Solar Dermatitis in a Woman of 45

1st visit, 5. 10. 2019
A 45-year-old woman comes with solar dermatitis, which she developed at the age of 28. At that time, she was on holiday in Croatia and on the first day she developed, for the first time in her life, an eruption of dermatitis after sunbathing. She now has problems whenever exposed to the sun, regardless of whether at home or abroad.

Before that holiday she was worried that something bad might happen there (2). She had been worried for several weeks before she went on holiday. For a long time, she had suffered from an extreme fear of heights (4). She cannot go to shopping centers with steps made of glass – any stepping on such a glass step brings out panic, trembling, anxiety and, as she says, completely paralyzes her (manifestations of a panic attack).

Her thermoregulation is fine, she doesn’t mind the heat or the cold. She has a strong fear of crossing bridges (3) – whenever on a bridge, she starts to feel anxious and the stronger the anxiety, the faster she has to walk.

She is overly superstitious (2); for example, when driving and a black cat crosses the street in front of her in the distance, she turns around and takes another route. This is not new, she has had it ever since she had started to drive.

In recent years, she has developed a craving for spicy things, especially chilli (2). Before menses, she is very irritable, even aggressive (3). For about the last nine months, she has been waking up with non-specific headaches three times a week. Her sleep is worse now, she keeps waking at night quite often and in the morning, she wakes up unrefreshed.

Case analysis:
All remedies with aggravation by exposure to the sun (see the rubric below) should be considered in any case of solar dermatitis because the rubric “eruptions from sun” is too small. Remedies such as Belladonna, Natrum muriaticum, and Camphora are among the most important ones.

The question is whether any of the remedies in this rubric covers her fears as well, especially the fears of high places and crossing bridges. Both these are keynotes of Argentum nitricum, which is missing in this rubric. However, as we know from Materia Medica, Argentum nitricum is one of the remedies most aggravated by heat and sun.

This example shows how failure to know Materia medica and relying purely on the repertory can prevent us from finding the correct remedy. Argentum nitricum was the first remedy I thought of in this case as it corresponded to both principal aspects of the case (fear of high places + of crossing bridges + aggravation by sun).

It is also interesting that the first manifestation of the sun rash was preceded by anticipation and anxiety the patient felt before the holiday. Argentum nitricum is one of the most important remedies for patients who become sick out of anticipation.

If Argentum nitricum is the remedy needed by a patient with mental/emotional symptoms (in this case, fears), the patient would likely have impulses in dangerous situations, which is one of the most important confirmatory symptoms of Argentum nitricum.

Hence, my first additional question was directed specifically at impulses, and the patient answered without thinking and very spontaneously, “I have such impulses very often – for example when I’m driving in a car and the traffic stops me on a bridge, my mind runs wild imagining what would happen if the bridge collapsed and everyone started falling down.” These images are very vivid and often come hand in hand with fears and anxiety.

Such imagination during fears or anxiety is another keynote and confirmatory symptom of Argentum nitricum, these fears and anxieties being the consequence of the patient’s impulsiveness. The thoughts unfold into scenarios of this type, with the inability of the rational mind to control them.

Let us first select the most important symptoms and then look at the repertorization result.

Intensive symptoms:

1. Ailment from anticipation
2. Aggravation by sun
3. Fear of high places
4. Fear of crossing the bridges
5. Superstitiousness
6. Impulsivity
7. Irritability before menstruation
8. Unrefreshing sleep
9. Frequent waking at night

Repertorization in RADAR software with Synthesis 9.1 repertory

Repertorization is performed using the Sum of symptoms and degrees –

Intensity is considered technique

Differential diagnosis:
Sulphur can be confirmed on the basis of two symptoms, namely the fear of heights and frequent waking at night, both of which are keynotes of Sulphur. It also covers the totality very well. However, although it covers most symptoms of the case in the repertory, none, except for the two mentioned above, are its keynotes. Since the case involves very specific fears that are very strong in this patient, we need to find a remedy that does not just “cover” these fears; it should have them at a similar (i.e., strong) intensity. In other words, we are looking not only for a match at the level of symptoms but also at the level of their intensity.

