Abstract:
Eczema is one of the most common condition seen in children. Its incidence is more likely during the first decade of life. The relationship between eczema and respiratory conditions is often seen to be interdependent. Suppression of eczema can lead to respiratory symptoms in the long term and this can create an acute with chronic case presentation of asthma due to external triggers.
Prolonged use of corticosteroids and other suppressant applications used on skin can contribute to an inward progression of the condition affecting the lungs. Homoeopathy has been used very effectively for treatment of respiratory conditions such as asthma where the patient has a previous history of eczema which may have been suppressed. This case report analyses and discusses a treatment approach to asthma using constitutional medicine based on the homeopathic principles and causative factors that are factored into the complete case totality.
Keywords: Asthma, Children, Eczema, History of suppression, Homeopathic management
Introduction
Eczema is an inflammatory skin condition manifested by redness and dryness of skin accompanied with severe itching. The causes of eczema can be varied from person to person and this makes it a complex condition with varied aetiology.
Eczema can be caused by allergic response, genetic factors, elevated IgE levels, certain triggers or allergens in food and environmental reactions and even stress (Oszukowska et al., 2015).
Eczema is commonly seen during the first decade of life i.e. in children. Whilst there are not many treatment options for this condition in Western medicine as it primarily follows a symptomatic treatment of reducing the itchy red patches, homeopathic medicines can help in overall improvement of the skin and enhancing the resistance in the body to allergens and external triggers.
In clinical practice, I have observed the reversal of symptoms in a case of asthma with prolonged history of suppressed eczema. A homeopathic constitutional remedy can help in stopping the disease progress inward and damaging the respiratory system along with helping to build a strong immune response to external triggers.
Asthma is one of the commonest global health conditions and its incidence in children is rapidly increasing since the past decade. The probability of reoccurrence persists with this condition when the treatment is more focused on symptom relief rather than the cause (Rossi, Bartoli, Bianchi, & Da Fré, 2012). Using homeopathic principles and understanding the triggers or factors associated with asthma can help in alleviating symptoms for the long term (Ratcliffe et al., 2002).
Homeopathic Approach
As mentioned by Roberts (1999) susceptibility is the reaction of an organism to external and internal influences. Dr Hahnemann has discussed the inward progression of a disease that can occur as a result of topical applications in aphorisms 202 and 203.
He mentioned that when a physician destroys the local symptom by using topical applications under the belief that this can treat the whole disease, it actually drives the disease inward making it systemic and with an increased severity.
Therefore, by understanding one’s susceptibility and the factors that may have contributed towards the inward progression of the disease, we can determine the causes and miasmatic disposition of individuals. This can help in forming a case totality that would provide a constitutional simillimum (Das, 2006).
Asthma is a disorder characterized by narrowing of the airway in spasmodic episodes which can cause breathing difficulty along with shortness of breath (Harrison, 2012). This condition is due to an over sensitiveness of the immune system and therefore it is not a local issue but more of a systemic condition.
Research suggests that homeopathic treatment for respiratory conditions is effective as it acts on the immunoregulator or immune-modulator response (Feingold E, 2008). A clinical study conducted by Taylor et al. (2000) showed statistically significant improvement in the nasal symptoms for patients who were treated with homeopathic medicine in comparison to placebo.
Even with eczema, evidence suggests that homeopathic treatment in children with eczema was seen to be effective as compared to conventional medicine considering that conventional treatment showed effectiveness for a short period of time and had higher cost in the long term as compared to homeopathic treatment (Roll et al., 2013)
This case report discusses the homeopathic approach used in my clinical practice for treating asthma with a history of suppressed eczema in a child. The case is discussed with the symptom picture and remedy selection for a ten-year-old boy presenting with respiratory symptoms.
Case presentation
A ten-year-old boy presented to the clinic with his parents for treatment of nasal and respiratory symptoms. The chief complaints involved dry cough and occasional sneezing aggravated early in the morning with thick nasal discharge.
The boy had developed asthma and was taking corticosteroids on and off for the past three years. The symptoms of asthma were aggravated in cold weather and he had recurrent colds with dry cough.
His sleep was also disturbed due to cough at night. His complaints were better in a warm room and aggravated by cold air. Another characteristic symptom was occurrence of headaches when he was hungry. The headaches were associated with weakness, tiredness and fatigue. During winters the client would require an inhaler almost every second night due to the episodes of asthma.
Past history
His mother mentioned that he had dry patches on the skin, mostly on his right elbow and shin when he was 4 years old. He had itching, redness, dryness and he would scratch till there was bleeding from the patches.
The skin developed cracks with crusts and dryness. This was treated with steroids for a few months consecutively. Later on, as the skin complaints got better the respiratory symptoms started appearing. Initially it started with runny nose, wet cough and sneezing which was treated with antihistamines.
Recurrent treatments and use of suppressants have led to development of dry cough and asthma.
Characteristic Physical generals:
The mother mentioned that the patient had offensive perspiration and halitosis.
The respiratory complaints are aggravated in cold weather and patient is overall better by warmth.
His appetite was good with aversion to spicy foods.
His mother had to remind him to drink water as he is mostly thirst less.
He had aversion to cold (Chilly+)
Overall, there seemed to be lack of vitality with lethargy and weakness.
Mental history
In appearance he was lean and initially shy to open up. He liked to focus on studies but also liked to play sports such as cricket. He was good in math and his mother added that he was an obedient child.
