The patient is a 72 years lady with fair skin, thin grey hair, dark eyes with a low self confidence and self-conscious demeanor. She is short and stout of build. She presented with complaints of skin itching and pain in her knees.
Her case as given 27th February, 2016:
I have black patches that have spread all across the body, with intense itching that bothers me all the time. This skin complaint started in July 2015 and spread very fast from forehead to face to trunk and then arms and legs. I noticed that it first appeared on the right side and then spread to the left. It started after my husband expired. Ever since, I don’t feel like going out and meeting other people because of my face. Everyone asks me what happened and I don’t like it. I look so bad. I don’t even color my hair because it increases itching on my scalp. These days I just stay in my room. I used to be a very active lady but now I just be in my room. I don’t want anyone to see me. I have also become irritable with my family, this is especially more during night and if I step out in open air I feel much relaxed. Also I feel less morose and sad when I am walking out in the open. There is increased restlessness internally, I feel I must do something and still don’t know what. My knees have also started hurting, especially when I get up and start walking, I can’t walk easily, for a while I limp. After a few steps it gets better. Right knee is more affected it seems, though left is also getting bad now.
At times my ear swell after itching a lot and then a fluid discharge comes out from the skin. My skin burns and then I wash it with warm water and it feels slightly better. At night it itches more, so can’t even sleep properly, I keep getting up. I don’t know if I am eating something that caused it or is increasing it, so I am eating only vegetarian and no spices. My appetite has gone very low because of this fear that it might aggravate. I love to eat rice, soups and sweets. I have always been prone to allergies of the skin, which could never really be ascertained what caused them. I drink a lot of water easily 10-15 glasses a day, though little at a time.
I have been applying some mild topical steroids for the last 2 months, but though it gets better for a while wherever I apply it, it erupts somewhere else. I am also hypertensive and I take Amlodipine since 3 years.
This lady has come to get rid of her skin complaint and also to get relief from her knee pain. Her tongue was thickly coated with central furrow and red tip. She has aggravation from first motion while beginning to walk which settles after a few steps. The skin on inspection has silvery scales on the patches and there was intense itching, which was better by washing with warm water. Her mind is extremely irritable which is aggravated at night and ameliorated by going out in open air. She is depressed and morose, which she feels is more when in the house and she feels better while walking in open air. There is also internal restlessness.
Repertorization using Synthesis Repertory:
Mind, Ailments from, grief
Mind, Irritability, night
Mind, Irritability, night, air in, open, amel
Mind, Sadness, Company, aversion to company, desire for solitude
Mind, Morose, house agg; in, open air amel.; on walking in
Mind, Restlessness, internal
Generals, Side, right
Skin, Itching, night
Skin, Itching, burning
Skin, Itching, bathing, warm, amel, hot
Extremities, Pain, Knee, motion, beginning to move
Extremities, Pain, Knee, motion, amel.
The remedies that were considered from the repertorial result were Rhus Toxicodendron, Lycopodium and Sepia.
Rhus Toxicodendron: With all the other rubrics that were repertorised, it also has red triangular tip of tongue which was observed by me during the case taking. It covers the skin eruptions with silvery scales, itching and its modalities along with mind symptoms very appropriately. The extremities manifestations too are very aptly suited. The nightly aggravations and right side predominance too are characteristic keynotes of Rhus Tox. The thirst in addition to the repertorised symtoms is increased and she likes to have little at a time. These additional confirmations make Rhus tox the strongest choice.
Lycopodium was one of the remedies that came to my mind while I was taking her case due to the right side predominance, lack of self confidence, her desire for sweets (though not very well marked), her irritability towards her family and also her grief for her husband’s loss. But the particular symptoms did not seem to go too well with the drug picture. It did not cover the skin itching better by warm bathing nether did it cover the pain in knee aggravated during beginning to move. Also generals like desire for solitude and open air amelioration were not covered in Lycopodium.
Sepia was characteristic of her ailments from loss of her husband, desire for solitude and internal restlessness. It was also marked for the kind of skin lesions that were almost circular and intersecting with itching. Right sided predominance and nightly aggravation of complaints were some prominent keynotes that was leading me to consider this remedy while analysing the case. Also the irritability towards her family and grandchildren was depicting indifference towards her loved ones. But the absence of irritability at night and its amelioration in open air, which were characteristic symptoms in this case, made it a less likely candidate. Also modalities of particular symptoms were missing in its drug picture like knee pain aggravated on beginning to move & skin burning better by washing with warm water.
Based on my evaluation, Rhus Tox was selected, it was given in 0/1 potency. She was instructed to tap the bottle of medicine 6 times before she poured the medicine into the cap, then 1 capful of medicine to be to be mixed in 1/2 cup water and 1teaspoon to be taken from that, once daily, every morning for a month. LM potency is generally my preferred potency to dispense especially in chronic skin complaints and old patients, as most often I have seen aggravations from the centesimal scale in such cases. She was also advised to stop applying any medicinal topical applications.
