Clinical Cases

Answer to Case # 3 of case solving contest: ‘Everyone Is Looking at My Acne’

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Helen F. is a dramatic-looking young woman, tall and willowy, with jet black hair, pale skin, and blue eyes. She is wearing all black, her top cut low to reveal her cleavage, and the lace sleeves ending just short of her wrists to show off her bracelet-shaped tattoos. She presents for cystic acne, primarily on her cheeks and jaw line, which is worse premenstrually; and for amenorrhea since going off the birth control pill. (She had to go off the pill because it was causing side effects, including the acne and mood swings.)

She had a pregnancy scare when she first had amenorrhea; after skipping her period for several months, she was sure she was pregnant because she felt something moving around in her abdomen.

She also wonders if homeopathy can help her with dyslexia. She has trouble writing term papers because she tends to leave out letters or words.

Although she is now a graduate student at a local alternative/holistic university, she paid her undergraduate tuition by working as what is euphemistically called an “exotic dancer.” She knew that sleazy old men were watching her strip, but she didn’t care. The money was good plus she loved dancing, wild and free, alone in the booth, just her and the music. She describes her life at the time as “dancing close to the flame,” in other words, pushing life to the limits.

In her teenage and college years, she enjoyed these extremes; she used a lot of drugs, hung out with a fast crowd, and had a lot of one-night stands. Now at the ripe old age of 28, she looks back on her wild youth and feels she has really settled down. She has been with the same boyfriend for five years and they are talking about getting married.
Their relationship is basically good, both emotionally and physically, however she has an issue with feeling unattractive. The acne really bothers her; she is extremely self-conscious about it and feels that “everyone is looking at it.” She wishes she could hide it but feels frustrated that it is on a conspicuous part of her face. She reports “low self-esteem” and feeling “less of a woman” because of the acne. She also considers herself too fat and feels “disgusted” with her body. She also believes that somehow “everyone knows” that she doesn’t get her period and as a result feels “diseased, something is wrong with my body.”

Her past medical history includes genital warts (frozen off), recurring vaginitis, and probable candida (diagnosed by a naturopath, for which she takes probiotics). Her naturopath, who is into Louise Hay, told her that amenorrhea signifies “dislike of her femininity”; she disagrees, but admits that her mother was a poor role model. Her father was alcoholic and physically abusive, her mother weak and dependent and non-protective of Helen. Her father was also verbally and emotionally abusive, telling Helen when she was a teenager that she was “only fit to be a streetwalker.)

Her main fear is of loss of control. She weeps easily when she feels helpless. On a day-to-day level she worries about finances, whether people are talking about her behind her back, and whether her hair is falling out. She likes tidiness because messiness makes her feel chaotic and agitated. She feels jealous when she sees a “beautiful woman who seems to have it together.” She has been treated in the past for depression, anxiety and insomnia.

She also reports disliking damp weather; drinking lots of tea as her favorite beverage; weepiness and irritability with PMS; constant burning vaginal discharge and postnasal drip.

In sum, she says ,”I would like to feel attractive and womanly and in control of my body.”

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ANSWER

This is a Thuja case (the client did extremely well on Thuja; not only did it clear up her acne, it improved her relationship with her boyfriend and her coworkers; it helped give her the strength to quit her job at the health food store and go into the music promotion business; you can see the Medorrhinum characteristics from a previous layer, a previous time in her life, and in fact she did need Medorrhinum at one point when the Thuja had done all it could. She mentioned that many of the customers in the health food store remarked to her how well she looked when she started the Thuja.

List of characteristic symptoms:

acne

cystic
worse premenstrually
on cheeks and jawline

amenorrhea NWS going off birth control pill
delusion pregnant, delusion something moving inside her
dyslexia: leaves out letters or words when writing
sensual: exotic dancer, shows cleavage
loves wild dancing
pushes life to the limits
extremes
drugs, promiscuity
feels unattractive
feels everyone looking at her acne
wants to hide
low self-esteem
disgusted with body
feels diseased, something wrong (r/t amenorrhea)
PMHx genital warts (frozen off)
recurring vaginitis
candida
fears loss of control
easy weeping when helpless
feels people talking about her behind her back
hair falling out
dislikes damp weather
likes tea
weepiness before menses
irritability before menses
constant burning vaginal discharge
postnasal drip

Evaluate and Prioritize the Characteristic Symptoms

The first thing that jumps out is all the sycotic characteristics. Another theme that stands out is the wildness and sensuality, although this is mostly in the past and may represent a past layer that needs a different remedy. I need to keep this in mind.
Another theme (part of the sycotic miasm but so marked in her that I want to be sure to cover it) is the hiding/self-conscious/self-disgust theme in how she feels about her body.

