TWO CASES OF ECZEMA

TWO CASES OF ECZEMA

Introduction

When I first began to prepare this presentation I feared that these cases might not be all that fascinating. They seemed to be pedestrian, rather ordinary cases. However, as I studied the cases and the remedy that was curative for these two patients, I found a great deal of interesting information. I learned quite a lot. It reminds me of the old adage that we teach what we most need to learn. I hope that you will also learn some useful information from these cases.

Case Number 1

Male

Age 4

Initial Visit: January 26, 1994

Chief Complaints: Eczema and asthma.

His parents think that the eczema started as cradle cap when he was a baby. It was thick and yellow. He also had really bad diaper rash. His parents used over-the-counter shampoos and creams for the cradle cap and diaper rash, and they cleared up.

The eczema proper started around his mouth and chin when he was about one year old. It gradually got worse and worse.

Eczema treatments to date have included over-the-counter creams and ointments, steroid creams from the doctor, and herbal treatment from a medical herbalist. The only thing that has helped a little has been coal-tar preparations.

His skin is generally sensitive (2).

Location of the eczema: face, ears, neck, back of knees, left call and around the scrotum. It is worse around folds in the skin (ears, knees, and genitals).

The eruptions are thick (3) and raised (3), with large, thick, gray-brown flakes. They are vesicular -- small blisters that itch, break open very quickly, weep, and then form thick scabs.

Itching (3). Worse at night (3) and in bed (3). Bathing helps the itching but makes it sting.

He scratches so hard that he takes the skin off and bleeds, with weeping (clear) after scratching.

Generally, bathing in the sea ameliorates (2) and summer ameliorates (2) his condition.

Milk may aggravate the skin a bit. Using soy milk the past few months has helped the facial eczema somewhat.

Oranges aggravate.

The asthma started when he was around 18 months old, with a chest infection that lasted for three months.

His first chest infection occurred when he was two months old (in January). They recur yearly -- in December and January (2).

When his chest is bad, his skin is better.

Treatments have included a Ventolin inhaler at bedtime for the asthma and antibiotics for the chest infections.

His parents are very vague about his chest symptoms. Basically, he has a cough with wheezing, with the common symptoms of wheezing on exertion and wheezing with a chest infection.

His glands (tonsils and cervicals) have been swollen for years (probably since the first chest infection).

His voice is nasal (2). (Chronic nasal obstruction?) He doesn't snore at night.

He is warm-blooded (2). Getting overheated aggravates him (2) generally and also aggravates the eczema.

Desires fruit (2).

Dislikes eggs (2), cheese (2), and pickles (2).

Thirsty (2) for fruit juices.

He perspires easily (2), all over his body, especially with exertion. His head perspires at night in his sleep (1).

His birth was long and difficult, with forceps.

His mother was anemic during the pregnancy and vomited a lot. She also suffered from low blood pressure and fainted easily.

His developmental milestones have been normal.

He has had all the usual vaccinations (DPT, polio, MMR, and Hib) without any bad reactions.

He had chickenpox at age four.

As a baby he was fractious, clingy, and restless (3). He cried a lot and wanted to be carried.

He is "nervy" (2). Jumps and cries with loud noises, such as thunderstorms or fireworks. This has become worse the past two years.

His parents say that he is a bright, open, trusting child. (He makes good contact with me.)

When he was two years old, his brother was born. The brother has no health problems. The two boys get along really well. There doesn't seem to be any jealousy.

He is a "chatterbox," talking easily with me.

He weeps when he is reprimanded (2).

He has been getting increasingly irritable as his skin has become worse.

He moans and whines when he is awakened from a sleep.

Affectionate (2).

Family History:

- Mother: Severe acne as a teenager.

- Maternal Grandfather: Acne, eczema, and herpes.

- Maternal Great Grandfather: Died of bowel cancer at age 68.

- Maternal Aunt: Asthma.

- Paternal Great Grandfather: Died of throat cancer.

Analysis of Case Number 1

The father brought the child in, and this was the case he gave me. I was not able to elicit any further information from him. The mother worked full-time and could not come in, so I would speak with her on the telephone occasionally. I never met her in person.

Looking at the case, I found that many remedies came to mind as possibilities. I thought about Graphites, Sulphur, and Antimonium crudum, among others.

Graphites? The classic stickiness of the discharge was missing. I asked about this three separate times. If the remedy were Graphites it would be unusual for such a severe skin problem not to have this sticky discharge.

