A Case of Atopic Dermatitis
stasis-eczemaA 3.5 year old boy suffered from skin eruptions for one month. His mother stated that these eruptions started on the legs and then spread all over his body. The eruptions were denser on the extremities and face. The boy experienced voluptuous itching that was treated with antihistamines before this visit. Itching was also ameliorated with cold applications and was aggravated at night. His mother said he “yells in his sleep”.
His mother said that they were from Calcutta and had relocated to Bombay. She had tried some allopathic lotions and anti-histamines when she moved to Bombay and the skin eruptions looked better one day and worse on other days. She was sure he was not improving but worsening and pointed to the boy’s skin with a sense of disgust.
Full term normal birth
Had jaundice at birth (assumed to be physiological).
Milestones were noted to be slow by the mother as she compared him to his brother. She added that he started walking two months later than his brother and teething was slow too.
Symptoms related to child’s nature/behavior:
His mother rated his stubbornness as 3+ and anger 3+. She said he was attention seeking and wanted his mother in the room all the time. He won’t cling to her but will keep on touching things and move around restlessly. His tantrums were characteristic of yelling, screaming, throwing things, hitting the grounds, bangs himself on the ground. When asked what calmed him down, the answer was ”chocolates and music”. His love for music was rated as 3+ “In any situation, if we play the music he will keep quiet”. The kind of music was not very specific so she played tunes that were handy on her cell phone.
The boy appeared lean, averagely nourished, brown skin with scanty hair growth on the head. Opposite to his brother (a year older) who seemed to be calm and mild, this boy appeared restless and attention seeking. He moved from one toy to the other without exploring the toy much. Being comfortable with his mother around he sat on the toy truck for a couple of seconds then moved on to a pile of books and then another toy. This went on for the whole hour that they were there. The boy wouldn’t listen to his brother, wanted everything he had in his hand, and the mother had to intervene after every few minutes. He yelled out loudly as his wishes were not complied with. This whole time he continuously kept scratching; there were small bleeding spots and reddened skin on his legs and hands. The eruptions had spared his cheeks and were more on the forehead and scalp.
Mother’s pregnancy history:
It was stated that this was an unwanted pregnancy. The mother did not wish to get pregnant after the first child. She had a Master’s degree in business management and wanted to pursue her career goals. She stated in a very sorrowful way that she tried to get rid of her unborn baby. She tried exercising heavily, jogging and even at times hitting at her womb. She was emotional, frustrated and angry during her nine months. Following birth, her emotions did not change much. She saids she did not take care of her second boy the way she did the first child. She did not pay much attention to him and responded to his actions with anger. She expressed the need to escape her pregnancy, her family and her husband.
The child had thin extremities, round head and stomach that looked disproportionate to the body structure. His eyes looked popped out and cheeks and lips were rosy red in the hot humid Bombay weather. His weight was appropriate to his height and age; however to the naked eye with his skin eruptions he looked unhealthy and under-nourished. Skin was dry, red spotted with scratch marks. The boy’s eyes had a staring look and the face looked expressionless. Thirst was not very peculiar. Heat/hot weather was intolerable. The boy had poor appetite and had to be forcibly fed most of the time. His aversion in food was especially to milk and chocolates.
Initial Assessment Of The Case
Several peculiar symptoms related to the child came to light during the case taking, such as restlessness with a desire for change. A strong desire for music was also considered. However, the one peculiar characteristic related to the mother that was very prominent and could also be used here, was the feeling of not wanting or desiring the pregnancy. The eruptions typical of atopic dermatitis, helped me to keep the common elements out of the particulars.
Repertorisation with the Aid of ‘Complete Repertory’ •Mind, Music desires •Mind Restlessness •Mind Anger, temper tantrums •Mind, Obstinate, headstrong children •Mind, Forsaken feeling (mother did not even cuddle him) •Mind, Change desire for •Food and drinks, chocolates desires
Remedies that were closely related to these symptoms and were seriously considered were Calcarea Carbonica, Pulsatilla, Carcinosin and Stramonium.
Calcarea Carb came to mind, as I was watching the child, who was bit slow and sluggish, intelligent eyes full of curiosity but yet shy to explore. Calcarea is a remedy close to Sulphur and Lycopodium and they are often prescribed in a cyclical manner. While parts of the child’s presentation fitted each of these remedies the whole picture did not come together. In addition, Calcarea failed to cover desire for change and desire for music.
