TREATING AMY (AMZ), a case of childhood psoriasis

This article was published in the Australian Homeopathy Journal Similia in 2007 under the title Treating Maryam

I first saw AMZ when she was a month old . She was born in 2003.

AMZ is the youngest child in a family o 3 children. Her other siblings had no history of eczema or asthma . Her parents are also healthy and have no history of any chronic skin problems or asthma.

When her mother was pregnant with AMZ , she was treated for a viral fever which subsided after a week.

AMZ first had an exfoliating rash when she was a month old. I treated her with homeopathic remedies based on the law of similars. The remedy that I had given her when she was a baby was Bell which ameliorated what looked like a bad infantile eczema. Bell worked well several times, whenever she had a recurrence.

The reason I chose Bell in the first place was because the rash always had an erysepelous base and in my experience Bell works well. It proved to work quite well at first.

From Lippes Materia Medica on Bell:

Under face:“Erysipelatous swelling of the face.

Under skin:”Vesicular eruptions, with scabs, white edges and œdematous swellings.

Whenever she had a fever, she also had a very mild erythematous rash and Bell also suited the fever which was very hot and dry.

I usually give Bell in 200c potency as a liquid dose. I ask the dose to be stopped when the condition starts to improve. If 5 doses failed to act, they were to stop the dosing and get back to me.

Her condition recurred several times throughout the years, leading up to her flare up in December of 2006 which makes one think of a miasmatic base. I should have suspected it already, seeing that her initial complaint was at one month old!

She was not always treated with homeopathic remedies, since she was also seeing other doctors who were panel doctors for the company her father worked in so I note several occasions when she was given paracetamol, anthistamine and steroid creams for her skin.

What I write below is the focus of this paper so I will put a time line for the events that took place as well as try to give a rationale of my prescriptions.

27/11/2006

She had a bad flare up on for which I gave Bell. Her symptoms at this time were the same rash on an erythematous base  on her head. Her rash was exfoliating, which gave me more reason to prescribe Bell.

I gave Bell 30c to be taken daily until improvement. This time I gave dry doses.

She did not get better and then, in fact she became steadily worse.

In December 2006( 1/12/2006) she had a very bad flare up which spread to her whole body .

Her symptoms were again, an exfoliating rash now not confined to her head but had spread from her head to her limbs as well as her torso in the front and in the back.

15/12/2006

She came to see three days after getting discharged from the General Hospital.

 Two weeks before, I was away from my clinic and my locum  referred her to the General Hospital and admitted to the ward for one week. She was  given IV  steroids and antibiotics. They thought she had childhood psoriasis. The doctors warded her for a week and, 3 days after they discharged her and  she had was ill again, only this time it was worse than before she was admitted.

She was febrile, her joints were stiff and painful, her knees swollen and red with the skin exfoliating.!She also had a wet cough . I gave her hepar sulph 200c , 5 doses in water ,  6 hourly based on her extreme sensitiveness and she seemed a wee bit better  when I saw her after 3 days But , she was still quite bad I changed to pulsatilla 200c , 5 doses 6 hourly in water. My rationale for the pulsatilla was her extreme clinginess as well as the polyarthritis and the weepiness and the cough which was worse lying down. I was also thinking that the rash resembled an  exanthema .

Lippe on Pulsatilla.

Peevishness, which increases to tears, with chilliness thirstlessness

Red-hot swelling of the feet extending up to the calf, with stinging pain.

“Cough, with expectoration in the morning or during the day only, without expectoration at night.

“Exanthemata itching-stinging, chapped.

26/12/2006

 No  improvement , if anything she seemed worse, with severe chilliness, needed to be wrapped up with extreme sensiviteness, joint pain,swelling and stiffness, the whole body was peeling.She was febrile  and her legs looked like erysipelas , with redness swelling and heat as well as pain. I feared for her life since she was losing a lot of heat and moisture from her skin but parents refused to send her to hospital and there are no homeopathic hospitals here. .Her whole body was peeling away , the skin was red and inflammed., she had an exhausting cough and she was also having rigours . It was too painful for her to move so she was lying down semi curled up , at the same time she was uncomfortable and had to move slightly to change position.

Then, based on her appearance which reminded me of scarlet fever and taking note of all her symptoms , I repertorised for the case and I gave rhus tox 200c in water, with instructions not to exceed 5 doses and to stop as soon as there was some change. I also gave her a referral in case the remedy did not work since she was in grave danger of dying from dehydration..You can see the repertorising I did was only for her symptoms .The remedies that were in all the rubrics were Aconite, Arsenicum, Rhus Tox, Sulphur Phosphorus and Mercury.  I chose Rhus Tox because of her modality of finding it painful to stay in one position while it was also painful to move. The desquamation was also a deciding  factor and I  was certainly not going to prescribe sulphur in such an acute state. Arsenicum would seem an obvious choice given the severe anxiety everybody was going through but the extent of the skin made me think Rhus Tox .Mercury might have made some sense as would Phosphorus but Rhus Tox scored higher using weightage.

