Holistic Healing for Lichen Planus: A Homoeopathic Perspective

Abstract: Lichen planus(LP) is a chronic inflammatory mucocutaneous disease that affects skin, mucous membranes or both. It adopts different morphologies and manifests unpredictable periods of remission and exacerbation. This article deals with an overview of LP, focusing upon its various aspects along with Homoeopathic management of the same.

Keywords: Lichen planus, wickham’s striae, Homoeopathy.

Introduction: Lichen planus (LP) is an inflammatory disorder of the skin and mucous membrane of no known cause. It appears as pruritic, violaceous, papules and plaques, most commonly found on the wrist, lower back and ankles. A lattice-like network like white lines called ‘wickham’s striae’ overlies the lesions but is most easily observed on the buccal mucosa where erosion may also be present. Lichen planus is an idiopathic disease. Its pathogenesis is not fully understood but it appears to represent a T-cell mediated immune disease.1Patients with LP are 5 times as likely to test for HCV as the general population. Women are more frequently affected than men at ratio 1.5:1 and most cases develop between the ages of 30-60 years.1 Pruritic, polygonal, purple (but violaceous is the term to use), Plane flat-topped and papules show a network of white lines known as wickhmen’s straie.Site– Wrist, legs.2

Associations– LP may be associated with mucosal (oral and genital) lesions and nail involvement.2

• Oral mucosa- Involved in 50% of patients. Sole manifestation in 10% of patients. May be asymptomatic. Or patients may complain of intolerance to spicy food.
• Genital mucosa- Involved in 25% of patients. Annular lesion, on the glans penis, characteristic.
• Nail changes- seen in 15% of patients. Common findings in LP of nails are:

• Thinning and distal splitting of nail plates.
• Longitudinal groove.
• Pterygium.

Lichen Planus variants-

Variant	Sites of predilection
Annular	Face, glans penis.
Actinic	Face, dorsal aspect of extremities.
Linear	Extremities.
Follicular	Scalp, trunk, medial aspect of extremities.
Hypertrophic	Shins.
Bullous	Extremities.

Miasm-Sycosis.3

Complications2 –

• Nail and hair loss in LP is irreversible.
• Chronic ulcerative LP of oral mucosa can undergo malignant change.

Course2– LP is a chronic but self-limiting disease which may last many months to a couple of years. Hypertrophic LP is very persistent.

Diagnosis-

• Itchy violaceous, (5 P’s- pruritic, purple,polygonal, plane topped papules).
• Typical sites (Wrists, ankles, shins).
• Nail changes: Thinning of nail plate and pterygium corroborates the diagnosis.

Differential Diagnosis –

Lichenoid eruption	LP
Lesions larger and scaly.	Lesions smaller, scaling minimal.
Wickham‘s striae absent	Wickham’s striae present
Residual hyperpigmentation common	Residual hyperpigmentation possible.
Alopecia common	Alopecia uncommon
Sun-exposed area	Flexures and Extremities
Mucous membrane involvement less common	Very common

Homoeopathic Medicine for Lichen planus-

• Antimonium crudum– Scaly, Pustular, eruptions with burning and itching, worse at night. Thick, hard, honey colored scabs.Dryskin.Worse- evening, water, and washing. Better- open air, moist warmth.4
• Arsenicum album– Itching, burning, swelling, edema, eruptions, popular, dry rough, scaly, worse cold and scratching.Unhealthy, dryness and burning heat in mouth.4Desquamation of the skin of the body. Skin dry as parchment, cold and bluish.Worse- After midnight, wet weather, cold. Better- from heat.5
• Arsenicum iodatum– Dry, scaly, itching, marked exfoliation of skin in the form of large scales. Persistent itching of various parts of body, most of back.5
• Kalium bichromicum– Ulcer with punched out edges, with tendency to penetrate and tenacious exudation. Itching and pain in the penis, with pustules.4Affections of mucous membranes.Discharge of tough, stringy mucus which drown to the parts and can be drown into the long strings. Worse- hot weather, undressing,. Better- cold weather.6
• Mercurius solubilis– General tendency to free perspiration, but the patient is not relieved thereby. Skin is constantly moist. Flat, painless ulcers, pate, covered with phlegm like pus on scalp, skin of penis6.Worse- at night, perspiration.
• Sulphur–Dry, scaly, unhealthy; every little injury suppurates. Itching, burning; worse scratching and washing. Pruritus from warmth, in the evening.Skin affections after local medication. Itching, voluptuous; scratching>; ‘’feels good to scratch. Worse-  warmth of bed, washing. Better- dry, warm weather4.
• Agaricus muscarius– burning, itching, hyperaemia, and swelling, as from frostbites. Sensation as if ice touched or ice- cold needles were piercing the skin; as from hot needles. Burning, itching, redness of various parts; ears, nose, face, hands and feet; parts red, swollen, hot.6 Worse- Open cold air, before a thunderstorm. Better- Moving about slowly.4
• Juglans cinerea– Itching and pricking when heated. Red, like flush of scarlatina.4Worse- walking. Better- on getting heated, scratching.4
• Apis mellifica– Oedematous swelling, skin usually white, almost transparent.5 Extreme sensitiveness to touch. Burning, stinging, soreness of affecting part.6 Worse- touch, heat. Better- Open air, uncovering.4
• Staphysagria– Eruption of itching, oozing nodosities, with burning,  pain5.Thick Scabs, dry and itching violently; scratching changes location of itching. Worse-least touch on affected parts. Better- warmth4.

References:

• Arnold DL, Krishnamurthy K. Lichen Planus. [Updated 2019 Mar 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526126/

1. Khanna N. Illustrated synopsis of Dermatology and Sexually Transmitted Diseases. 3rd ed. Delhi: Elsevier; 2009.
2. Master FJ, Pooran DA, Petigara SD, Weisz Elizebeth, Arnold Herald. Diseases of the Skin( Including of Exanthemata).Bombay: B. Jain Publishers (P) Ltd.; 1993.
3. Boericke William. New Manual Of Homoeopathic Materia Medica, New Delhi: B. Jain Publishers(P) Ltd; 2011.
4. Clarke JH. A Dictionary of Homoeopathic Medicines. 3rd ed. New Delhi; B Jain (P)Ltd; Volume 3, 2005.
5. Allen HC. Allen‘s Keynotes Rearranged and Classified Leading Remedies of the Materia Medica and Bowel Nosodes.

About Authors

Author: Dr Kirti Kumar Mevada, Prof. Department of  Physiology and biochemistry, Gokul Homoeopathy medical College, a constituent college of Gokul University, Siddhpur,Gujarat

Dr. Neha Mahawer, Assistant Prof. , Department of Materia Medica,. Gokul Homoeopathy medical College, a constituent college of Gokul University, Siddhpur,Gujarat

Dr. Saeed Vagadiya, Asst.professor, Department of human anatomy, Gokul Homoeopathy medical College, a constituent college of Gokul University, Siddhpur,Gujarat.