Clinical Cases

A Kind of Livedoid Vascular Ulcer

Written by Piyush Joshi

Dr. Piyush Joshi presents a case of chronic ulceration, which yielded to a single remedy.

PJT F/23 yrs. single, (B Sc, Hom) DoC: 03 July 2010.

The medium built female patient was referred to me by a skin specialist from Vapi, some 250 kms away from my clinic.

Patient History:

She used to develop some kind of eruptions on her lower limbs since May 2005. She was treated by a local doctor for some time, but without any benefit. Hence she was referred to a skin specialist. She was treated for some time without  relief and then underwent a skin biopsy. The SRL Ranbaxy skin biopsy report dated 19th May 2007 was suggestive of Livedoid Vasculitis. She was treated with medicines and when those failed to relieve, she was given local injections.

In the past she had suffered from unilateral headache which was diagnosed as migraine and treated accordingly. During the treatments she developed Hepatitis (drug induced? ) and was advised to discontinue treatment for the skin complaints for some time.

The presenting complaints were as follows:

She would feel itching in her lower limbs especially on her legs in the evening which used to last till late at night. The itching was better with warm water and local application of coconut oil (as advised by her skin specialist). The scratching would cause blisters which used to increase and gradually turn into an ulcer. She had burning pain which became intolerable as the evening progressed. Initially she had less frequent ulcers but now the frequency had increased. Lately she developed a deep ulcer on her right leg with dark discharges.

The ulcers were then treated with local applications along with intermittent oral antibiotics and steroids. This was the ordeal for almost four years.

She complained of headaches which used to increase from hunger and sun exposure, especially on the left vertex. The headaches were also experienced when she had insufficient sleep.

She had difficulty in studying mathematics and failed in her 12thstd examination, in 2004.

During the consultation her elder sister provided most of the details of the complaints, while the patient was looking dull and buried in thought. At times she would bite her finger nails. On most of the occasions she came out with short answers. According to her sister, she was indecisive, unsympathetic and not tolerant of any kind of criticism. She did not care about herself or about her family. The patient herself could provide no further details.


These are the eruption on and near her left ankle.


This kind of eczematous eruption developed after prolonged scratching (right inner ankle)


The scars remaining at outer malleolus on left leg, where previous ulcers had develop and were treated.


The deep ulcer, on right shin, surrounded by discoloration. The ulcer has extension to the tibia bone. (All the photos were taken at clinic at her first visit on 03 July 2010).

The following symptoms were considered for totality and repertorised.


Considering that all her complaints started after her failure in her board examination, and keeping the indifference in mind, we need to make our choice of remedy. The tendency for ulcers, and burning favoured Anthracinum.

Anthracinum 0/3 was given, for 15 days.

Follow up:

27 Aug 2010:  Itching reduced by almost 95%. She had experienced fullness of stomach and eructations after eating (reappearance of old symptom: she had forgotten to mention this on the first visit). She had suffered from headache only once, as she had disturbed sleep and change in food.  On examination, the wound had healed completely with disappearance of all discoloration surrounding it. The noteworthy point was the earlier site of the scar, which also developed healthy tissues and recovered.



The patient did not show up after the first follow up.

This case demonstrates the ‘simplicity’ of the homoeopathic system of medicine. It is worth noting the footnote of §1, Organon of Medicine, where Hahnemann states the need to help the sick by using laws of nature and by providing for ‘rapid, gentle and permanent restoration of health.

Footnote to §1:

His mission is not, however, to construct so-called systems, by interweaving empty speculations and hypotheses concerning the internal essential nature of the vital processes and the mode in which diseases originate in the invisible interior of the organism (whereon so many physicians have hitherto ambitiously wasted their talents and their time); nor is it to attempt to give countless explanations regarding the phenomena in diseases and their proximate cause (which must ever remain concealed), wrapped in unintelligible words and an inflated abstract mode of expression, which should sound very learned in order to astonish the ignorant – whilst sick humanity sighs in vain for aid. Of such learned reveries (to which the name of theoretic medicine is given, and for which special professorships are instituted) we have had quite enough, and it is now high time that all who call themselves physicians should at length cease to deceive suffering mankind with mere talk, and begin now, instead, for once to act, that is, really to help and to cure.

About the author

Piyush Joshi

Dr. Piyush I. Joshi received DHMS in 1987 from G. H. Medical College, Savali. He worked under Dr. K. B. Shah, Khambhat, immediately after appearing for the final examination. He also worked at the Public Charitable Clinic, established by Late Shree Ravishankar Maharaj, at Bochasan. Dr. Joshi started own private practice in1987, at Vadodara. He has contributed several articles to homoeopathic journals, some of which won prizes from the National Journal of Homoeopathy. Dr. Joshi presented scientific papers at the 14th International Homoeopathic Congress, 2003, New Delhi, organised by AHML. Dr. Joshi has participated in more than 75 seminars all over India, including the National Scientific Seminars and Congresses organized by HMAI. He is presently President HMAI, Gujarat State Branch.


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