Male: 33 y.o.
Weight: 70 kg
Height: 174 cm
1st visit November 22, 2013
The patient comes with the diagnosis of psoriasis vulgaris which appeared in 2010 and has been treated unsuccessfully for two years with immunosuppressive agents and adalimumab – a biologic agent used for treatment of several auto-immune diseases. For the last few months, after discontinuing those drugs, the patient applies just a cream based on salicylic acid. The psoriatic plaques cover almost the whole surface of his body, but without itching. There is a very intense redness covering his whole face (2). Dryness of the scalp (2).
He also suffers from recurrent tonsillitis since puberty, with a frequency of 3-4 times a year for the last few years, with high of fever 40 C, always treated with antibiotics. The ASOT (antistreptolyssin O titre) is 1546 IU/ml (normal value < 200).
Perspiration of hands (2), offensive perspiration of feet (2), perspiration of axillae. Perspiration of cervical region (2). Frequent urination.
Hct (hematocrit) 38.1 % (normal value 40-52%)
Hb (hemoglobin) 13.6 g/dl (normal value 13-18)
He is biting his finger nails (2). He has a little anxiety about his health due to the psoriasis, but he has not anxiety for others.
Fear of high places (1) and a fear of injections (2).
He is chilly (2).
Desires: vinegar (1), cheese (2).
Aversions: pungent food
His memory is good. His sleep is good. His thirst is normal. His stamina is good.
Condylomata on testes many years ago, treated with allopathic drugs
There is no family history of psoriasis.
The father has hyperlipidemia and hypertension. The grandfather had multiple heart infarctions.
My effort to investigate if there had been any particular factor or specific situation that might have a causal relationship with the manifestation of the psoriasis in 2010 did not reveal a certain etiology. However, what was really striking during the consultation was the great tension with which the patient described the fear of being humiliated or laughed at by others. After further questioning on this subject, the patient with difficulty revealed that he had been suffering from such fears because he was homosexual and nobody else knew it, neither his family (his father had always been rude, censorious and insulting), nor most of his friends. He described the intolerable feeling of trying to keep it a secret during his entire life, pretending to be someone else. It was a tremendous burden and a constant cause of anxiety for him. He is a mild, yielding and gentle person. He admitted that he needed security and reassurance in his relationships and that his self- confidence was not very good.
Analysis of the case
The manifestation of the psoriasis may have been the outcome of the longstanding inner turmoil of the patient for so many years. The fact that the disturbance is located mainly on the skin (psoriasis) and also on the lymphatic tissue (tonsils) indicates that we are dealing with a quite strong immune system without any serious hereditary predisposition. This is also confirmed by the frequent acutes with very high fever that suggest that the organism functions in a quite organized manner, prohibiting the disturbance to produce systemic disorders by keeping it on the most superficial layers of the physical plane.
Another factor suggesting that the patient belongs to a relatively high level of health is the fact that the organism has managed to keep the imbalance on the physical body despite the remarkably suppressive nature of the allopathic drugs administered for so many years (immunosuppressive agents, biologics, and antibiotics).
Based on the aforementioned reasons and considering also the fact that the disease is not present in the family medical history, we can assume that the prognosis is good and the patient belongs probably to the level 4 or 5 – Group B (according to theory of the Levels Of Health by professor G.Vithoulkas)
The repertorisation was done using two different methods, VITHOULKAS COMPASS online homeopathic expert system and RADAR software as well.
SILICA fits the essence of the mild and yielding personality of the patient, the low self-confidence, and as keynotes it has the fear of injections and the offensive perspiration of feet. It has affinity with tonsillitis and perspiration of hands, feet, axillae and cervical region and is a cold remedy, thus covering the totality as well.
SULPHUR covers the pathology, as it is a specific remedy for skin disorders, and also it covers the offensiveness of feet and the fear of high places. Moreover, it is present in the rubric ‘aversion to pungent things’. However, it cannot be confirmed by essence, as the Sulphur patient is usually irritable and more aggressive, and the fact that the patient is chilly is a contraindication.
