Name: Mr. Y
Age: 40 years
Marital Status: Married
September 2019: A 40 year old male patient reported with erythmatous, scaly, papular lesions with itching on lower area of face at madibular region on both sides of his face.
HISTORY OF PRESENTING ILLNESS:
A dry lesion started slowly on his face during change of weather, i.e from cold to warm in March 2019. It appeared on the right side and gradually increased in size. The lesion developed fine scales and gradually another lesion also appeared on the left side. Other scaly lesions also appeared on his face gradually during the course of time and he presented in OPD in September 2019.
Applied skin ointments but of not much use.
PAST HISTORY: No history of any significant illness.
FAMILY HISTORY: No significant family history present.
PERSONAL HISTORY: No addition of any kind. Vegetarian.
Thermal reaction: Hot patient
Aversion: Nothing significant
Stool: Constipated, feels as if there is narrowing of anal opening and so he has to strain to expel stool.
Urine: Regular, no associated complaint. D4-5N0
Sleep: Sound sleep
Intolerance to coverings, unable to cover face while sleeping, feels as if suffocated.
In the OPD he was constantly talking and was describing his complaints too much. For answering a simple question, he was telling long stories.
GENERAL PHYSICAL EXAMNATION:
Pulse: 80 beats/minute
B.P. 130/80 mm Hg
Nails: No clubbing noticed
G.I.T/C.V.S/C.N.S/Musculoskeletal system: No abnormality detected.
DIAGNOSIS: Psoriasis (on basis of clinical presentation of lesions – erythmatous papular lesion with characteristic scales)
Medicine selected: Lachesis 200
BASIS OF PRESCRIPTION:
In this case the prescription was done on basis of “Keynote symptoms” of the case. In this case the following keynotes of the case were taken into consideration:
- Loquacity, theorizing (as stated in mental generals, constantly talking, telling long stories for to answer a question)
- Discomfort on covering his face
- Complaint started at change of weather from cold to warm
These selected keynotes were matched with the symptomatology in Allen’s keynotes. In Lachesis the following symptoms are found:
- Great loquacity; wants to talk all the time, one world often leads into another story.
- The least thing coming near mouth or nose interferes with breathing.
- Spring aggravation
These three symptoms and considering the thermal reaction as a hot patient, the most appropriate remedy came out to be LACHESIS.
|Follow up||Medicine prescribed||Remarks|
|1st prescription (12/09/2019)||Lachesis 200/3doses
Sac lac 30/tds/15 days
|Sac lac 30/tds/15 days||No specific change|
Sac Lac 30/tds/15 days
|No specific change|
|Sac lac 30/tds/15 days||Scaling and itching slight reduced|
Prescription ( 16/11/19)
|Sac Lac 30/tds/15 days||No new lesions appeared. Existing lesions slightly reduced in size.|
Sac Lac 30/tds/15 days
|No further improvement, so same medicine in same potency repeated.|
|Sac Lac 30/tds/15 days||Much improvement. Scaling and itching less, lesions size decreased.|
|Sac Lac 30/tds/15 days||Lesion size further decreasing, scaling improved and smaller lesions disappearing.|
|Sac Lac 30/tds/15 days||Patient much improved|
|Lachesis 10M/1 dose
Sac lac 30/tds/15 days
|No further improvement|
|Sac lac 30/tds/15 days||Much improvement|
|Sac lac 30/tds/15 days||Lesions almost disappeared|
|Sac lac 30/tds/15 days||Lesions completely better|
Patient followed for a further 3 months and no new lesions appeared.
Conclusion: In this case the correct medicine was selected based upon the keynotes. The concept followed was “Three legged stool” as stated by Dr. Hering. The higher potency (200C) was selected in this case. As stated by Dr. Stuart Close in The Genius of Homoeopathy, Chapter XIII, Homoeopathic Posology “The more similar the remedy, the more clearly and positively the symptoms of the patient take on the peculiar and characteristic form of the remedy, the greater the susceptibility to that remedy, and the higher the-potency required.”
- Khanna Neena, Illustrated Synopsis of Dermatology and Sexually Transmitted Diseases. 4th New Delhi. Elsevier, a division of Reed Elsevier India Pvt Lts, 2011
- Mayo Clinic. Psoriasis. Updated on 2020 May 02 [Cited on 2020 October 16]. Available from: https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845
- Allen H.C. Keynotes and Characteristics with comparison of some of leading remedies of the Material Medica with Bowel Nosodes. 8th edition (15th impression). New Delhi. B Jain Publishers (P) Ltd. 2016
- Close Stuart. The Genius Of Homoeopathy- Lectures and Essays on Homoeopathic Philosophy. New Delhi. Pratap Medical publishers Pvt Ltd