Psoriasis is a heterogeneous inflammatory disorder that targets the skin and joints. It affects 1.3-2% of the population. Plaque psoriasis is the most common form of psoriasis, affecting nine out of 10 people with this skin disease. Redness of the skin, silvery scales and red plaques covering the skin are the main clinical signs. Sometimes itching or burning are the only clinical symptoms. The plaques tend to get bigger until they reach a certain size, then they may not change for months or years. Recently there has been an increasing range of conventional treatment options for plaque-type psoriasis. Biological agents are indicated for moderate-to-severe plaque-type psoriasis in adults who fail to respond to, have a contraindication to, or are intolerant to other systemic therapies including cyclosporine, methotrexate and PUVA (1). However, mild or severe side effects of those modern therapies compel patients to discontinue them (2) and sometimes biological drugs have side effects that can be very severe and life-threatening.
Here we present the case of a 41-year-old man, a farmer, who visited our homeopathic medical practice in September 2010. He had been suffering with plaque-type psoriasis for three years. Plaques were mostly located on his chest, abdomen and arms. There was intense redness and persistent itching.
As far as his past medical history was concerned, he had been a very healthy person; measles and chickenpox were the only childhood diseases he had been through. He would get infrequent colds accompanied by high fevers, which, according to G. Vithoulkas’ Theory of Levels of Health (3), signifies a strong, healthy immune system. He was a medium-to-heavy smoker (20-25 cigarettes a day) and consumed at least one bottle of beer daily. From his family historywe obtained the information that his father had also been suffering from elbow psoriasis since the age of 23.
Regarding his main metabolic and physical characteristics, the following stood out to us: he was aggravated by warmth and liked to uncover his feet; there was offensive perspiration of the whole body; there was significant thirst for cold drinks and water, desire for pasta, meat, vegetables, spicy food and olives; he would always be tired in the morning (unrefreshing sleep) though he found that afternoon naps refreshed him.
Analysing the history of his present complaint, we noted the following information: one and a half years before the appearance of the first psoriatic plaques, a romantic relationship that he had been in for eight years had suddenly ended. The separation had happened unexpectedly and had really shocked him, as he had been certain of the prospect of marriage. He manifested symptoms of depression accompanied by insomnia and increased alcohol consumption. Two months after the separation he was prescribed 50 mg of sertraline daily, which he took for more than a year. He said that this treatment helped him considerably. When asked in what way this treatment helped him, he said that he started to feel like a teenager again. He bought a motorcycle again, began wearing an earring, and even began wearing torn jeans! He also seemed to become very lascivious, having sexual intercourse with different women without wanting a steady relationship. When asked whether his novel need for such behaviour might be justified by suppression during his teenage years, he admitted that his strict father had never allowed him to act like a normal teenager. This had forced him to significantly suppress his way of communicating with girls initially, and women later. He had become too timid to make the first step and speak to girls, although his desire had been irresistible.
During the time he was taking sertraline, the first psoriatic plaques appeared. He thought that this was a side effect of the remedy and gradually reduced the dose. Finally he stopped it altogether. However, psoriasis then quickly spread out. The key question for understanding our patient’s total pathology was: what was his behaviour and mental condition like, after the psoriasis appeared and spread out? He replied that he had become so anxious about the appearance of his skin that the lasciviousness had disappeared! It was obvious that his wise organism had saved his mental balance, by offering him a skin madness instead of a mental madness.
Other characteristics of his personality were his inability to fight for his rights; a selective sociability depending on the educational level of people, avoiding the company of highly-educated and intellectual people; and untidiness as far as his personal belongings were concerned, but tidiness and responsibility around places and projects that would be checked by other people. He felt irritable inside but everyone who knew him would say that he was “one of the calmest people they knew”. He was quite diplomatic in his professional environment, but never really had hopes for a promotion. His main life purpose was to become successful with women, as this urge had been suppressed since his adolescence and had never been “cured”. His sentimental development had been fixated at that age.
The above information was sufficient to explain his shock about the sudden separation from his previous partner. It is not uncommon for a shocking event to raise and reveal, in an adult, deeper unsolved problems that have persisted since childhood or adolescence. In fact, many emotional symptoms and behavioural disorders can manifest in the adult if he/she never fully lived out his/her adolescence; this is even more so if there was parental or environmental suppression.
