This is the case of Miss Y, a 14-year-old female, that has been successfully treated for acne that she had been suffering from since the onset of puberty.
INITIAL APPOINTMENT (04 MAR 2019)
Miss Y is a 14-year-old female with a chief complaint of facial acne that started around the same time that her menses started in Aug 2017. She attended the initial appointment on her own, with her mother’s consent. At the time of her initial appointment, I observed some acne on her forehead, cheeks, chin and eyebrows as well as small comedones on her nose.
Diagnostics: None provided at the time of initial appointment
Previous Health History: Eczema – started at 6 months of age and lasted until she was about 2 years old.
Does not take any supplements or vitamins
Vaccinations: All vaccines are up to date and last vaccines were for HPV & Meningitis – 2018
Family History: Diabetes, Heart Disease, Depression, Anxiety, Cancer
Miss Y is of average height with a stocky build. She has thick, tight curly hair that is cut short. She has blue eyes, light brown hair and was dressed very casually. Her skin is pale but with visible signs of inflammation from acne at various stages of healing. In touching the skin on the forehead using gloves, I was able to feel hard nodules or small hard bumps under the surface of the face. The bumps or acne were not painful on her forehead and cheek, but they were bothersome to miss Y because she did not like the way they looked.
Miss Y is a 14-year-old female that came to me for facial acne. She referred to her acne as ‘stars’ on her face. There are some small blackheads and mild acne on her nose and cheeks, chin and forehead. The blackheads on her nose were visible but not inflamed. The facial acne was inflamed on her cheeks and forehead, producing some red spots. She has noticed some smaller acne on her shoulders with a little pus but these were not painful. Despite her ‘stars’, Miss Y has healthy looking pale skin with some tiny freckles on her nose. Her skin is very sensitive and she gets burned easily from the sun. She hates taking showers or bathing and does not want to take her clothes off to get washed. She has noticed an increased amount of thick yellow ear wax when she cleans her ears after a shower.
At the time of her initial appointment, she started a new school for Grade 9. She completed semester 1, however refuses to go to school for semester 2. She has clarified that she has not been bullied or picked on, however there are a couple of people in her class that ‘annoy’ her. She loves art class but is not fond of English or religion classes. For the past 3 weeks, she finds it hard to wake up in the morning during weekdays, and does not look forward to going to school. She struggles to get out of bed, struggles to get dressed and is often late getting to school if she goes. She refuses to get ready for school, claims to feel unwell and when pushed to get ready for school, gets emotionally upset and starts to cry. Her refusal to go to school is creating conflict with her parents in the morning. To her, school is like hell or jail; that being in school ‘feels like regular people have power over me’ and that ‘everybody hates school work’
She has an easy-going disposition and appears to be always smiling. She’s a very artistic, creative person who likes to draw anime characters and cats. Miss Y spends most of her spare time sleeping or on the computer watching movies or playing games. She currently is not part of any social or sporting activities. She found it very difficult to talk about herself or her interests, and kept changing the subject to avoid answering the questions. She would turn her attention to watching cat videos on the tablet to avoid answering questions about herself.
In her mind, ‘teenagers are very lazy, sleep a lot, play on the phone, watch Netflix – don’t care about the life outside of their own life’. Miss Y sleeps 12 hours and more when she can. She prefers to be ‘lazy’ and keeps her room messy. She rarely gets angry, but when she does, she will at the person to leave. She has a great fear of spiders. She is a very quiet person who likes personal privacy.
She gets seasonal allergies when the weather starts to get warm. She gets red, itchy eyes and occasionally sneezes a lot. Her allergies last from spring until fall when the temperature starts to get cold, which gives her some relief. She is allergic to some flowers, such as tulips, dandelions and daisy. She is also allergic to dust and sneezes from cat hair. Her nose gets very dry during this time and gets nosebleeds which tend to happen mostly during the night while she is sleeping. The blood of the nosebleeds is typically bright red and occasionally has dark-red jelly-like blood clots with it. They happen randomly and without warning.
She does not find oral hygiene important and her mother is constantly reminding her to brush her teeth. The patient said she could go days without brushing her teeth.
Her mother has noted that Miss Y used to suffer from severe eczema as a baby, she was covered from head to toe. The eczema was red, itchy and would bleed easily if scratched too much – her mother had to put socks on her hands to prevent her from scratching all the time. The family doctor prescribed many topical cortisone creams in various strengths, but nothing worked. Her mother found that the best way to relieve her symptoms was to give her a warm bath and rub Vaseline all over her body. The symptoms got better after this and Miss Y has not had any eczema since. Eczema started at 6 months and lasted until she was 2 years old.
