Supplementary Material for: Homoeopathic Management of a Lower Leg Ulcer with Cellulitis: An Evidence-Based Case Report

Background: Cellulitis is an acute bacterial infection involving the dermis and subcutaneous tissue, characterized by erythema, warmth, swelling, and pain. It commonly follows disruption of skin integrity and may progress to ulceration. Leg ulcers are chronic or acute breaches in skin continuity of the lower limb, frequently associated with infection, inflammation, delayed healing, and significant morbidity. When cellulitis complicates a leg ulcer, the risk of tissue damage and prolonged recovery increases. Although antibiotics constitute standard management, integrative approaches are increasingly explored to support wound healing and reduce complications.
Case Presentation: A female patient presented with a painful ulcer on the left lower leg that had evolved from a pimple-like lesion. Clinical examination revealed diffuse erythema, oedema, warmth, tenderness, and ulceration consistent with cellulitis. No systemic complications were noted at presentation. An individualized homoeopathic treatment strategy was adopted based on clinical assessment. Pyrogenium, Calendula officinalis, and Myristica sebifera were prescribed sequentially according to symptom evolution. Supportive management included antiseptic wound cleansing, maintenance of dryness, and topical application of Calendula officinalis ointment. Serial photographic documentation was performed to monitor progression.
Results: Progressive reduction in pain, inflammation, and ulcer dimensions was observed during follow-up, with satisfactory wound healing and no reported adverse events. Causality assessment using the Modified Naranjo Criteria for Homoeopathy (MONARCH) yielded a positive attribution score, suggesting a possible relationship between the intervention and clinical improvement.
Conclusion: This case highlights favourable clinical evolution of lower leg ulcer with cellulitis managed with individualized homoeopathy alongside wound care, warranting further controlled investigation.

背景：蜂窝织炎（Cellulitis）是一种累及真皮层（dermis）与皮下组织（subcutaneous tissue）的急性细菌感染性疾病，以红斑（erythema）、皮温升高、肿胀及疼痛为典型表现。该病常继发于皮肤完整性受损，可进展为溃疡形成。下肢溃疡（leg ulcer）指下肢皮肤连续性出现急慢性破损，常伴随感染、炎症、愈合延迟及显著的发病负担。当蜂窝织炎并发下肢溃疡时，组织损伤风险与康复周期延长的概率均会升高。尽管抗生素为标准治疗方案，但整合疗法（integrative approaches）在辅助伤口愈合、降低并发症方面的应用正日益受到关注。

病例报告：1例女性患者因左小腿疼痛性溃疡就诊，该溃疡由丘疹样皮损进展而来。体格检查可见弥漫性红斑、水肿、皮温升高、压痛及溃疡形成，符合蜂窝织炎表现。就诊时未发现全身并发症。根据临床评估制定了个性化顺势疗法（Homoeopathy）治疗策略，根据症状演变序贯给予Pyrogenium、金盏花（Calendula officinalis）及Myristica sebifera。支持治疗包括伤口消毒清洁、保持创面干燥，以及局部外用金盏花软膏。通过系列摄影记录监测病情进展。

结果：随访期间可见疼痛、炎症反应及溃疡面积逐步减轻，伤口愈合良好，未报告不良事件。采用顺势疗法改良纳兰霍评分标准（Modified Naranjo Criteria for Homoeopathy, MONARCH）进行因果关系评估，获得阳性归因评分，提示干预措施与临床改善之间可能存在关联。

结论：本病例展示了合并蜂窝织炎的下肢溃疡采用个性化顺势疗法联合伤口护理后获得的良好临床转归，值得开展进一步的对照研究。