Chronic Idiopathic Urticaria

PRELIMINARY DATA

Name: Mr. S S

Age/sex: 38 years/M

Occupation: Electronic weighing machine distributor, field work

Religion: Hindu

Date: 23-10-2016

CHIEF COMPLAINT

1. A) Skin- itching since 2 years < since 6 months.

Location: Whole body

Itching lasts for 20-30 min

Dermatographism

No known triggers, no specific food or cloth allergy.

Itching changes place after scratching+++

Voluptuous itching – burning- warm air from the body, scratching amel temporarily+

< heat/warmth+ <uncovering++ < rainy season <summer > fanning >cold application

>with avil <evening

Treatment taken: Tab. Avil or Tab. Allegra as sos, no other medications taken.

1. B) Tendency to catch cold easily since 1 year <since 2-3 months, every 15 days. Lasts for 7-8 days

<cold drink <cold food <curd >clearing throat >home remedies <morning

<Drinking cold when overheated

Starts with itching in throat, hawk disposition to, then running nose, sneezing.

Usually accompanied by frontal sinusitis, occasional cough, watery discharge from nose.

No expectoration, lachrymation with sneezing

Redness of eyes with swelling of eyelids

GENERALS:

APPETITE: Good. Can tolerate hunger

CRAVINGS: Tea++, Tobacco++

AVERSIONS: Sweet

THIRST: 4 ½ litres, for cold water

STOOL: NAD

URINE: Retention of urine since 4 months

PERSPIRATION: Profuse. Whole body, Offensive, Yellow stains, non-delible

SLEEP: Good. Refreshing. Position: back, Salivation during sleep

DREAMS: Not remembered

HABIT: Tea 15/day, tobacco – 20/day

THERMAL MODALITY: Chilly

BATH: Tap water all season

COVERING: Yes, all seasons

FAN: Not in winter

MOTION SICKNESS: NAD

NOISE: < Anger/irritability

FEARS: God

CHILD DEVELOPMENT:

Normal development

All vaccinations given, no complications

PAST HISTORY

Jaundice 2 years back

Filaria ’89

FAMILY HISTORY

Grandfather- Asthma; Mother- Cervical spondylosis, GERD, Mild deafness, Migraine, Renal stones

Father- Appendicectomy

PERSONALITY TRAITS

Born and brought up in UP. Education- 12^th.

He is the eldest brother, has 2 younger brothers. After 12^th, came to Mumbai with assistance of dad and uncle, and started working as an electrician. Since 2004, started his own business of distribution of weighing machines, financially not very stable.

Stays with wife and 2 children. Initially he used to stay with his father and uncle, but they asked them to move out after his wife asked to stay in a separate room for some privacy, which they didn’t like, so they told him to buy a new home if y’all want to sleep alone. This episode occurred 3 years back. He didn’t say anything, nor his father helped, yet they moved out and have to now live in a rented place. His emotion in that situation: “I felt bad, but I said nothing, they’re elder to me, they know what they’re doing.” His father keeps asking him for financial help, even though he knows they have to look after rent and his 2 children, and he never tells his father no, even if there is no money left for him. If he doesn’t have money, he takes loans and gives it to his dad, but never denies it. When asked for a reason, he says: “I can’t say no, if he is asking he would be needing it, he knows what he is doing. I feel bad sometimes, as he asks me and not younger brothers who live with him, but I’m the eldest so he will ask me first.” What if you don’t do it? “Its bad, what will people say? I can’t even handle and help my father; they will think I’m useless as a child that can’t even do what my father wants.” Wife: “He will obey each command and even go against me, lie and do it as I don’t like it when he takes loan for this.”

Doesn’t talk much at home, doesn’t express his feelings to anyone.