Natrum muriaticum is a remedy of which skin reactions to the sun are very characteristic. Patients who need this remedy sometimes have fear of heights, but not as intensive as in this patient. Impulsiveness is something that contraindicates this remedy, as we often see the opposite in Natrum muriaticum, i.e., very strong control of emotions.

Pulsatilla is another remedy for which aggravation by the sun is a keynote. Although it is listed in the third degree in the rubric “ailments from anticipation”, this etiology is not its keynote. Fears, which are very strong in this patient, are not covered by Pulsatilla. The same can be said of Lachesis.

Calcarea carbonica is one of the remedies with the strongest fears of heights, along with Sulphur and Argentum nitricum. Fear of crossing bridges and impulsivity are, however, symptoms that Calcarea carbonica does not cover.

Nux vomica comes up relatively high in repertorization but is not the remedy of choice in terms of similarity. The main symptoms of the case, i.e., aggravation by the sun and severe fear of heights and crossing bridges, are not typical of Nux vomica.

Argentum nitricum, besides covering the totality of symptoms very well, has the most important symptoms of the case (aggravation by the sun and strong fears of heights and crossing bridges) as keynotes, just like ailments from anticipation and impulsivity.

Sepia, Cocculus, and Phosphorus are neither aggravated by the sun nor correspond to the patient’s fears and impulsivity.

Selection of the remedy and dosage:
Argentum nitricum is the remedy covering the case best as it is the only one that can be confirmed on the basis of totality, keynotes, and etiology. As the picture of the remedy is very clear and there is no other remedy that could be considered, I decided on a single split dose in the potency of 1M.

Prescription: Argentum nitricum 1M in a single split dose

1st follow-up 30. 11. 2019 (7 weeks after the remedy)

One week after the remedy, her fingers started to ache (stitching pain), which lasted for 1-2 days. The following week, she had one episode of intensive headaches but after that, her general condition improved considerably.

Her sleep is much better, she does not wake up at night and in the mornings, she feels well-rested. Headaches have, since the one episode, disappeared. She has no anxiety in the car when crossing a bridge, she has no unreasonable impulses, either. Her fear of high places has disappeared completely. She had no PMS symptoms. The reaction to the sun cannot be evaluated as the weather has been quite gloomy lately.

Analysis of the 1st follow-up:

After she took the remedy, there was an aggravation followed by a marked and long-term improvement, which persists. This is a great reaction showing that the remedy was correct and we have to wait.

Prescription: wait

2nd follow-up, 6. 6. 2020 (6 months after the 1st follow-up)

She had no reaction to exposure to the sun (she was sunbathing intentionally to see if it would affect her) until 20.5.2020. On that day, after being in the sun, eruption appeared on her forearm and hands, and in her cleavage. The eruption was pink and was accompanied by itching and burning. Still, it was localized and it did not erupt all over her body as before the homeopathic treatment. On 1st June, she had another eruption but it was about 50 % better than on 20. 5.

Analysis of the 2nd follow-up:

The patient was entirely without problems until 20th May; from then on, two episodes of eruptions appeared. The first time was better than before the beginning of the homeopathic treatment and the second time, it was even weaker. As the improvement in the remaining areas persists, it is likely just a temporary swing, which does not need another dose of the remedy (or a new one) as the organism can normalize on its own. This is corroborated by the fact that the second episode was much weaker than the first one. For this reason, we have to wait now.

Prescription: wait

3rd follow-up, 5. 9. 2020 (3 months since the last follow-up)

She has no reaction to sun exposure, no panic attacks, feels well, has no new symptoms. She walked the “sky walk” in Dolni Morava without any problems or panic symptoms.

Analysis of the 3rd follow-up:

The patient is completely free of problems as well as of any reactions to the sun, free of any anxiety. Hence, we still have to wait without repeating the remedy.

Prescription: wait

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