Sulphur? Well, the problem wasn't worse from bathing. In my experience, if the eczema isn't worse from bathing the remedy isn't Sulphur, although Sulphur will always score highest in the repertorization of a case like this.

Antimonium crudum? The eruption was not white, although the scabs were thick, and he lacked other symptoms to confirm the remedy.

I studied the case for an hour and a half or more. When I prescribe a remedy I like it to fit the whole picture -- a totality prescription. In this case, I tried every way I could think of to find that kind of remedy. I was not able to do this. Nothing I considered was satisfactory from a totality point of view.

What were the other options? The physical symptoms were severe, and the case lacked a useful mental picture or a clear physical general symptom. This led me to focus more exclusively on the local physical symptoms and to strongly consider the possibility of a smaller remedy. I wanted to know what remedy fit his skin symptoms well.

I selected a few of his prominent physical symptoms: the specifics of the eczema and the desquamation and the itching worse at night. These were not small rubrics!

I entered the rubrics into MacRepertory and then eliminated the polycrests from the graph analysis. This is what I most appreciate about the program -- its flexibility in allowing me to look at a set of symptoms from several points of view. Then I played the "alphabet game." I simply went through the list of all those smaller remedies, reading and studying them one by one until I found the remedy that fit his symptoms best.

The remedy was Croton tiglium. Under this remedy I found the following: thick, raw eczema; eczema alternating with asthma; terrible itching; eczema of face and genitals; with vesicles; worse scratching; itching worse at night; with restlessness. I also found swelling of tonsils and asthmatic respiration.

When I arrived at Croton tiglium, I felt hopeful and excited. In Hering, I found a little phrase, "idiopathic eczema of children." This really thrilled me. It felt right. These little "nuggets of gold" are hidden in the proving symptoms, and we need to seek them out and remember them.

I called the parents to check whether there was any alternation of the eczema and asthma. They thought that when his chest was worse, in the winter, his skin was better, but it was not a true alternation, just an amelioration.

The restlessness was the only mental symptom of Croton tiglium that fit this boy's case.

Plan: Croton tiglium LM1, one dose daily.

Follow-Up on Case Number 1

February 10, 1994

The sores are smaller and not as itchy (about 20 percent better, generally, all over the body).

His face is better.

His skin color is better.

His scrotum and neck are not better.

He picks at the scabs.

The respiratory symptoms are better.

His parents report that he is happier, especially in the past couple of weeks. He is easier to be with. He is more content and less nervy.

Plan: Continue with Croton tiglium LM1 and switch to LM2, also once daily, at the end of February.

March 4, 1994

His face is now much better.

His skin is generally less itchy and hot.

He still picks at his skin.

His glands are markedly reduced.

He looks marvelous.

March 31, 1994

He is much better.

The itching is better.

His neck and genitals (the worst areas) are now nearly completely clear.

His sleep is much improved.

His behavior also is much improved. His teachers say that he has settled down and his concentration is much better. He is happier in himself.

(It's quite interesting to note the improvement in behavior at school. I hadn't known how bad it was. This part of the follow-up information came from his mother, who also said, "This modem medicine, I don't understand it. It hasn't been around for five minutes and they give the same treatment to everybody! Why do they do that?" She really understood what we were doing with the homeopathy, and it made sense to her, especially when she noticed how different her son's eczema was from that of her friend's child.)

Plan: Croton tiglium LM3, once daily.

April 30, 1994

Continuing progress in all areas.

Plan: Croton tiglium LM4, once every other day.

Long-Term

There was an aggravation of his eczema at the beginning of May 1994, which cleared up after stopping the remedy.

By the end of July 1994 he was nearly symptom free. His chest was completely clear. His skin was 80 percent better.

In May 1995, his parents reported that he had no chest problems the past winter. His chest has remained clear. His skin gradually cleared up totally through the autumn of 1994 with no further treatment. He has had no skin symptoms since then. His mother said, "He is a different child. Happy and healthy. Just like he should be!"

Case Number 2

Female

Age 53

Initial Visit: May 1, 1994

Chief Complaint: Eczema.

Observation: She is a very pleasant, well-dressed, articulate woman. She sat upright and made direct contact with me throughout, answering my questions easily.

The "nervous" eczema started about ten years ago on her face and chest (between her breasts) at the time of the menopause. The eruptions were symmetrical and itchy and got worse when she took antibiotics.

She had a lot of stress in her life at the time: moving and a new job. "The man I worked for was a bully. It was a disaster. When I stopped working for him my skin cleared up."