Anger on contradiction⁺

Sensitive to opinion of others³

Ailments from anger suppressed⁺

Anger at trifles

Conscientious

EXAMINATION: GENERAL

Pulse: 72 beats/min

BP: 128/70 mmHg

RR: 16/min

Temperature: Afebrile

Pallor: Nil

Icterus: Nil

Cyanosis: Nil

Clubbing: Nil

Lymphadenopathy: Nil

Tongue: Clean

Thickened nerves: Nil

Skin: Dry with scratch marks     

SYSTEMIC

RS: Clear, AEBE

CVS: S1, S2 Normal, no murmurs heard

GIT: P/A: Soft, non-tender, No organomegaly

CNS: Normal sensorium and well oriented

DIAGNOSIS: CHRONIC IDIOPATHIC URTICARIA, UAS7 was 35

AUXILLARY TREATMENT:

• Cold fomentation if itching is severe, advised to avoid scratching.
• Application of coconut oil on skin to overcome the dryness
• Counselled to discontinue tobacco use

TOTALITY:

• Ailments from, anger suppressed
• Sensitive to opinion of others
• Anger from contradiction
• Anger at trifles
• Sensitive to noise
• Reserved
• Perspiration- offensive
• Perspiration- stains the linen yellow
• Salivation during sleep
• Sleep position: on back
• Cold food and drinks <<
• Tendency to take cold easily
• Desire for tobacco
• Desire for tea
• Aversion: sweets
• Skin, Itching, scratching, changes place after scratching
• Skin, Itching, < undressing
• Skin, Itching, < by warmth/heat
• Skin, Itching, < by scratching transiently
• Skin, Itching, burning

REPERTORIZATION:

SELECTION OF REMEDY WITH REASONS: STAPHYSAGRIA

The main essence of the patient was his suppressed anger and disregard to things happening with him, yet he didn’t have any hatred against them, and would keep performing his duty; the strong drive to perform his duty was present on account of his sensitiveness of what others will think about him and they may build up a bad image, which is peculiar of staphysagria. The strong generals, desire for tea and tobacco, sensitive to noise, salivation in sleep were supportive. Particular characteristics like itching while undressing and itching that changes place after scratching was characteristically covered by the remedy.

PRESCRIPTION: 27-10-2016

Rx: Staphysagria 200 BD x 7 days.

FOLLOW UP (03-11-2016)

Symptoms	Prescription
Skin: Itching: improvement lasts for a few hours after taking meds   Frequency: SQ   UAS7 – 28   Cold sine 2 days, fluent coryza, no cough, sneezing only in morning   O/E: Nose: congested+   Throat: congested RS: Clear, AEBE Generals – Normal	Rx   Staphysagria 200 BD x 7 days

FOLLOW UP (17-11-2016)

Symptoms	Prescription
Skin: Better when takes medicines, returns soon after stopped.   UAS7 – 28   Cold: >>   Generals- Normal	Rx   Staphysagria 200 TDS x 7 days

FOLLOW UP (25-11-2016)

Symptoms

Prescription

Skin: No further improvement.   Cold: Nil   Generals Normal   UAS7 – 28

Rx   Staph 1M OD x 7 days   Reason: Potency increased as the effectiveness of the remedy didn’t last   for long but there was sure improvement but stagnant even after increasing the repetition. Here, changing the remedy is not the right choice as the original picture of the patient was still the same, no aggravations or alterations of symptoms seen. Thus, a stronger dose was needed to stimulate the vitality.

FOLLOW UP (04-12-2016)

Symptoms	Prescription
Skin: Itching 40% >>   UAS7 – 14   Frequency: reduced 20%   Tobacco use reduced   Generals Normal	Rx   Staph 1M OD x 7 days

FOLLOW UP (18-12-2016)

Symptoms	Prescription
Skin: Itching 60%>>   UAS7 – 7   Frequency: only while undressing now.   Generals- Normal	Rx   Staph 1M OD x 7 days

FOLLOW UP (26-12-2016)

Symptoms	Prescription
Skin: Itching 95%>>, dermatographism mildly present   UAS7- 1   Generals – Normal   Tobacco use: 2/day, hates the smell and taste now, avoids with friends too.	Rx   No medicine

BIBLIOGRAPHY

• Materia medica of homoeopathic medicines by Dr. S.R. Phatak, Second edition- Revised and enlarged, Published by B Jain Publishers Pvt. Ltd.
• Keynotes and characteristics with comparisons of some of the Leading Remedies of the materia medica by Dr. H.C. Allen, Second edition, published by B Jain Publishers Pvt. Ltd.
• Dictionary of practical material medica by Dr. J. H. Clarke, published by B Jain Publishers Pvt. Ltd.