CALCAREA CARBONICA is a chilly remedy. The perspiration of the cervical region and the fear of high places are keynotes of the remedy (although it would be more fitting if the perspiration of the cervical region was more intense during sleep). The remedy is not confirmed by the food preferences (Calc likes sweets and eggs) or by easy fatigue.
HEPAR SULPHUR covers the chilliness and the recurrent tonsillitis and it is present in the rubric ‘aversion to pungent things’. The fear of injections and the desire for vinegar are keynotes of the remedy. But the essence of Hepar sulphur is described as irritable, abusive, angry and impolite, totally different from the personality of the patient.
PSORINUM is chilly, it has great affinity with skin eruptions and it has offensiveness and anxiety of health. But it also has intense itching that usually drives the patient to despair, a symptom that is absent in our case. Moreover, Psorinum is expected to have fear of poverty, anxiety about the future and despair of recovery and usually has a lack of vital reaction, while in our case the patient presents frequent acutes with high fever.
NITRIC ACID is a chilly remedy. The anxiety of health and the offensiveness are in favor of this remedy but the essence of the remedy is totally different from the mild and gentle personality of the patient. In addition, the good sleep of the patient is a contraindication.
BARYTA CARBONICA fits the mild personality and the lack of self-confidence of the patient, as well as the need for security and reassurance. A strong characteristic of this remedy is the recurrent tonsillitis. The biting of the nails and the chilliness are also in favor of this remedy. The fact that the memory of the patient is good (while Bar-c usually has memory problems) does not mean that Bar-c cannot be considered as a possible choice for the case.
LYCOPODIUM, ARSENICUM ALBUM, SEPIA, PHOSPHORUS and NATRIUM MURIATICUM cannot be confirmed neither by essence nor by keynotes. LYC has low self-confidence, but is haughty, dictatorial and has usually gastrointestinal problems and bad sleep. ARS has a greater anxiety of health and a different essence, being fastidious, restless and usually censorious. SEP is usually spiteful, malicious and critical. PHOS has different fears, cares a lot about others and has a greater thirst. NAT-M is a warm remedy with a very reserved personality, rendering almost impossible to confess secrets of that personal nature during the first consultation. Also, the food preferences do not confirm the remedy.
According to the analysis, the remedy that most probably is the simillimum is SILICA, confirmed on the basis of essence, keynotes and totality. Other possible choices for me were CALC and BAR-C. However, CALC is a more down-to-earth practical type of personality compared to the refined, mild and insecure nature of the patient standing in front of me. BAR-C seems also to be fitting the case, but it lacks the fear of injections and the perspiration of hands, feet, axillae and cervical region.
I prescribed SILICA 30C, one dose per day for 20 days
Follow up 1
December 23, 2015
The patient had an intense and prolonged aggravation of psoriasis, with intense itching, that is still going on. The dryness of the scalp is better. The offensive perspiration of feet is reduced significantly. His sleep is even better. Perspiration of hands and cervical region remains the same. Frequent urination is still present. Redness of the face remains the same. He has developed a desire for sweets lately. But the most important thing is that the patient is reporting a significant amelioration of his emotional state. “I cannot explain what is happening to me. With my skin in such a bad condition after the remedy, I should have been a wreck and extremely ashamed to go out of my house. On the contrary, I feel very good”.
The prolonged aggravation of the psoriasis accompanied with a clear improvement of the mental/emotional plane shows that the remedy was correct and verifies that the patient belongs to level 5 or 6 of group B. As professor G. Vithoulkas analyses in his book Levels of Health: “The defence mechanism is, however, not as strong as in the higher levels where we find a much quicker development of the case. Here we see that the organism is only able to respond by phasing the reaction, first ameliorating the deeper areas and shifting the disturbance to the local complaint that therefore aggravates temporarily. It does not have the strength to do two things at once, namely to shift the disturbance in the periphery and lessen the intensity at the same time. The weaker the defense mechanism and the deeper the pathology is, the longer it will take before the intensity of the disease can be lessened regarding the peripheral symptoms.” (Vithoulkas G.-Woensel van E., Levels of Health, International Academy of Classical Homeopathy, 2010, page 133)
We must not interfere at this point. We have to wait.