She has had mild outbreaks over the past three or four years.

Steroid creams from the doctor cleared up the outbreaks each time, until recently. About 15 months ago (February or March 1993) she had a severe outbreak after a period of emotional stress. She is working for another man who was bullying her at the time. "My loyalties were divided. I liked my job but had an inner conflict that left me feeling very angry (3) and doubting myself (1)."

Observation: This anger is not expressed. She describes the conflict in a pleasant way, smiling all the time.

She describes herself as a loyal person with lots of integrity. She works hard, long hours.

Eventually, the conflict with her boss resolved after a huge argument during which she did not get angry. "I feel in control now. I feel I have his measure now."

At the time of the conflict she would dwell on it constantly and would wake in the night with it all "churning over in my mind." She would try to plan what to do next and would feel anxious about what would happen. Her skin flared up after the conflict had resolved.

The eczema is on her face -- over her nose, chin, and temples. The itching is worse from radiant heat (2) and from getting hot (2). The eruptions are symmetrical (2), bright red, hard (2), dry (2), rough (1), scaly, and flaky (2), with large, thick flakes. "My skin feels stiff and tight, as if it is sunburned."

Over this last year or so the steroid creams have been barely keeping it under control. The doctor recommended homeopathic treatment rather than putting her on oral steroids.

Her menses started at age 12. They were regular, with no problems.

She chose not to have children. She had one miscarriage when married to her first husband. She took birth control pills continuously for 20 years, starting in her early 20s, with no problems. She never bled. "It was wonderful." She stopped taking them about three years ago because her husband had a vasectomy. She then experienced PMS for the first time, with symptoms of backache and exhaustion. Her menses came every two months.

She was put on hormonal replacement therapy about two years ago and then because of the weight gain she went back on birth control pills because she didn't like having premenstrual tension. She had PMS for one week before her period, with nausea (a "queasiness felt in my head"), vertigo (worse in the mornings), a rumbling abdomen (distended and hard), and irritability "with everybody -- with the sky, the trees, and life!" All the symptoms disappeared after the first day.

She has had constipation (2) her whole life, which was worse premenstrually (2). Large (2), hard (2) stools and straining (2) every three days or so. She has one hemorrhoid, which doesn't bother her. Eats a high-fiber diet and keeps it under control.

Desires bread (3), salt (1), and yellow raisins (3).

Averse to slimy foods (3).

Her energy is poor (2). Worse between 4 and 6 p.m. Naps help (2). "I am a great catnapper. Always have been, even as a child."

She doesn't exercise. Has a sedentary job. Loves to read (2).

She has been happily married in her second marriage for eight years. About 1 1/2 years ago her husband lost his job. One year ago he bought a shop and now works very long hours. "I miss him. He is always very tired when he comes home."

She gets occasional colds that move into her chest, with occasional laryngitis.

She is assertive (2). "I like to have my own way." Stubborn (2). Loyal (2). "I do my job well. And I like peace and quiet and tranquillity. I despise maneuvering -- people who manipulate and lie."

She is irritable at times. "I hate it when people don't do their jobs right." Likes her own company.

She is close to most of her family. Ten years ago, her father died of cancer at about the same time she was being bullied at work. She felt numb afterwards, not especially sad. They didn't get along very well. "We irritated each other!"

She's afraid of heights (1) and of enclosed places (1).

"I don't like not being in control."

She sleeps mainly on her left side. She doesn't remember her dreams. Occasional somnambulism as a child.

Assessment: Eruptions on the face, ailments from suppressed anger, fear of losing control, and etiology of being bullied.

Plan: 1. Staphysagria 1M, single dose.

2. Stop the steroids.
3. Stop the birth control pills.
Follow-Up on Case Number 2

May 26, 1994

She has been up and down.

Was depressed (2) for two weeks, with crying. "It came out of the blue. It isn't normal for me. I feel more volatile."

Her constipation is the same.

The eruptions are worse. The rash has spread and is raised and red, with big flakes. "It feels hot (2), fight (2), and itchy (2). It stings like little needles moving about. It stings on top. It feels as if it is badly sunburned. She has had to use a little steroid cream from time to time. She doesn't want to look at her face in the mirror. "Is it going to go on and on? It is dragging me down now."

She hasn't had a menstrual period for two months now. "Thank goodness."

Assessment: Eruptions on the face -- symmetrical, itching, aggravated by warmth, rosacea, desquamating; constipation; and menopause.