I am not going to include the amenorrhea because it is normal in women going off the pill, and my experience is that it comes back with a good hormone-balancing remedy. However, I do want to find a good hormone-balancing remedy for her, so I want to take a couple of her symptoms of hormone imbalance like weepiness and irritability before menses. I will also use her chief complaint of cystic acne before menses.

I could repertorize the “likes tea” and “hair falling out” but I think I will save them for a confirmatory or later remedy differential. Instead, I will use several distinctive mental symptoms: dyslexia, fear of losing control, and sensation something moving in abdomen. These don’t really fit into another theme so I will just list them so as not to forget them.
I did not list her past history of depression and anxiety, because there are no specific features to narrow down these huge rubrics. I can keep them in mind when comparing remedies at the end.

Themes

sycotic: cystic acne, wants to hide, disgust with body, genital warts, vaginitis, candida, averse damp weather, burning vaginal discharge, postnasal drip
wild/extremes: exotic dancing, drug use and promiscuity, pushing life to limits
hormone imbalance: acne, weepiness, irritability
hiding/feels unattractive: disgust with body, feels people are looking at her
dyslexia
fear of losing control
sensation something moving in abdomen.

Remedy recognition

Thuja: delusion something alive in the abdomen, disgust about her appearance, acne etc.
Medorrhinum: sex and drugs, wild dancing, sensual/provocative, tattooed and wearing black

Search for rubrics (from Synthesis)

Sycotic

Face, eruptions, acne
or Face, eruptions, pimples [combine]
Female, leucorrhea, burning discharge
Female, condylomata [genital warts]

Wild/extremes

Mind, passionate
Mind, vivaciousness (these two rubrics were not used; not accurate enough)
Mind, dancing, desire for (not used; different reasons for desiring dancing)
so no rubrics for this difficult-to-repertorize theme; keep in mind
for the remedy differential at the end

Premenstrual: Mind, weeps, menses before [combined with]
Mind, irritable, menses, before
Hiding: Mind, hide, desires to
Dyslexia: Mind, mistakes, writing [this was used because broader and it includes the following two more specific subrubrics]

Mind, mistakes, writing, omitting letters

omitting words

Fear of losing control: Mind, fear, control, of losing
Alive/moving in abdomen: Mind, delusions, animals, of, abdomen, in

Abdomen, movements, as of fetus
Mind, delusion, pregnant [these are small and can be combined]

Remedies from Repertorization of the above rubrics
Sulphur, Pulsatilla, Thuja, Calc carb, Ars, Lachesis, Ammonium carb, Sepia.

Miasmatic analysis
The patient is sycotic as noted above.
Family miasm: no information given

Choose three, pick one

Lachesis matches in some ways: can be high energy, wild and vivacious, with hormonal, acne and sex issues. Lachesis can be suspicious (which might cover her belief that people are talking behind her back) but we would not expect Lachesis to have such a negative body image. If she stated that her PMS symptoms immediately got better as soon as her period starts, we might take Lachesis more seriously. But it doesn’t match the wide range of symptoms that Thuja does.

Thuja is not only is it the top sycotic remedy, but it best embodies the desire to hide and the disgust for the body. As a sycotic remedy, it will cover well all her specific sycotic conditions; as a hormone-balancing remedy, it will cover her PMS and (eventually, although maybe not right away) her amenorrhea. In addition, it covers her delusion of something alive in the abdomen; her desire for tea; her hair falling out; her fear of losing control; and her past history of anxiety and depression. Almost every aspect of this case is covered by Thuja. This is a real case and I chose it because this woman was such a remarkable living example of Thuja.

Medorrhinum must also be considered for her. It does not show up in the repertorization because it does not repertorize well (not enough symptoms in the repertory). However, it matches her past better than her present: her wild, drug-using, promiscuous, exotic-dancer days. It shows up now only in her dress (black, showing cleavage, tattoos, etc.) I expect that she will definitely need Medorrhinum at some point.

About the author

Begabati Lennihan

Begabati Lennihan is director of Teleosis School of Homeopathy in Cambridge, MA. A Harvard alumna, she practices homeopathy at the Lydian Center for Innovative Medicine and teaches meditation at Harvard Health Services"™ center for mind-body medicine. She is an Adjunct Instructor in homeopathy at Massachusetts College of Pharmacy and has edited several textbooks of homeopathy.

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