Pulsatilla is a strong remedy that comes to mind when we think of the forsaken feeling, lonely and not desired for. While at such a tender age, these feelings are not very prominent, this particular symptom had to be a part of the totality because it very closely represented the mothers’ characteristic when she was carrying the boy. Pulsatilla was further ruled out due it being mild and timid. This boy was not mild at all per his mother, he was obstinate, and often threw a tantrum, which is quite opposite of Pulsatilla who is yielding.
Stramonium is yet another strong remedy; however one cannot overlook the mania described in books about this remedy. Although the plethoric look and wide eyes made me give Stramonium a thought, the lack of loquacity and phobias quickly ruled out this remedy.
The one remedy that stood out in my mind following the mother’s narration of her feelings during pregnancy was ‘carcinosin’. The mother felt the child was not a part of her and wanted to get rid of it and never really accepted him. This type of desired detachment came out as a very peculiar symptom. The other symptoms such as obstinate, restlessness, sensitive to music, anger, temper tantrums, cravings for chocolates and desire to frequent changes are also covered by this remedy. In addition, past treatments indicated temporary ameliorations, so at this point Carcinosin was a well matched remedy.
I prescribed Carcinosin 200c. A lower potency or an acute repetition was not considered as the symptom picture although not quite chronic, had been treated prior and had been suppressed to some extent. He was given a single dose and was asked to follow-up after two weeks.
May 3rd 2005
After three weeks the skin had improved and the mother was glad to see that there were no new eruptions and the previous marks left behind were lightening. Dry skin and restless were still a concern to the mother who requested topical applications. I convinced her not to use any topical applications or any anti-itch medications. The mother added that the boy had a runny nose for about three days after she started the medicines and she had called the clinic for the same. I advised her to continue the medications, not apply anything on the chest and nose (a usual practice in India is to apply Vicks vaporub during a cold)…keep the child on warm liquids and food intake. Hygiene tips were provided.
Evaluation: Coryza followed the first intake of Carcinosin. At this time ‘no interference’ was called for in this case and hence the patient was given no more medications and asked to follow-up at her convenience after three weeks. The mother was advised to introduce the child to a few summer classes, a way to feed his curious nature. (Summer in India falls during the months of April-June)
May 17th 2005
At this follow-up marked improvement in the child’s skin was observed. Height and weight gain were good. The appearance of the face was much clearer. The mother had put both her boys in a summer camp and since then she had noticed a few changes. The boy was now listening to the mother and in her own words had ‘calmed down’. The mother seemed relaxed and was considering taking up teaching. The child was provided with no medications and asked to follow-up after a period of 3 months.
Aug 20th 2005
During this visit, the child had no complaints and was very willing to answer my questions, although in monosyllables. The mother expressed her gratitude and continued with some of the issues with the boy. Although happy that there were no more new eruptions, she complained of his skin being too dry. She pointed out that he sweated on his upper lip and forehead only and rarely all over. He had this peculiar odor when she carried him and she considered that to be the detergent she was using to wash the clothes and she’d changed that but was not very sure. She continued that there was a difference in his nature too….he was no longer breaking things or restless. As the boys played in the play-area of my clinic the mother stated that she had taken a teachers post. Her boys were going to the same school and the patient was to be pre-school for a year and move on to kindergarten.
Evaluation: The child had no complaints that affected his general mileu. His appetite, thirst, sleep and food intake were good/normal. There seemed to be no need of any medication at this time as the child was doing better and we would wait and watch for any further skin issues if any. The mother was encouraged not to use any topical ointments for the skin dryness. A follow-up visit was scheduled for after 6 months.
Feb 26th 2006
The family had gone for a winter vacation to north of India to experience the snow….as in Bombay it doesn’t snow. The child had developed a few eruptions back then but they had gone down by themselves per the mother. In the last six months she had not seen any major skin issues and said the boy continued to be as he was and had no problems. The boys were looking forward to their summer vacation mid-April and he would start his kindergarten in June. He followed his brother everywhere and would try and repeat what he did. His brother, per the mother was his teacher more than she herself.
Evaluation: With no complaints, the other was requested to bring the child as and when needed in the next year.
It so happened that the patient’s parents relocated to Calcutta after a year or so and I got a letter from the mother stating that they were doing fine and if need be they’d get in touch with me.
You may also read this on Hpathy.com: http://hpathy.com/clinical-cases/a-case-of-atopic-dermatitis/)