Follow up 2
January 22, 2014
The patient developed acute tonsillitis without fever, which was cured without any drugs in 2 days. This had never happened before in his life. The dryness of the scalp has disappeared. The offensive perspiration of the feet has disappeared. The redness of the face has reduced significantly. The psoriasis has started to disappear from the shoulders and the area of the neck. For the first time in his life is talking about his psoriasis to other people without being ashamed. His energy and mental/emotional state are great. The desire for sweets is not present any more.
The improvement is obvious at all levels. The organism is strengthened even more and it follows the direction of cure according to Hering’s Law of Cure which states that: “All healing occurs from within out, from the head down, and in the reverse order in which the symptoms have appeared.”
We have to wait again.
Follow up 3
April 8, 2014
The improvement is progressing furthermore. Slight irritation of tonsils occurred once and passed in a few hours without any drugs. The upper part of the body is free from psoriasis. The perspiration of the cervical region has reduced. New symptoms are salivation during sleep and a condyloma on the penis. Energy and mental/emotional state are great.
We are witnessing the reappearance of condylomata, an old symptom that the patient had cured allopathically in the past – Hering’s Law still in progress. Overall condition very good. We must wait.
Follow up 4
July 3, 2014
Psoriasis has disappeared from the head, the upper limbs and the trunk. Some small plaques still remain on the legs and calves. Salivation during sleep has reduced. He is not biting his nails anymore. He says that everyone around him has noticed an impressive change in his attitude. He feels great. The condyloma still remains.
The improvement is unquestionable at all levels. However, the fact that the condyloma still remains shows that the organism has not yet reached its optimal state.
We must wait.
Follow up 5
September 9, 2014
Laboratory tests: ASOT 376 IU/ml (previous test ASOT 1546, normal value < 200),
Hct 43% (previous test 38.1 %, normal value 40-52%)
Hb 14.2 g/dl (previous test 13.6, normal value 13-18)
Psoriasis has disappeared from the legs and calves as well. “There is no sign of psoriasis left. It is as if I had never had psoriasis in my life”. More condylomata have appeared on the penis and scrotum. New symptoms: he enjoys staying up late at night during the last days and he is washing his hands many times during the day. He has a new affair with a person. He enjoys the relationship, but he has developed strong feelings of jealousy and suspiciousness recently.
The improvement is also confirmed by the laboratory tests. The psoriatic plaques have disappeared, but we are not sure yet about the ability of the organism to counteract the effect of a strong stress without relapsing to its previous condition. The fact that the condylomata have proliferated may indicate that the organism needs more time or more energy to deal with this condition. It is interesting that the new symptoms (staying up late and frequent washing of the hands) combined with the condylomata and the family history of myocardial infarctions of the grandfather point towards Medorrhinum, but when asked during the follow up the patient did not express any desire for sea, salt, lemon or uncovering of the feet. Moreover, the feelings of jealousy and suspiciousness may constitute the basis of another underlying remedy or may represent a possible stress factor that may put the balance of the organism at risk. It seems that the organism is shifting towards a new direction. It is crucial not to make a hasty decision right now, because an untimely interference would probably spoil the case. Since we are not sure about which of the above assumptions is correct, the only choice we have right now is to wait again and see how things will settle.
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I am a student of Vithoulkas` online Homeopathy courses and I am really impressed by analysis and work-up of presented case. Thanks you for your work!
Thank you for your kind words.
dear dr. Stamou,
i am also an IACH student via the e- post graduate programme and i really appreciate the analysis you gave us here. it is really important for us as novices to see a full correct approach according to the teachings of Prof. Vithoulkas.
I am really glad that you liked the case.
a verry merry Christmas and a blessed new year to you and to everybody!
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Merry Christmas to everyone!