Miss Y is a warm person in general except when she sweats, her feet would feel cold to the touch and get stinky. Her shoes get stinky from the perspiration, the smell would get worse when not wearing socks. (She normally hates wearing socks) She hates the hot weather and prefers the cold weather, she likes winter, specifically the late fall season. She likes to sleep, preferably 12 hours or more and does not like to be woken up in the morning. When her brother wakes her up in the morning, she tends to yell at him and throw anything she can to get him to leave her alone to go back to sleep. She likes to sleep fully dressed, no socks, with one cover on but leaving her head, hands and feet out.
Miss Y loves sugar, she craves it daily. Her mother has noted that is Miss Y does not get a ‘daily dose of sugar’, she can become quite irritable. She likes to eat rich, starchy foods such as cheese, lasagna, pasta, pizza, Chinese food (rice). She is typically not very thirsty. She says that her urine is normal yellow colour, but she only goes 3-5 times a day. Her mother has noticed that her urine leaves behind a strong pungent smell that is very noticeable after she goes to the washroom. She used to get episodes of constipation, however she is now able to go regularly once a day. During her last episode of constipation 5 months ago, it lasted for approximately 4+ hours where she would get a strong urging for a bowel movement but could not move it. It was so painful that she was afraid to go poo.
Miss Y is in good health overall and rarely gets sick. She has received all her scheduled vaccinations since birth, the last two vaccinations were the HPV and meningococcal vaccines. She does not smoke, drink, or do any recreational drugs, but she does enjoy cold caffeinated beverages 1-2 times a week. When asked about exercise, she would only say ‘not much’.
REPERTORIZATION (Using Mac Repertory (Kent’s Repertory) – By Totality):
- Face; ERUPTIONS.; acne (41)
- Eye; ITCHING (101)
- Eye; INFLAMMATION (133)
- Generalities; CHANGE; weather agg. (52)
- Teeth; DENTITION; difficult (16)
- Female Genitalia; LEUCORRHOEA; acrid, excoriating (86)
- Mind; SENSITIVE; noise, to (90)
- Mind; TIMIDITY (77)
- Mind; INDOLENCE (138)
- Mind; IRRITABILITY; waking, on (51)
TOP 2 REMEDIES & ANALYSIS
PULSATILLA – is another remedy for acne at the onset of puberty in girls who are affectionate, mild tempered and timid with a yielding disposition, as seen in the patient’s normal constitutional state. The remedy is adapted to persons that are fleshy with sandy hair, blue eyes, pale face and who are easily moved to laughter or tears. A striking symptom in this remedy is indolence, which was also striking in the patient, as she preferred to be lazy; too lazy for have a bath or personal hygiene, to get up in the morning, to change clothes, etc. Congestion usually affects single parts, typically the mucus membranes, where it produces dry eyes with a lot of redness and burning, as experienced when hayfever season begins. The strong urine is another striking symptom in the patient for her age as well as nocturnal enuresis, both of which were covered in the remedy. The stool is hard and large which is also a keynote of the remedy. The remedy also covers the waking in the morning feeling tired, irritability on waking, feeling worse when overheated in general, better in the cold air, desire for cold drinks, stinky, sweaty feet and crack in the middle of the lip.
SULPHUR –has an affinity for the mucus membrane, rectum, skin and glands. The patient had eczema as a baby until she was 2 years old and was treated with medicated soaps and washes (suppressed by medications). The skin has redness and dryness, with pimply eruptions, pustules and black heads on the nose. The remedy has a keynote of dry mucus membranes in interior of nasal passages that cause nose bleeds at night – as expressed by the patient. The remedy also covers the predominant mental symptoms of feeling too lazy to rouse in the morning and the irritability on waking. The remedy also has craving for sweets, constipation from large hard stools, cold sweat on the feet, going to bed late, sleeping long but feeling unrefreshed in the morning, feeling warm, excoriating leucorrhea and feeling worse with severe weather changes (hayfever season), especially when weather goes from cooler temperatures to warm.