Plan: Psorinum 30c, single dose.

June 13,1994

She had immediate amelioration.

Her eczema was not as itchy for about a week, and then it got worse again and spread across the forehead.

It is very tight and itchy, especially in the evenings. It is prickly all the time. The flakes are large (2), white (2), and dry (2). It is sensitive to touch (2).

She reiterates that it feels sunburned. (I ask her to elaborate.) She says it is very tight, sort of like a mask.

She has a lot to do at work.

"I should be happy. I really resent this rash and all that is accompanying it. I have got nothing to be depressed about. I am determined to beat it."

Further Analysis of Case Number 2:

The Remedy Is Found

I knew that I was absolutely on the wrong track. I studied the case again. I reviewed her symptoms in great detail and focused on the word "sunburned" that she had used over and over to describe how her skin felt. When I had asked her to elaborate on this sensation, she said, "tight, sort of like a mask." In another place she described it as "stiff."

So, I sat down with the repertory and went through it. What could this mean? Did it mean hard? "Sunburned" did not mean painful or burning to her. What was another word for this? The word that I found was "hidebound" (SKIN, Hidebound, sensation as if). Literally, it is a sensation in the skin as if it were bound. There you will find Croton tiglium as the main remedy. I saw that Croton tiglium was one of the remedies coming through in my repertorizations.

The more I thought about it, the more this remedy rang bells for me, especially because I had already seen the boy's case and there were some similarities in the symptoms. One big difference was that this second patient's eruptions were not vesicular and weeping. Her eruptions were dry. I decided to ignore this, once I found that dry eruptions were in the Croton tiglium provings.

Plan: Croton tiglium 30c, once daily until improvement.

Further Follow-Up on Case Number 2

June 21,1994

She took the remedy for five days and then stopped.

Nearly all the eczema symptoms have cleared. They faded considerably day by day.

"I feel tons better. My old self. I have my confidence back."

She had one small outbreak a few weeks later. She took the remedy again for two days, and the eruption resolved.

Plan: Wait.

May 1995

She is better on every level.

Her bowels are more regular.

Her energy is good.

She hasn't had any menstrual periods for about six months and has had no menopausal symptoms.

She feels good emotionally. She is happy at work and at home.

No skin symptoms.

What I Learned from These Cases

I really enjoy presenting cases because it makes me question carefully what I have done. Every time I present a case, I get to review my note-taking and case-taking techniques.

In retrospect, it seems to me that I didn't ask nearly enough about the skin symptoms in either case. I learned to ask more questions, to get more symptoms, and to be more specific and more curious about every little detail, such as the type of eruption, how and when it itches, and so on.

I also learned, once again, that if we don't know materia medica we are in trouble. There is so much information in Hahnemann, Allen, and Hering that is not in the repertories. This is frustrating, even infuriating. I don't have a photographic memory! Working only with the repertory, without materia medica, is like trying to create a novel using only a dictionary.

I learn through my cases. This is how I work. I do what I call "dog work." I just sit down and spend hours with my books. I learn a great deal that way. I'm still learning, and I expect this will always go on in this way. I'll never be bored!

Croton Tiglium: A Review of the Major Elements

Croton tiglium is an extremely poisonous plant from the family Euphorbiaceae. The seeds contain an inactive oil and a resinous anhydride called crotin. This anhydride is the active (and toxic) principal. It is a violent cathartic. In orthodox practice it has been used as a purgative for alcoholics, for lunatics suffering from obstinate constipation, and for cases of apoplexy.

The provings were made by chewing the beans and swallowing the seeds and also by taking the oil by mouth, by olfaction, and by external application. Results were similar in all cases, except that those obtained by olfaction were weaker and the external application resulted in more skin symptoms.

When rubbed on the skin, the oil produces an immediate reaction -- an itching eruption of small, hard, red, raised spots or small, yellow vesicles that turn to pustules and then dry off in scales. The effect extends beyond the part where the oil is applied, and the rash may appear on remote parts of the body. The violent tingling and itching progress to burning and itching. Oral ingestion also produces skin reactions.

Croton tiglium affects the mucous membranes of the bowels and the eyes and the skin of the scrotum and the face.

Interestingly, both these patients were likable people who made easy, direct contact with me and got along well with others. I would describe them as easygoing. They both laughed easily, even over their problems, although both described having difficulties with others at times.