He also seems to be very sensitive and attached to family. He likes to look after the younger brother and is very emotional. He can suddenly get angry and would just be alone if he is in a bad mood.
He doesn’t like to complain and is not obstinate as per the mother. On further questioning it was found that he can be very irritable and doesn’t like to be told off in front of others.
He can get angry easily if he is disturbed by his younger brother or if anyone talks rudely to him. He wouldn’t like to socialize a lot or go out with the family and had a very small friend circle.
He also seemed to be anxious about health and sometimes the anxiety could trigger the respiratory symptoms. The mother mentioned that his mood is mostly low during the day as if he is sad but this is also because of the respiratory condition as he feels it may get worse over time.
Case totality and homeopathic methodology
As per the symptoms presented and discussed with patients’ mother, the following rubrics were selected for the patient’s chief complaint, characteristic generals, particulars and mental symptoms:
- Dry cough
- Eruptions general suppressed
- Discharges, secretions offensive, fishy
- Anxiety respiration difficult, anxious with
- Irritability, children in
- Appetite increased, hunger in general headache during
- Cold aggravates in general
Remedy differentiation:
There were three key remedies that matched with the patient’s complaints: Arsenic Alb, Psorinum and Sulphur as per the order in reportorial matrix. All three remedies covered the selected rubrics and the remedy differentiation was based on the most peculiar symptoms of the case.
Remedy differentiation: Psorinum and Sulphur
Psorinum and Sulphur are remedies that are very close in their overall representation. Both of these remedies have affinity for skin and there is presence of eruptions with cracks, scales, dryness and itchiness of the skin.
Both remedies also have offensive discharges and aggravation from washing the skin. However, Sulphur has a desire for open air which ameliorates and the heat or warmth can aggravate their complaints. This was not seen in the case as the client always felt better in warmth and was aggravated by cold.
Another characteristic symptom of Sulphur is the presence of burning in general, which was absent in the case symptoms.
Mental irritability is seen in both Sulphur and Psorinum. However, the client’s tendency to sadness and suppressed emotions seemed to match the Psorinum drug picture rather than the anger which is expressed outwards in Sulphur (Vithoulkas, 2016). Psorinum also has the presence of exhaustion which was seen in the client as he complained of lack of energy and fatigue in general.
Remedy differentiation: Psorinum and Arsenic Alb
Arsenic Alb is an effective remedy for respiratory conditions such as Asthma. This constitution shows presence of cold intolerance with offensive putrid discharges and anxiety about health (Kent, 2004). All of these characteristics are also seen in the client.
However, suppressed eruptions are indicated in Psorinum also with the presence of headaches which are aggravated in hunger. This was a very peculiar symptom of the case and Psorinum fitted well, covering most of the specific case symptoms.
Both Arsenic and Psorinum cover anxiety for health, however the correlation of anxiety which aggravates the breathlessness is seen in Psorinum along with weakness (Vithoulkas, 2016).
Based on the comparison of the key symptoms in all three remedies Psorinum covered most of the specific symptoms of the client and therefore it was selected as the final remedy for this case.
Dosage and prescription:
7th September 2019 – Psorinum in 200 potency was given as a single dose to the client and his mother was asked to monitor his symptoms after the remedy.
First Follow up: 28th September 2019
The client came for a follow up visit after three weeks and there was a significant reduction in dry cough. The client initially experienced slight runny nose and sneezing in the first week of treatment. Following this there was an increase in stamina and better sleep quality with good general parameters.
The occurrence of asthmatic episodes had reduced. He used the inhaler once in 10 days during the winter season. There was reappearance of itchiness on the skin.
He rarely experienced any headaches and appetite was good. Overall, the client looked better and there was a sense of positivity in his tone of voice also. No new dose of the remedy was given at this stage and client’s mother was asked to continue monitoring his general parameters, activity and symptoms.
Second Follow up: 26th Oct 21st
The mother came with the patient for another follow up after a month and on this occasion, she advised that the episodes of asthma had become frequent requiring the inhaler once in the week.
Sleeplessness had returned with some cough but there were no headaches at this stage. Mentally the client had positivity however he would sometimes get irritable and angry at his younger brother. A repeat dose on Psorinum was prescribed in the same potency 200C.
Third Follow up: Dec and 18th
The patient returned for a follow-up after a gap of almost two months as they had gone overseas for a holiday. The mother advised that patient’s health was overall good in the trip but he got a stomach infection due to eating outside food and had to take a course of antibiotics.
Following this, his asthma episodes became frequent due to the change of weather on returning back home. His sleep and activity levels were good but he felt lethargic and weak. A repeat dose of Psorinum 200C was given.
Fourth Follow up: Jan 2020
The client returned after 4 weeks and was feeling much better overall. There was no dry cough and the episodes of breathlessness had reduced. He only used the inhaler on one occasion over the 4-week period. His mother added that his stamina had increased and he could now enjoy playing cricket for a couple of hours. Appetite was improved and he had good sleep.
Apart from the follow ups discussed above, there were two more face to face follow ups on the 29th Feb and 28th March when the patient confirmed no complaints of cough or episodes of breathlessness. I have been in touch via phone/message with the patient’s mother over the past few months since COVID lockdown period, and she has said that her son’s health is overall much better with no respiratory complaints.
This case provided a good insight into considering predisposing factors, understanding individual causations and prescribing on keynote characteristic symptoms which are seen to stand out in a case. It also helps us understand that the homeopathic process can be speedy when we offer a remedy by considering the holistic symptom picture.
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