Dr Varalakshmi Ramakrishnan
Varicose ulcer is common around the ankle due to chronic venous hypertension. It is due to the varicose veins ( long saphenous vein/ short saphenous vein/ perforators) or post phlebitic limb. 50% of venous ulcers are due to varicose veins and other 50% are due to previous DVT ( deep vein thrombosis). Pain, discomfort, pigmentation, dermatitis, lipodermatosclerosis, ulceration, periostitis, ankle joint ankylosis, talipes equinovarus deformity and Marjolin’s ulcer are problems of varicose veins and later of venous ulcer (1)
KEYWORDS – Homoeopathy, Venous insufficiency, Varicose veins, Varicose ulcer
Venous insufficiency syndromes are most commonly caused by valvular incompetence in the low-pressure superficial venous system but may also be caused by valvular incompetence in the high-pressure deep venous system. In addition, they may result from the congenital absence of venous valves. The term varicose ulcer, post thrombotic ulcer and gravitational ulcer are also used as synonyms of venous ulcer. Majority of venous ulcers follow many years of venous disease, so the patients are usually of the age group of 40 -60 yrs. Women are more affected far more than men. Discomfort and tenderness of the skin, pigmentation and eczema exist for months to years before an ulcer develops. The ulcer is painful in the beginning but once it settles down and becomes chronic it becomes painless ( 2)
Venous ulcer occur at the rate of 3/1000 at age 61- 70 and 20/1000 at > 80yrs. Venous 40 to 50% of ulceration is due to superficial venous insufficiency alone. Uncomplicated varicose veins are rarely associated with ulcers.( 3)
Examination of an venous ulcer
- Location – Lower part of the leg on its medial side, sometimes lateral side , often both sides of ankle
- Shape – Vertically oval, can take any shape
- Floor – Covered with pale / often without any granulation tissue
- Margin – Thin and blue of growing epithelium
- Edge – Sloping edge, pale – purple blue in colour
- Base – Indurations and tenderness, often fixed to deeper structures
- Discharges – Sero purulent with occasional traces of blood
- Surrounding skin – Shows signs of chronic venous hypertension- pigmentation, indurations and tenderness (4)
(Clinical-Etiology-Anatomy-Pathophysiology) was adopted worldwide to facilitate meaningful communication about CVD and serve as a basis for more scientific analysis of management alternatives. This classification, based on correct diagnosis, was also expected to serve as a systematic guide in the daily clinical investigation of patients as an orderly documentation system and basis for decisions regarding appropriate treatment.
INVESTIGATIONS – Venous doppler study, Venography, study of ulcer discharges, wedge biopsy, X ray part (3)
- Conservative management – pharmacotherapy, compression therapy, sclerotherapy,
- Surgery in venous ulcer disease
- Skin grafts for venous ulcers
- Laser treatment (6)
ROLE OF HOMOEOPATHY IN TREATING VARICOSE ULCERS
Homoeopathic medicines are very effective in treating the varicose ulcers, medicine helps to prevent the complication and recurrence of the disease. Homoeopathic remedies directly enhance the inherent healing capacity and treat by addressing the underlying causes. Each case is assessed individually and treated according to the underlying cause.
HOMOEOPATHIC REMEDIES FOR VARICOSE ULCERS
Cardus mar, graphites, hamamelis, pulsatilla, rhus tox, sulphur.
Syphilytic- mercurius, aurum, carbo veg, lachesis, nitric acid, thuja, iodum, kali bichromicum, mezereum,
Mercurial – silicea, lycopodium, hepar sulph.,belladonna, carboveg, kali bichromium, lachesis, nitric acid, phos acid, sepia, sulphur.
Appearance : discoloured, unclean, dirty ulcers – ars alb, calc carb, lachesis, lycopodium, mercurius (7)
A male patient of 57 yrs, working in Government sector, had swelling of both legs with skin eruptions since 6months.History of smoking and alcohol since 20yrs. known case of hypertension and has deep vein thrombosis. He mainly complains about heaviness of his leg and skin eruptions with discharges which are not healing from last 6months .
History of his complaints –
- Gradual onset and progressive in nature
- Location – both lower limbs
- Swelling with skin eruptions with itching, started to spread later
- Appearance of skin – dry, scaly, crusts, bleeding after scratching
- Started on left – right side
- Left leg – skin eruptions more with cracks and discharges
- Right leg – mild eruptions
- < – covering, warmth
- > – scratching, cold applications, uncovering
Family history – Hypertension, Diabetes
Past history – Deep vein thrombosis, Hypertension
Treatment history – for Deep vein thrombosis and hypertension on allopathic medications
No history of allergies
- Mixed – Non vegetarian
- Thirst – normal
- Aversions – sweets
- Habit – had smoking and alcohol , stopped since 2yrs
- Sleep – disturbed due to complaint
- Thermals – hot
- Bp – 140/80mmHg on medications
Mind – will, emotion and intellignet is good, hard working person, worries about his son future due to poor in studies, responsible in work, wants to get respect in society, anxiety about his health, anger when somebody does mistake in work, very much concerned about his health conditon.
AFTER REPERTORISATON (8)
REPERTORIAL RESULT – Lachesis , calc carb, sulph, bryonia , puls , merc, ars alb
REASONS FOR SELECTION OF THE REMEDY.
Lachesis was selected on the his complaints and it covers maximum of his symptoms, on the basis of repertorisation lachesis was given.
Remedy prescribed – Lachesis
Potency – 30
Dose – one dose , followed by placebo
First visit – 5/ 6/ 2016, along with dressing with calendula mother tincture.
15 days once – Lachesis 30 one dose with placebo was given.
CONCLUSION – The above result shows that Homoeopathic medicines are effective in treating varicose ulcers.
- SRB’s manual of surgery, Sriram Bhat 6th edition 2019, published by Jaypee , Chapter 1B ulcer, page no 27
- A Manual on Clinical Surgery, S Das, 6th edition JUNE 2004, published by Dr.S.Das, Examination of an ulcer, page no 53
- Clinical surgical case manual, a comprehensive treatise for students, teachers and practitioners, Kanchana Sundaramurthy, publishers Jaypee, Chapter leg ulcers, page no 150
- SRB’s clinical methods in surgery, Sriram bhat M, 3rd edition 2019, published by Jaypee , Examination and Clinical approach of an ulcer, page no 97
- CEAP classification of venous disorders , Zegarra TI, Tadi P, published on March 26,2022, publisher Stalpearls Publishing, Treasure Island (FL)
- Varicose veins and venous ulcers, Sue Simpson and Paul Roderick – Updated chapter included in 1st edition by M Robbin’s SJ Frankel, K Nanchahal, Coast and MH Williams
- Homoeopathic therapeutics,The classical Therapeutics Hints, Samuel Lilienthal, publishers B jain , Chapter ulcers , page no 1066
- Radar software for repertorisation, synthesis repertory, Vithoulkas expert system
Dr. Varalakshmi Ramakrishnan
MD ( Hom) Gold Medalist
Assistant professor, Department of surgery
Government Homoeopathic Medical College,Bangalore