I saw her  5 days later, a real huge change,the skin on her face and body was no longer peeling, joints were no longer stiff nor were they swollen, the skin on her legs were  still red and the skin from her feet were still peeling but she was cheerful and afebrile. Her cough had become very minimal . Her appetite was good!  No remedies at this point.

When I saw her five days after the Rhus tox, She was very well and very cheerful, all that was left was some rough skin and a wee bit of scurf on her head .

Follow up11 /1/2007

AMZ still had a mild rash but was otherwise well.
I retook her case and gave her Phosphorus a remedy that fitted her very well constitutionally. It is a miasmatic remedy in Hahneman’s book Chronic Disease and seemed to be a good constitional remedy as well. (When she is well, she is a very cheerful and friendly girl) Looking through her notes again I discovered she had seen a regular doctor a month prior to her severe attack complaining of cough and was found to be having asthma. Another reason for the phosphorus since I found that in my practice, more than 60 % of the asthma cases seemed to need phosphorus. I have her 3 dry doses of 200c to be taken 12 hourly.

Follow up: 11/2/2007

 Not even any scurf, very well indeed.

24/4/2007

She came in with a cough cold and fever , for the first time she had a fever without any accompanying rash. Prior to this , she would always develop a slight erythematous rash when she had a fever from a cold or a flu. The dandruff was also  quite persistant. There was none on this visit .What comes to mind is that such chronic symptoms in one so young should have given me warning of the miasmatic basis of her dandruff rash and erythema.

There was some slight exfoliation on the feet , it was very mild and I would wait and see if she needs another remedy. This exfoliation is a feature of both psoriasis and eczema  but at this point , I am thinking perhaps another miasmatic picture is showing itself. Ardavan says to let the miasm speak to you and I think now she is expressing a different miasm. Her mum showed me her nails which recently manifested as pitting of the nails., another feature that could be either eczema or psoriais except it is rare in childhood psoriasis.. According to Ardavan’s materia  virosa , this could be a herpes miasm. 

Here are some photos I took as she was getting better, I did not take any pictures when she was gravely ill, never thought to take them at that point!

1st Jan

5 days after Rhus Tox 200c no more exfoliating on her face which was still slightly red and she had dandruff on her head .

1st Jan

She was very much better but her feet and legs were still red and peeling. This was the first time I thought to take pictures and before this the whole body including the face looked like this.

adryana4 

9th Jan

When she came again a week later, there were only scabs in her scalp .

9th Jan

Her legs look great don t they?

adryana7 

24 April.

 She had a cold and a slight fever, which explains her solemn look. No rash , only  mild exfoliating on her feet which is good because being confined to her feet would be consistent with the direction of cure.

adryana8

Discussion:

Thus far it seems that I have noted that the rash was erythematous and also that right from the start there was an element of exfoliation and desquamation. The clinical picture would be consistent with infantile eczema or childhood psoriasis .

Going by the above description, it would not have been off the mark for the doctors to suspect that AMZ had a severe form of childhood psoriasis as well as their wanting to opt for cytotoxic drugs.

It is claimed that the cause for childhood psoriasis is unknown but also that it can be triggered by a viral such as chicken pox or bacterial infection such at a strep throat .2 This is interesting in the treatment of AMZ because I noted that the symptoms looked like a very bad case of Scarlet Fever .

AMZ did have her skin peeling in the hands and the fingers and toes as well as on the limbs , in fact all over her body! She also had swollen legs which looked like erysipelas , only it did not respond to antibiotics which I presume was chosen according to what the lab findings showed was

Differential Diagnosis for the pitted nails and the skin peeling: Both psoriasis and eczema have pitted nails but pitted nails is rare in childhood

Postcript May 2009

It is almost 3 years since AMZ was cured from this condition.

In this time, the past remedy was repeated 2 times when there was a very mild rash during epsisodes of fever.

For the past one year, AMZ has had a few episodes of viral fevers with NO rash.

Her nails are normal .

There is not the slightest skin problem .

 

1http://www.bbc.co.uk/health/conditions/psoriasis2.shtml

2Childhood bouts of psoriasis can be triggered by a cold, chicken pox, tonsillitis, or a respiratory infection, like strep throat

3http://dermnetnz.org/bacterial/scarlet-fever.html

4http://www.gpnotebook.co.uk/cache/772145171.htm

5http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1112987

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