This case report is focusing more on the understanding of levels of health as a clinical prognostic and follow up analysis tool. While there are many cases of dermatitis that have been reported to have benefited from homeopathy, the attempt here is to delineate learning points from one.
The patient, a 21-year-old male, sought homeopathic treatment for skin eruptions on 08/01/2022. He was a student and had no significant health issues till 4 to 5 days prior, when he developed the skin eruptions. They first appeared on the right axilla and then the left, followed by the legs, arms and back.
He had tried taking L-Dio 1M (Levocetirizine 5mg + Montelukast 10mg), with no relief. The itching was intense and constant, and he scratched at the skin constantly. He described it ‘as a persistent sweet itching’. He could not connect the onset of these eruptions with anything except may be a change in food. He also had watery nasal discharge every day after bathing for 1-2 hours which subsided on its own.
Past medical history: No significant diseases in the past. He had taken vaccinations in childhood (no details available). No history of any physical/emotional/mental trauma. No suppressive therapies taken. He rarely got acutes, and hadn’t had a fever in the last 2 to 3 years.
Family history: Both the parents are healthy with no significant health issues. They suffer from acute diseases according to seasonal changes.
He is thermally hot, perspires a lot +2 and the odor is very offensive +2. The perspiration stains the linen white +2.
Appetite was increased, he became hungry often. Hunger specifically around 10:30 – 11:00 am +2, despite breakfast in the morning he must eat something at that time.
Thirst was increased, drank potted water in large quantities.
Desired spicy food
No specific aversion or intolerance to any food substance
Bowels and bladder showed no abnormal pattern.
Sleep was sound and refreshing, no snoring, wakes up at night in between sleep. He dreamt of problems that he didn’t solve while waking and solved them in the dream.
He became angry easily, and expressed his displeasure to the person’s face in anger but later smoothed it over by smiling and pacifying the other person.
He had no specific fears; He disliked company as he felt awkward with people. He was very engaged in his studies (computer engineering), always pondering over problems and solutions, and projects. He felt he was slow in comprehending concepts that involved calculations and required multiple efforts. He is hurried, especially in eating. Never really cries.
Fig. 1. Skin eruptions at first intake of the case
From personal medical history it is known that patient has not suffered from any specific major diseases in past and has not taken any medications for the same except the vaccination which were taken in childhood.
From family history, it is known that no major diseases are present in heredity except seasonal acutes in parents. There is no history of any physical/mental/emotional trauma in the patient.
From the above description, we can say that the organism is very healthy as no strong hereditary predisposition, or any suppressive therapies have been taken by the patient. Therefore, he belongs to Level 2 of Group A according to the Prof Vithoulkas’ theory of Levels of Health.
This implies that the organism is very sensitive to any external stimulus and will react immediately throwing the disturbance on most superficial level i.e., skin by producing skin eruptions. It also indicates that the remedial picture will be very clear and that the cure will proceed without much repetition of the remedy. He probably will not need more than one remedy and will also throw up an obvious aggravation.
Symptoms available for prescription:
- Skin eruption going from right to left +2 (peculiar)
- Skin itching night +2 (intense)
- Skin itching – voluptuous +1 (intense)
- Perspiration odor offensive +2 (peculiar)
- Perspiration staining linen +2 (peculiar)
- Appetite – increased around 11 am +2 (peculiar)
- Likes to be alone +1 (peculiar)
Fig. 2 Repertorial totality at first intake of the case
Differentiation Of the Remedies:
Sulphur – It is very clear from the repertorisation that the patient needs Sulphur. All the characteristic symptoms are covered by this remedy. Not only the totality but the essence as well as keynotes match the case. So it is the correct choice at present.
Lachesis – This remedy, though it covers some symptoms of the case, does not cover the chief complaint for which patient has sought treatment. Moreover, the essence does not match the case. So it cannot be the simillimum.
Lycopodium – It covers the main peculiarity of the chief complaint that is side of spread of eruptions but the intense symptoms as well as the physical generals are not covered by the remedy. Moreover, essence does not match the case. The sweet, warm food desire, 4 to 6 pm agg etc. are not present here. So it cannot be the drug of choice.
Psorinum – Offensive discharges and itching in the night are covered but little else. It does not cover the totality as well as essence of the case.
Carboneum Sulphuratum – Again, it appears for two main rubrics, offensive sweat and itching in night. So it is not the similimum.
Prescription: SULPHUR 1M Single dose followed by Sac Lac 6 pills TDS for 1 month (Sac lac as emergency medicines as aggravation was expected and patient must feel secure).
|Response to remedy and interpretation
|There is aggravation after the remedy. Itching increased in hands, skin started drying, cuts developed bleeding due to over scratching.
Spreading of eruptions over various parts stopped.
Hunger as it is.
Nasal discharge everyday as it is. Energy better.
Analysis: As discussed earlier, organism is very strong and reacts very strongly to any stimuli. So, the aggravation is as expected.
|There is amelioration after aggravation of complaints.
Voluptuous itching reduced after 10 days. Bleeding after scratching stopped. Night itching still present.
Eruptions on back vanished and started disappearing from legs. Eruptions on hands still present.
Perspiration still offensive but now does not stain the linen. Hunger in forenoon as it is.
Patient feels comparatively better than before.
Analysis: As amelioration has begun and symptoms have started disappearing in reverse order of appearance, we must wait.
|There is a good response – Amelioration continues.
Patient is better.
Itching in night decreased.
No eruption on leg, back. Eruption decreasing on arms. Hunger can now be tolerated.
Analysis: We must wait as the amelioration continues in the right direction.
|No more eruptions. Energy good.
Instructions – Stop the medicine.
Fig. 3. Aggravation followed by steady amelioration of skin eruptions
Fig. 4 Skin eruptions completely cleared
Conclusion: This case of simple dermatitis demonstrates the advantage of understanding the level of health of a patient as taught by Prof Vithoulkas in clinical prognosis and analysis. The direction a case must take can clearly be mapped with the help of this invaluable tool