Abstract :- Cellulitis is a bacterial skin and soft tissue infection which occurs when the physical skin barrier, the immune system and/or the circulatory system are impaired. Diabetes, obesity and old age are associated with defects in all of these areas and as a result are major predisposing factors for cellulitis.
Keywords:- Homoeopathy, cellulitis, edema etc.
Introduction :– Cellulitis is a spreading subcutaneous inflammation caused by haemolytic Streptococcus. Streptococci produce hyaluronidase and streptokinase. Net result is that the inflammatory exudate spreads in the subcutaneous and fascial planes resulting in a gross swelling of the affected part. Wherever there is loose subcutaneous tissue, as in scrotum or loose connective and interstitial tissue as in face and forearm, it spreads fast.
Source of Infection :- Injuries—minor or major
Graze or scratch
Snake bite, scorpion bite, etc
Precipitating factors :- Diabetes
Low resistance of an individual
Common sites :- Lower limb
Face
Scrotum
Clinical Features:- The affected part shows evidence of inflammation such as redness and itching followed by diffuse swelling. Skin is stretched and shiny. Pain, fever, toxaemia follow later. It is differentiated from an abscess by features.
| Cellulitis | Abscess |
| No edge ( Diffuse swelling) No limit No pus No fluctuation | Well circumscribed, has an edge Limit is present Pus is present Fluctuation is positive |
Treatment :
1. Bed rest with legs elevated. This reduces edema of legs.
2. Glycerine MgSO4, dressing which reduces edema of the part by osmotic effect.
3. Diabetes mellitus, if present, 1s treated with injection insulin given subcutaneously.
4. Appropriate antibiotics such as injection crystalline penicillin 10 lakh units, intramuscular (IM) or intravenous (IV), 6th hourly for 5—7 days or cephalosporins have to be given.
5. Antisnake venom is given in snake bite cases.
Complications :
1. Cellulitis can turn into an abscess which needs to be drained.
2. Necrotising fasciitis: Certain highly invasive strains of Streptococcus pyogenes can cause extensive necrosis of skin, subcutaneous tissues and may result in necrotising fasciitis. It is firstly treated by debridement and skin grafting later.
3. Toxaemia and septicaemia: Streptococcal toxic shock syndrome can result if exotoxins are produced by the organisms.
4. Cellulitis can precipitate ketoacidosis in a patient who has diabetes mellitus.
Presenting Complaint:- Cellulitis in left leg since 5-6 days.
Redness in left leg
edema in left leg
Mild fever present
Burning present
Location -left side of leg
Sensation – Needle like pain & burning
Modalities -Aggravation: night
Amelioration: rest , cold
Concomitant – weakness present & constant fanned desire
Causation – bacterial infection
Duration – 5-6 days
History of Present Complaint :-
Onset -gradual
Progress – H/O Injury in left foot 10 days ago and then develop fever , edema , tenderness , redness in left leg.
Treatment adopted – allopathic
Result – mild relief
Past History :-
Childhood to adulthood : History of type 2 diabetes mellitus since 10 years .
Personal History
Mind & disposition : Aversion to darkness & mental exertion ,Indifference , .
Married or single : married
No. of children : 3 children
Health of children : Healthy
Marital relations : normal
Physical Generals
Diet : Vegetarian diet & non vegetarian
Desire : Salty things
Disagrees : milk.
Thirst : Increased, (4-5 lit.per day)
Tongue : white coating
Taste : No altered taste as mentioned by the patient.
Salivation : Moderate as per patient.
Perspiration : Hot perspiration, more on back no specific odour and no staining on clothes as mentioned by the patient.
Stool : Constipated and stool is hard most of the time. Passes stool irregularly.
Urine : Passes urine every 3-4 hours with no burning and no specific odour.
Bathing : Regularly.
Covering : Not specific
Sexual relations : Not specific.
Dwelling place : Well ventilated house with proper sunlight
Appetite : decrease since 5-6 days .
Aversion : Nothing specific.
Habits / Addictions : Alcohol as mentioned by the patient.
Tobacco : No
Alcohol : Yes
Coffee / Tea : tea drinker
Drugs etc : No
Thermal reaction : Chilly patient.
Skin : left leg redness and shiny edematous skin
Sleep : Sound and refreshing sleep
Dream : Daily routine .
Gynecological History – Not applicable
Obstetrical History – Not applicable
Pregnancy : Not applicable.
Labour : Not applicable.
Delivery : Not applicable.
Abortion : Not applicable.
General Examination :-
Anaemia: Not detected Cyanosis: not detected
Jaundice: Not detected edema: unilateral pitting edema in left leg
Hair: Black, slight hairfall present Neck glands: Not swollen
Neck veins: Not engorged Teeth: Healthy
Gum :Mild redness and swelling Tongue: white coated
Pupils: Normal Pulse: 91 beats/min
Temperature: febrile (mild) BP: 130/80 mm of hg
Respiration: 16 beats/ min
Systemic Examination:-
Respiratory System: Normal vesicular breathing heard all over the lung field.
Gastrointestinal System: Liver, spleen not palpable. No free fluid in the abdomen. Normal peristaltic sounds.
Cardiovascular System: Apex normally placed, S1, S2 heard normal, no added sounds.
Nervous System: Higher functions cranial nerves and speech were intact.
Motor system: Power and tone normal. No involuntary movement or atrophy detected.
Reflexes: Jerks and superficial reflexes were normal.
Coordination: Both upper and lower limbs were coordinated.
Sensory system: No sensory loss.
No hyperaesthesia.
Gait: No abnormality detected.
Urogenital System: Nothing abnormality detected.
Locomotor System: No restriction of movement of all joints were there.
Skin and Mucous Membrane: : left leg redness and shiny edematous skin
Laboratory Investigations Previously Done– Yes Hba1c -7.6%
Laboratory Investigations Advised- CBC
Provisional Diagnosis– Cellulitis
Differential Diagnosis – Erysipelas ,DVT, Abscess
Symptom Miasm
Cellultis Psora
edema Sycosis
Burning in leg Psora
Aversion to darkness psora
Miasmatic Result – Psora, Sycosis,
Rubrics-
1. Mind – Darkness – aversion to
2. Mind – Indifference
3. Mind – Mental exertion -aversion to
4. Generals – Diabetes mellitus
5. Generals – Fanned , being- desire to be
6. Generals – Inflammation – cellulitis
7. Generals – Weakness
Prescription- 01/06/2024 RX Belladona 200 BD for 2 days 4 globules to be taken twice a day for 2 days , Basis of patient is anxious , present with fever and redness , inflammation , burning and tenderness in left leg.
& Apocynum Cannabinum Q BD 10- 10 DROPS for 5 days
Follow up
03/06/24 Pt. complain mild relief, edema redness pain mild reduce then prescribe RX Carbo Vegetabilis 200 BD for 3 days
07/06/24 Pt. complain better RX Rubrum met 30 OD 5 days
About Author : Dr. Ragini Soni , MD Scholar, Department of Practice of Medicine, Government Homoeopathic Medical College and Hospital Bhopal, Madhya Pradesh, India
Guided by :- Dr. Babita Saxena, H.O.D., Department of Gynae & Obstetrics, Government Homoeopathic medical college & Hospital Bhopal, Madhya Pradesh, India
