A Case of Psoriasis
11/12/2008 – Mumbai, India
A 44year old man visited the clinic with the chief complaint of skin problems. He had skin peeling off of his palms with some deep and superficial cracks. Water-proof bandaids were around his finger nails. He had cracks running between his fingers. He mentioned his previous visits to a skin specialist who had confirmed this as ‘palmo-plantar psoriasis’ and he had been treated in the past with oral steroids and local applications. The patient had also tried Ayurvedic therapy and had come turned to homeopathy as a last resort.
Appearance: Tall (6’4”), dark, round at the stomach, eyes had a bit of a red tinge.
Onset: It had all started 4 years ago when he was out of the country (India) working on an assignment. He had been away from home for almost a year and had a high level of stress from work and home.
Life situation as narrated by him: I was working as a marketing manager for a Dubai based company and doing very well since the last 4-5 years. I’ve been out of the country since I was in my 20s. I had a love marriage and we were doing fine just like any married couple. My wife was living here in India and I used to fly down once a month or two. We have two kids together, a girl 13years and a boy 5 years old. Presently they are with me. My wife and I separated a couple of months ago. I lost my job then and flew back here. Everything started falling apart then. I understand I did not have much time to spend with my wife and children. After I lost my job I had problems financially, as I have house and car loans. My wife got a job in Pune (i.e. 11hrs drive from Mumbai) and also government quarters to stay in. I visit her over the weekend. To be honest, I think she is having an affair; she makes excuses when I touch her at night, will get angry with me over small things…especially my hands. She suggested I go see a homeopath for this. I drink often. I’m searching for a job out here, but it’s not the same. I had a high post and out here the offers are below my level. I knew (names were mentioned of high ranked people, few of them I ever heard of but were described as being of uttermost importance to the world) …so how can I accept these job offers?… But doctor. these hands, I’m ashamed to shake hands; I can’t shake hands with people I meet.
They look dirty; I put bandages on the deep cuts, as they burn and sting. It feels better in ice-cold water. And I perspire a lot especially my palms….so that is not good as the band-aids keep coming off.
Some people call me restless, but I disagree…I’m more of a perfectionist. If I like the pen to be next to the pad and not anywhere else its fine; my wife thinks I keep on picking at little things in the house such as the cushions or the way the table is set. I like to invite few important people over and they should not get the wrong impression.
Anger: I’m easily angered, over small things, especially if they don’t go my way. But now I’m suppressing it more and go to drinks. I won’t lie, I don’t smoke. I tried stopping but then there are frequent binges; I’ve tried AA meetings but they won’t help much. My wife gets me irritated a lot and we have fights over everything. I’ve had my share of affairs, she does not know, but if she is having one I won’t accept it….and I think she is seeing someone. I was on steroids for this for about 3-4 months, a year ago but then I switched to Ayurveda and now I’m coming to homeopathy. First it was only on my palms, since two months I see some skin peels on my right sole….is it the same?
Family life – Well my wife calls us to Pune to settle there but I am looking for jobs out here. Children have their school here so we are here for now. My apartment is on a loan; may have to give that up. Not sure of financial things right now.
Dreams: They are of sexual nature…mainly cause I miss my wife; and to be honest I do have someone I usually go to.
INITIAL ASSESSMENT OF THE CASE
Given the life-situation, the patient was facing some financial and family crisis and was a chronic alcoholic. The fact that he was laid off, and every job he found now seemed beneath him clearly underlined the characteristics of a high ego and boastful person. With regards to his wife, there were hints of jealousy, openly confessed doubts and suspicions. Suppressed sexual desires, anger-irritability, haughtiness and self-consciousness were marked. Thermal modality: Hot; Thirst: less thirst for water; Appetite: No change.
REPERTORISATION WITH THE AID OF ‘KENTS REPERTORY’ •Mind, Haughty •Mind, Embarrassed •Mind, Jealousy •Mind, fastidious •Sleep, Dreams amorous •Skin, Itching scratch until it is raw •Skin, cracks, burning washing after •Generalities, alcoholics
Remedies that were closely related to these symptoms and were seriously considered were Arsenic, Lachesis, Lycopodium, Nux vomica and Sulphur. I decided to concentrate on remedies that covered the mental picture of this patient rather than his disease presentation mainly because of the peculiarities that came through distinctly during his narration of his life-situation.
Arsenic, is a great remedy for skin ailments and did match to the restlessness, anxiety, and fastidious nature of this patient. However, the lack of indifference and the want of taking medications and need of trying several other therapies to find a treatment to his skin affection ruled this remedy out. Keynote symptoms such as ‘anxiety fastidious and restless’ were present but the patient did not have the exhausted feeling, the fearful nature and indifference that complete the picture of Arsenic….so I moved on to more related remedies.
Lachesis, this remedy indeed covered a lot of the patient’s mental symptoms of jealousy, vexation, disappointment in his wife/love and alcohol cravings. The sensation/ feeling of constriction did not stand out so well in this patient. Symptoms were not very predominant to the left side.
Lycopodium, yet another great remedy to be considered especially as it covered the whole of the mental picture presented by the patient. Right from his haughty nature to his sense of pride….this remedy was a good match and was on the top of my list as I went ahead to consider the other two remedies.
Nux vomica is a remedy widely studied for ill effects following other therapies and very well suited in patients struggling with alcoholism. “Nux is chiefly successful with persons of an ardent character; of irritable, impatient temperament, disposed to anger, spite and deception”.
