🔺CASE STUDY : NO 56 🔺 PART NO : 1 🔺VISARPA (Herpes zoster/ cellulitis/ skin hypersensitivity disorders) 🔺 Nidana (Etiology / Causative Factors) *General causes for Visarpa (vitiation of all three Doshas, mainly Pitta and Rakta): *Excessive intake of Katu (pungent), Amla (sour), Lavana (salty) and Ushna (hot) foods *Excess alcohol and spicy food *Excess exposure to sun and fire (Agni) *Mental factors – Krodha (anger), Bhaya (fear), Shoka (grief) *Improper Shodhana (purification) procedures *Injuries or external infection Classical Reference: Charaka Samhita, Chikitsa Sthana 21/4-6 Sushruta Samhita, Nidana Sthana 5/3-5 🔺 Purvarupa (Prodromal Symptoms) *Daha (burning sensation) *Kandu (itching) *Toda (pricking pain) *Sphurana (throbbing sensation) *Raga (redness of skin) *Gourava (heaviness in the body) Reference: Sushruta Samhita, Nidana Sthana 5/8 🔺 Lakshana (Clinical Features) Visarpa is characterized by: *Sudden onset of spreading red patches *Burning pain, fever *Edematous, warm, inflamed skin lesions *Skin discoloration: red, blue, black, yellow depending on dosha dominance *Rapid spreading nature (hence the name Visarpa = spreading disease) 📌Specific dosha-wise features: *Vataja Visarpa: Stiffness, dryness, pain *Pittaja Visarpa: Severe burning, redness, fever *Kaphaja Visarpa: Heaviness, itching, whitish swelling *Sannipataja Visarpa: Mixed symptoms, dangerous *Agni Visarpa (Fire type): Very acute, may cause tissue necrosis Reference: Charaka Samhita Chikitsa 21/8-14, Sushruta Samhita Nidana 5/10-15 🔺 Systemic Examination -General Physical Examination *Fever (common in infections like cellulitis or erysipelas) Malaise, fatigue *Localized swelling, erythema *Skin vesicles or pustules *Pain/tenderness *Lymphadenopathy (especially regional) 📌System-wise Examination *Skin: Rash distribution, color changes, vesicles, ulcers, discharge *Neurological: If Herpes Zoster is suspected — assess dermatomal distribution and neuralgia *Cardiovascular/Respiratory: Evaluate for systemic involvement in cellulitis with septicemia *Lymphatic System: Enlarged lymph nodes near the affected area 🔺 Laboratory Investigations and Expected Results for Visarpa (Modern Correlation) *Complete Blood Count (CBC): This test helps assess the body's inflammatory response. In cases resembling cellulitis or erysipelas, there is often an elevated white blood cell (WBC) count, particularly neutrophils, indicating a bacterial infection. *Erythrocyte Sedimentation Rate *(ESR) and C-Reactive Protein *(CRP): Both of these are markers of inflammation. Elevated ESR and CRP levels are commonly found in active infections and inflammatory conditions such as erysipelas, cellulitis, and autoimmune skin disorders. *Blood Culture: This is performed to detect systemic bacterial infections. In severe cases of cellulitis or erysipelas that have progressed to bacteremia or sepsis, blood cultures may come back positive for organisms such as Streptococcus pyogenes or Staphylococcus aureus. *Skin Swab for Culture and Sensitivity: A sample from the affected skin lesion is taken to identify any bacterial or fungal organisms. Positive results are most often seen in bacterial conditions and guide antibiotic selection. *Tzanck Smear: This cytological test is useful if herpes zoster (shingles) is suspected. A positive result shows multinucleated giant cells, which are characteristic of infections caused by herpes simplex virus (HSV) or varicella-zoster virus (VZV). * Skin Biopsy * Liver and Renal Function Tests 🛑https://chat.whatsapp.com/KLufxKFrXwbIIAXLxXDqOB