The patient’s acne started at the onset of puberty, which is important to the etiology of the case. I needed a remedy that has a strong keynote of acne at the onset of puberty. The remedy should also have an affinity for the mucus membranes. The patient tends to get allergies, which distinctly sounded like hayfever, at the beginning of spring and lasting until winter. She gets dry, itchy, watery eyes with a lot of sneezing, her condition is worse from pollen, flowers, dust or too much cat hair. The remedy should be well proven for itchy, watery eyes that are dry and burning with a lot of inflammation in the sinus and eyes. The remedy should be able to address her seasonal allergies when the weather starts to get warmer. For this case of acne the remedy should clearly address the acne.
The remedy should also have thirstlessness, skin that burns easily in the sun, strong smelling urine, cold sweaty feet that are stinky, bed wetting, constipation, irritability on waking, sleeping long into the morning and feeling better in the cold air.
The remedy should include such features as fair, sandy hair, blue eyes, pale face person with a mild timid manner that is easily moved to laughter or tears – a woman’s remedy that is inclined to be fleshy. The patient’s mild timid mannerisms match those in the remedy, indicating that this remedy would be better suited for the patient, than the irritable, angry mannerism of sulphur.
Initially I had thought it was a perfect case of Pulsatilla, as the patient matched several symptoms of the remedy. Then on re-evaluation of her case, the skin symptoms of suppressed eczema and the stinky feet with cold sweat were more pronounced above the rest. The indolence was also more striking in Sulphur than Pulsatilla, even the aversion to bathing and the constant desire to do activities that require sitting for prolonged periods of time. Sulphur was the remedy of choice for the patient.
- Sulphur 30 C in water, succus before taking, daily for 30 days.
- Help patient develop a routine system for cleaning the face at morning and at night that can easily to done to help develop good hygienic practice
- Suggest a good multi-vitamin for nutritional support
- Exercise – encourage the patient to explore some activities that she might like to participate in.
Remedy started March 11, 2019
The patient was aggregable in taking the remedy, however the practice of routinely washing morning and night was not as well received. (Very much a sulphur trait) She is still not open to joining any activities or sports yet. Her mother has indicated that getting her to go back to school was an important short-term goal that she is currently working on with her daughter. I chose to focus solely on treating the patient for the ‘stars’, since she is both open to being treated for this condition and it is most bothersome to her.
OBSERVATION: Patient had small amount of acne on her cheeks, forehead, chin, there were some new formations of pustules on the chin, forehead and eyebrow. None of cysts were painful or itchy. There was a small patch od comedones on her nose, there was no inflammation present.
Follow up March 15, 2019
Patient came to see me and was not very happy because there was a slight aggravation. In the past day, she had 3 new eruptions that were hard and pustular in nature. Black heads appeared to be the same. She felt discouraged and considered stopping the remedy because she seemed to be getting more ‘stars’, not less.
Advised patient that this is an aggravation that will settle down and to continue taking the remedy.
Follow up March 17, 2019
There are no newer aggravations, no more new eruptions and existing eruptions are in various stages of healing. The initial ones are almost not visible. There are fewer comedones on her nose. So far, the patient has not developed a facial cleansing routine, however symptoms are gradually healing up and the patient is not as bothered by them. Acne symptoms improving and healing good. Advised the patient to continue taking the remedy.
Patient called to cancel but reported that her ‘stars’ are healing nicely and there were no new eruptions anywhere on her face’. She is happy that she continued treatment.
Patient came to see me in a good mood, very happy. All ‘stars’ have healed up except for one that was part of the initial aggravation. The stars have left no visible scarring behind, skin appears to be restored to health. The comedones are not visible.
Symptoms of stars have gotten 90% better. Patient’s mood is improving as a result of the ‘stars’ healing up. I advised her to continue taking the remedy for spring allergy season coming very soon, however the facial acne appears to have remarkably improved.
The most bothersome symptom the patient had, which developed since the onset of puberty, was acne. This was almost a textbook example of a typical homeopathic healing process. The patient experienced a small break out of acne, or minor aggravation, but after a couple of more days, the symptoms resolved rapidly, and the healing began.
- ‘The Natural Treatment of Hayfever”, by Lysanji Edson ND, The New England Journal of Homeopathy, Spring/Summer 1999, Vol.8 No.1
- ‘An Encounter With A Moose’, by Carleen Johnson, The New England Journal of Homeopathy, Spring/Summer 2001, Vol.10, No.1
- ‘A Chronic Case of Belladonna’, by By Valerie Sadovsky, RC, RSHom (NA), CCH, The American Homeopath, pages 32-36