I wondered how all the suppressed feelings of my second patient might or might not fit into this remedy. Then I found the following mental symptom in Hering's materia medica:

Feeling as though one cannot think outside himself, "feels all pent up" inside, and no chance for thoughts to flow out; as if hidebound. That was exciting! My patient certainly felt pent up repeatedly, although she did not use these exact words to describe her state. How interesting that the word "hidebound" appears in the mental and the physical symptoms for Croton tiglium. Perhaps this description can lead us to an understanding of the core or essence of this remedy.

The following is a summary of some of the major symptoms and conditions associated with Croton tiglium.

Mental Symptoms

- Indolence:

- Indisposed to work.

- Aversion to mental work.

- Dancing, would rather dance than attend to business.

- Depressed with work shyness.

- Selfish:

- Egotistical.

- Thoughts, about himself, cannot think of anyone besides.

- Fear of people.

- Suspicious of people, wants solitude.

- Weak memory:

- Confused.

- Dull.

- Morose:

- Dissatisfied.

- Talk, indisposed to.

- Hysteria and insanity, with staring of eyes.

- Many dreams: anxious, sad, disconnected, of previous events, etc.

- Fears, anxieties, and irritability mainly connected with diarrhea, asthma, and pains.

- Nervous.

- Restless.

Skin

- Vesicular eruptions with itching, burning, stinging, and redness.

- Itching is followed by painful burning (Sulphur).

- Intolerable itching, ameliorated by light rubbing and aggravated by hard scratching (hurts).

- Vesicles that form scabs (gray-brown).

- Eruptions of face and genitals.

- Sensation as if hidebound (tight).

- Skin is bright red.

- Skin symptoms alternating with chest (with asthmatic cough).

- Idiopathic eczema in children (Hering).

- Eczema of the scalp in infants (with attacks of gushing diarrhea after a slight disturbance, alternating with the eczema), either purely vesicular or intermingled with pustules. With desquamation and a red, raw, inflamed surface that is sensitive to touch. (Sepia has a similar eruption.)

Differential Diagnosis of Skin Symptoms

- Rhus toxicodendron and Croton are so similar that Croton needs to be considered as an antidote to Rhus toxicodendron poisoning. With Croton, the itching is more prominent than is the burning. Gentle rubbing ameliorates. With Rhus toxicodendron, the burning is more prominent. Gentle rubbing aggravates.

- Petroleum has fine, red, vesicular and granular elevations, intermingled with a fine, red rash on the genitals. The itching is intense, made worse at times by scratching until burning comes on and then bleeding (which relieves).

- Anagallis has eruptions on the palms of the hands.

Diarrhea

- Sudden stools, forcibly expelled in a sudden gush (in one squirt -- Kent) in cholera or other diarrheas of children (and occasionally in adults).

- Stools are copious, liquid, or pappy.

- With terrible colic, which is worse from touch, pressure, and motion.

- With flatulent rumbling and a feeling that there is water in the abdomen swashing about.

- Painful bearing down or pains drawn back from abdomen to back.

- Diarrhea brought on by the least food or drink.

- Vomiting is not as important a feature as with other remedies.

(Anagallis has the drastic diarrhea, with colic, explosive stool, and great thirst.)

Cough

- Asthmatic cough that is worse at night, arousing the patient from a sound sleep, and worse with deep breathing.

Eye Symptoms

- Inflammations of all sorts, with vesicles, pustules, and a drawn backwards sensation.

Headache

- Headache as if the eyes are drawn back into the head (on a string).

(Many years ago I treated a man who had fallen into a Croton bush as a child. He suffered a horrible rash that lasted for months and was left with chronic, terrible, recurring headaches until I gave him Croton 10M at age 36.)

Sensations

- Pulling sensation:

- Of eyes into the head (with headache). (With Paris, this is due to overuse of the eyes; with Croton, it is due to inflammation.)

- Of nipple to back (while nursing child) (Silica).

- Of abdomen towards the spine.

- As if hidebound.

- As if insects were creeping on the face.

- As if stinging, with eruptions.

- As if heat, with eruptions.

Alternating States

- Internal with external (Kent).

- Alternation of skin, diarrhea, and chest symptoms.

Generals

- Worse from drinking, eating the least bit of food (diarrhea), washing, summer, touch, motion, receding eruptions (because of the cough), night and morning, fruit, sweetmeats, scratching, lying down, open air (vertigo and faintness), and drinking cold water while heated (complete loss of voice).

- Better after sleep, gentle rubbing, and open air (chest).

International Foundation For Homeopathy.

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By Miranda Castro

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