is necessary to wait.

Recommendation: wait

1 VITHOULKAS, G., WOENSEL, E. The Levels of Health: The Second Volume of The science of homeopathy. Athens, Greece: International Academy of Classical Homeopathy, Center of Homeopathic Medicine, STR.A., 2010. ISBN: 978-9-6087-4294-

2 SCHROYENS, F. The Essential Synthesis 9.2E. London: Homeopathic Book Publishers, 2007. ISBN: 978-0-9557151-0-5

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About the author

Petr Zacharias

Petr Zacharias

Petr Zacharias is the founder and main teacher at the Prague College of Classical Homeopathy. He studied with George Vithoulkas at the IACH and has conducted seminars with Dr. A. U. Ramakrishnan, Dr. S. K. Banerjea, Dr. Jorgos Kavouras and Erik van Woensel.

4 Comments

  • Thank you for sharing us your method of follow up the patient. to find the similimum is very important, but I think that the right follow up is at least as important. Please keep us in touch with the evolution of this case!

  • Wonderful presentation of case. Got to learn new aspect of Arnica, and the meaning of the rubric Approached. Thank you so much Petr Sir.

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