In this case, the mental rubrics of “timidity”, “intolerance of contradiction” and “amativeness” pointed to the homeopathic remedy Lycopodium Clavatum; the decision for this remedy was particularly determined by the knowledge of the effect that the pharmaceutical chemical “sertraline” had had on the patient’s mental level. Although the patient reported that the chemical remedy had helped him considerably, we, as homeopaths, clearly understand that the real effect was the development of a deeper and more severe Lycopodium pathology on the mental level. Five consequent doses of Lycopodium 200CH were prescribed and, within the first month, there was a severe aggravation of the psoriasis (Picture 1). During his first follow-up consultation one month later, the patient admitted that his emotional balance had been better than ever. He experienced many vivid dreams during the first week of treatment and also described a dream about his father shouting and hitting him when he was a child!
To a homeopath, the main question that needs to be answered, especially as regards patients with autoimmune diseases, is the following: Are there only symptoms and rubrics pointing to one remedy, or are there symptoms indicative of a superficial remedy overlying one or more deeper ones? Analysing a large number of patients suffering from autoimmune diseases, we frequently note a pattern where there is a great “distance” between the deeper and the more superficial remedy. This distance corresponds to the gradual, or sudden, change or suppression of some mental or emotional characteristics that are essential for the homeostasis of the mental aspect of the personality. For example, a Pulsatilla child may have been discouraged from crying because “real men don’t cry” and now he has become a Natrium muriaticum adult suffering from rheumatoid arthritis. A Phosphorus child may have been forced to become cruel because “this is a cruel world” and now he is an Anacardium adult with ulcerative colitis. A Sulphur child may have been forced to become a perfectionist because “perfectionism means success” and now he is a Carcinosinum adult with sarcoidosis. In every case, we note that the personality characteristics that, to a homeopath, are keynotes for the deeper remedy (weeping easily in the case of Pulsatilla, sympathy in the case of Phosphorus, untidiness in the case of Sulphur) have been suppressed to the extent that the whole organism has been forced to shift its psycho-endocrino-immunological balance. Thus, the patient presents to the homeopath as someone in need of a completely different remedy, that is a long “distance” away from the deeper one.
In the case we are describing, the metabolic symptoms of the patient were indicative of Sulphur rather than Lycopodium, but the mental symptoms were obviously more important for the first prescription. When the patient was asked whether he could remember himself being always timid and having an aversion to contradiction, he replied that “this had been the story of his life”. However, when asked to pinpoint since when he had become like that and for what reason, he effortlessly revealed that this had been the result of the suppressive behaviour of his father, who had always tried to change him. He said that as a child he had been very expressive, impulsive, joyful, standing up for his rights and even contradicting other people, including his father, when he felt injustice. But, obviously, living in an old-fashioned village environment, he was not the “ideal” son that his father wanted him to be. So, the father tried in every way that he could to mould his son how he wanted.
Delving a little deeper, the patient was asked why, according to his opinion, his father had tried to suppress his impulsiveness. As the patient began talking about his father, he described a typical Lycopodium patient, with great timidity and aversion to contradiction towards his village environment, though dictatorial towards his own family. The pathology of our patient was reflecting the pathology of his father. It is not uncommon for children to become “mirrors” of their parents’ pathologies and this is something we, as homeopaths, must always have in mind when treating patients with autoimmune diseases.
Lycopodium clavatum had wonderful results on this patient. No other dose was ever prescribed after the first five 200CH doses. After the initial therapeutic aggravation, a gradual amelioration appeared and within the next two months, the patient was completely free from psoriatic scales (picture 2). The most important thing is that his mental and emotional balance has been excellent since then and the Lycopodium mental rubrics have gradually disappeared, except for his ability to stand up for his rights and contradict when necessary. However, we can assume with good probability, that when this symptom disappears also, in the future, Sulphur will be the next appropriate remedy and that it will offer a complete cure to the patient. As long as a central rubric of the superficial remedy continues to be seen on the mental level (even though in a less severe form than it used to), we are obliged to wait without prescribing any further remedy.
(2) Yeung H, Wan J, Van Voorhees AS, Callis Duffin K, Krueger GG, Kalb RE, Weisman JD, Sperber BR, Brod BA, Schleicher SM, Bebo BF Jr, Shin DB, Troxel AB, Gelfand JM.Patient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis. J Am Acad Dermatol. 2013 Jan;68(1):64-72.
(3) George Vithoulkas, Erik van Woensel. Levels of Health. The second volume of “The Science of Homeopathy”. International Academy of Classical Homeopathy 2010. ISBN: 978-960-87429-4-9