Follow-up March 30th, 2016
I feel its drying up, the skin is feeling stretched all over, especially on my face. Though all the patches are still there and the itching seems to have increased. At night, itching doesn’t let me sleep. My knees feel better too. The pain isn’t as much, I am able to stand up more easily. Though I am still limping. My energy levels are better too. I am feeling better overall.
When questioned about her feeling towards her family and stepping out of home, she said she feels she has been more tolerable. She still doesn’t move out of her house as she doesn’t want people to see her with this skin complaint. Her daughter, who was accompanying her in this visit, said she continues to be irritable.
My assessment was that she was continuing to improve, her feeling of her skin drying up was an initial sign of improvement. Even temperamentally she feels she is calmer, though her daughter doesn’t agree. Her knees too are paining less. George Vithoulkas notes in The Science of Homeopathy, that emotional symptoms are the deepest. Because of partial physical and mild emotional improvement, I felt that the action of the remedy was in progress and it should be allowed to continue to do further good. The same dose and potency was repeated and a follow up was scheduled.
Follow-up April 28th, 2016
I feel my feet are clearing up, also the itching is still a lot, but less than before say 15-20%. Face is still bad and all the dried skin is looking darker. I just can’t step out; what will people think I have. My sleep is better, the itch at night doesn’t bother my sleep as much now. My appetite is also now better, I feel that food is not affecting my skin as much. My knees are not troubling me as much now.
When questioned about her temperament, she mentioned she is less restless and doesn’t feel as depressed. She is also less irritable. Even her daughter seemed to agree this time.
My assessment was that she was definitely improving steadily. The mental symptoms too were better as pointed out both by the patient and her daughter. Since there is an improvement on all planes and there is no aggravation or appearance of any new symptoms, the medicine, dose and potency seem just right and therefore I continued the prescription as it was. Follow-up was then scheduled for next month.
Follow-up May 27th, 2016
The medicine is doing good. I am much better now. My feet and legs have almost cleared up, also my arms have started to get much clearer. Itching is tolerable. I am feeling more positive. I am also eating a lot of greens and drinking juices. Also my knee pain is almost gone. Only on days I exert a lot, then the next morning on rising I do feel some pain.
Her tongue was more lightly coated compared to the first visit.
My assessment was that she continued to show forward momentum and was still progressing. Since the current potency hasn’t exhausted its action and is still helping the case to improve, I continued the same prescription for the next month as well. Follow up was scheduled for the next month.
Follow-up June 29th, 2016
Last complete month, there was no improvement. It’s just been the same way I reported last month. It seemed the medicine didn’t work. Did you change it? It was helping me so much till last month. Are you sure this skin complaint can completely vanish? I am beginning to worry. This worry doesn’t let me sleep at night, I become increasingly restlessness. Itching is still there, specially on my trunk. Will my face get ok?
On inquiring about her knee pain, she mentioned that it isn’t bothering her now.
My assessment was that the potency has exhausted its action and now it requires to go to the next one. Since there are no new symptoms and only a stagnation therefore the same medicine is still required. Now she was prescribed Rhus Tox 0/2 with the same instructions, dosage and repetition as before.
Follow-up July 26th, 2016
I am feeling this medicine is better than last one. My legs, arms, body and back are much better. The spots have lightened. I can see my normal skin coming over. Itching is still there, though tolerable. My face is also less dark now and I can see it improving.
I aksed if she started going out and interacting with people. She said that her grand daughter had her birthday party, where a lot of friends and relatives were invited with their kids. “I went out and interacted with everyone. It was fine; I didn’t dread it as I used to earlier. I think everyone just thought it was a summer tan. It turned out to be a confidence booster.”
My assessment was that the patient was appearing more confident, also her skin had cleared largely. Though the itching still continues, as this was the very first symptom to appear & is expected to go last. The skin patches have cleared largely. The last prescription was repeated again as the improvement was continuing.
Follow-up August 25th, 2016
The improvement continues, almost all my skin is looking normal. Itching is very minimal. My face is normal. Knees are doing good too. They don’t bother me now. In the middle of the month my fingers were paining and were stiff in the morning when I used to get up. but it settled on its own. I remembered this happened to me some 2 years back, then I had taken some painkillers and it settled after a few months, but then my knees started troubling after about 6 months.
On being questioned about her sleep and mind symptoms, she said she is doing good on both fronts. Since the itch is better, I am sleeping sound and getting up refreshed. I am also now moving out of home and meeting my relatives and friends. I am not irritable now, I am more patient and joyful with my family and my grandchildren.
My assessment was that the patient showed significant improvement. She also had reappearance of her old symptom, which she hadn’t mentioned during her initial case taking. She is showing all signs of Hering’s law of cure, therefore same prescription was repeated for 1 month. She was scheduled for another follow-up a month later
I continued to see this patient till October 2016 after which she moved back to the Phillipines, her native country. Her skin had completely settled by then and she was only on placebo (from September 2016 onwards) to keep a watch. Here are some pictures from the case, before & after treatment.