MY EXPERIENCE WITH TOPICAL HOMOEOPATHIC APPLICATION IN

A CASE OF STAGE IV DECUBITUS ULCER

Gyandas G Wadhwani MD (Hom)
Chief Medical Officer (H), Directorate of Ayush (Homoeopathic Wing), Govt of National
Capital Territory of Delhi, India. Email: drgyanwadhwani@yahoo.co.in

Introduction
Decubitus ulcers (Pressure sores/ ulcers, Bedsores) are areas of damaged skin
caused by staying in one position for too long. They commonly form where your
bones are close to your skin, such as your ankles, back, elbows, heels and hips
in persons with a medical condition that limits their ability to change positions,
requires them to use a wheelchair or confines them to a bed for a long time.
They can range from mild reddening of the skin to severe tissue damage-and
sometimes infection-that extends into muscle and bone and are described in four
stages:

Stage 1: The skin may be painful, but it has no breaks or tears. The skin
appears reddened and does not blanch. In a dark-skinned person, the area
may appear to be a different colour than the surrounding skin, but it may not
look red. The site may be tender, painful, firm, soft, warm or cool compared
with the surrounding skin
At stage 2, the skin breaks open, wears away, or forms an ulcer, which is
usually tender and painful. The sore expands into deeper layers of the skin. It
can look like a scrape (abrasion), blister filled with clear fluid, or a shallow
crater in the skin.
During stage 3, the ulcer is a deep wound and extends into the tissue
beneath the skin, forming a small crater. Fat may show in the sore, but not
muscle, tendon, or bone. The bottom of the wound may have some yellowish
dead tissue
At stage 4, the pressure sore shows large-scale loss of tissue, goes very
deep, exposing the muscles, tendons and bone. The bottom of the wound
likely contains dead tissue that's yellowish or dark and crusty.

Figure 1: Stages of decubitus ulcers

Who are at risk?

Smokers carry a higher risk of developing pressure ulcers. People are at risk of
developing pressure sores if they have difficulty moving and are unable to easily
change position while seated or in bed. Immobility may be due to:

Generally poor health or weakness

Paralysis with/ without lack of sensory perception

Injury or illness that requires bed rest or wheelchair use

Recovery after surgery

Sedation

Coma etc.
Decubitus ulcers may cause serious complications, some of which are lifethreatening.

Sepsis

Cellulitis

Bone (osteomyelitis) and joint (septic arthritis) infections

Cancer. Another complication is the development of a type of squamous

cell carcinoma that develops in chronic, non-healing wounds (Marjolin ulcer).
This type of cancer is aggressive and usually requires surgery.
Treatment
Addressing the many aspects of wound care usually requires a multidisciplinary
approach. Members of the care team may include:

A primary care physician who oversees the treatment plan

A physician specializing in wound care

Nurses or medical assistants who provide both care and education for
managing wounds

A social worker who helps you or your family access appropriate resources
and addresses emotional concerns related to long-term recovery

A physical therapist who helps with improving mobility

A dietitian who monitors your nutritional needs and recommends an

appropriate diet

A neurosurgeon, orthopedic surgeon or plastic surgeon, depending on

whether you need surgery and what type
HOMOEOPATHIC APPROACH
Unlike the modern medicine, the homoeopathic care-giver is usually self
sufficient to manage the cases of decubitus ulcers!
Besides the usual care of repositioning, keeping the skin dry and clean, taking
bowel and urinary care, which is a must for both healing as well as prevention,
the homoeopathic materia medica offers a vast repertoire of remedies suitable
for such patients:
Agar., ambr., am-c., am-m., ant-c., arg-n., arn., ars., bapt., bar-c., bell., bov.,
calc., calc-p., canth., carb-an., carb-v., caust., cham., chin., coff., colch., croth., dros., euph., fl-ac., graph., ham., hep., hippoz., hydr., hyper., ign., kali-ar.,
kali-c., kreos., lach., led., lyc., mag-m., mang., merc., mez., nat-c., nat-m., nitac., nux-v., olnd., op., paeon., petr., ph-ac., phos., plb., puls., rhus-t., ruta.,
sel., sep., sil., spig., squil., sulph., sul-ac., ter., zinc.
MY CLINICAL EXPERIENCE

A family visiting DGHD Aali village (regn no 1316) requested me to see a

bedridden person in early 50s. He was a diagnosed case of HIE (Hypoxic
Ischemic Encephalopathy) after an alleged history of RTA. After nearly 2 months
of stay in Safdarjung hospital and thereafter another another 3 months at Guru
Gobind Singh Hospital, he was discharged with directions to manage at home
and a bimonthly check up in OPD.
The attendants informed that he had developed a decubitus ulcer during his
initial few days of hospitalisation and thereafter gradually increased in spite of
best possible care given.
As per the available medical treatment records the decubitus ulcer had been
treated by the surgical team and debridement had been done twice, the last one
having been done nearly 4 months earlier.
At the time of initial visit, he was found to have grade IV decubitus ulcer with a
very foul smelling discharge.

13-8-2015 (Pre-treatment)
Prescription and follow up
Hypericum perfoliatum is a well known homoeopathic remedy for crushing
injuries and has a strong affinity for spine and sacral region. Amongst the other
indications, Hering mentions in the section on skin, Foul, torpid and
phagedenic ulcers.
In accordance with the condition and absence of any indication, the family was
advised to mix Hypericum Q and olive oil in 50:50 ratio, dip a gauze in the
mixture and apply on the ulcer every 8 hours, along with usual care.
The effect of the topical application can be seen over the following months.
Date
Follow up

1-9-15
(Decubitus ulcer
with Gauze
bandaging dipped
in a mix of
Hypericum Q and
olive oil)

1-10-15

5-11-15

1-12-15

No recurrence has been seen over last few months.

Bibliography
1. http://www.mayoclinic.org/diseasesconditions/bedsores/basics/definition/con-20030848 as accessed on 26-516
2. https://www.nlm.nih.gov/medlineplus/pressuresores.html as accessed on
26-5-16
3. http://www.webmd.com/skin-problems-and-treatments/four-stages-ofpressure-sores as accessed on 26-5-16
4. http://www.homeoint.org/hering/h/hyper-3.htm#45 as accessed on 26-516