Sulphur, a great remedy that covered all of the patient’s skin complaints from looking dirty to being averse to washing that caused burning; voluptuous itching and better by scratching. A remedy that also is called upon when several remedies fail to give the desired result. Sulphur is also complementary to Nux vomica.
I decided to go with Nux vomica in this case. I gave the patient three dose of 200c potency to be taken at night only for three consecutive nights. He took a single dose November 12’ 2008.
January 5th 2009
Patient’s report: In the first week there was no change in the symptoms, but the symptoms were a bit more aggravated then I thought. The cracks were hurting more and I could not fold my hand. As you may recall I called you a couple of times to say that and you asked me to wait and continue with therapy so I did. In the second week I saw some improvement and the cracks seemed to heal up. The healing was faster than I expected cause it usually does not happen so fast except if I was on steroids. As you’d suggested I had not applied any lotions and even band-aids to my cracking palm which was not easy to do. My children are quite concerned and do not like to look at my hands. But see now….it’s gone….it’s clean…..three weeks later my old cracks had healed and there were new ones coming but they were not deep and they were not painful. My hands as of today look good as they did before. Besides this I’ve also taken up a new job though it is not what I expected. I’ve to report to someone above me who is much less experienced than I am and makes me work more than he does. I’ve taken it up, as my wife and kids need me and the money is much needed; but I’m not sure how long I can take this guy. I asked him to give some examples at work and he mentioned that they were more like difference in opinions and his opinion was usually not considered. He had not had alcohol and was sober twp months. He said he did this for his wife as she was considering coming over the weekends and spend some more time with him and re-consider jobs here.
Evaluations – My assessment based on this information was that the Nux vomica had helped the patient. There was a noted aggravation initially and later the skin affections started healing. The newer cracks seemed to be manageable. With his family and financial situation under control this seemed to be a solved case at that moment. Psoriasis is not an affection that disappears forever and trigger points do exist. I asked the patient to continue to see me in a month’s time and as of now he did not need further medication.
March 9th 2009
Patient visited in a bad frame of mind. His whole disease is back. He confessed to binging in the last month and said it occurred after his wife refused to sleep with him. She is having an affair for sure he continued. To continue he said, “I fired my superior for not considering my opinions and left the job. I’m far better than what they think. Look at my skin. It looks more filthy than ever. I had a job interview today and I couldn’t shake the persons hand because of these cracks.” On examination, the hands did have new cracks but they did not look as bad as they did on day one. His foot though, had deeper cracks than before. The patient required counseling and was referred to a psychologist.
Evaluations – My assessment based on this information was that the Nux vomica was still helping the patient. As the hands showed steady improvement the feet were showing active disease as they had not prior to this. I decided to continue with placebo in this patient for now, as it looked like he felt he was better if he took medications than if he did not. A month’s dose of sac lac pills was prescribed to be taken thrice a day followed by no medicines for two months. A follow-up was scheduled after three months and the patient was encouraged to work with the psychologist.
April 30th 2009
Patient came over with his kids and appeared to be much relaxed and in control of his emotions. He had visited the psychologist, who had provided him with a wealth of information and mental exercises. He had worked with him closely for about a month and followed up with him after two months. During this period the patient had also joined some yoga and meditation classes to help his anger. He was now spending more time with his kids. As for his wife, they were separated and he wished her well. He still was jobless and had moved in with his mother. He was considering re-locating back to Dubai and finding a job to his liking.
His skin eruptions had improved but they kept coming back. The frequency and intensity were not that bad. He mentioned that he would see one crack in about two weeks, it would heal faster and he needed no bandaids. His foot showed improvement and there were no more deep painful cracks. The healing was but a bit slow there.
Evaluations – With this picture I decided not to interfere with the therapy right now, as I believed Nux Vomica was still helping the patient. Patient would have to work on the trigger points that would aggravate the disease but as expected his own body needs to take over and bring out the healing process before a new stimulation was needed. Patient was given a month’s dose of placebos considering his previous request and was asked to follow up after 6 months.
Sep 10th 2009
Patient followed up a month earlier than scheduled as he was to re-locate soon. His palms had deeper cracks and his foot showed no further improvement. Patient said there had been no change since he last saw me. He confessed having had alcohol binges in between and that things were not that great but they were not that bad either. He had settled his issues with his wife and was now re-locating. He continued to see the psychologist and his meditation classes had helped him a lot. Last week he had a bad crack in his hand that he showed me had a band-aid on it and was itching so much that he scratched till it bled and then it burned. He continued to have severe itching in his palms even if there were no cracks. When asked if anything different had occurred a week or two ago….he mentioned an argument with his wife and that she had moved on with another person.
Evaluations – My assessment at this stage was that the patient had suppressed anger/feelings and disappointment, and was trying to escape his feelings. He was encouraged to address these feeling with his psychologist. An acute trigger factor being present here I decided to give a dose of Nux vomica 200c, only one dose to be taken at night followed by placebos for a month and an appointment was scheduled via phone.
Oct 10th 2009
The patient called me in a month’s time and we had a consultation over the webcam. He showed his palms. They were all clear and his foot was improving. He had been much more relaxed out there and in his own words “I know this place… its mine, where I’ve worked and lived for so long, so I’m quite at ease here.” He was sober for a month now and hoped to continue the same. He planned to get his kids there for a month. He did not bring up his wife in his conversation this time.
Evaluations – He was asked to follow up as and when needed. As of this day I received an e-mail from this patient that he gets cracks on and off and has not had a bad spell of psoriasis in Dubai. He says the weather suits him there!!
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