Homoeopathic Approach in Lichen Planus - A Case Report

Abstract

Background –Lichen planus (LP) is an inflammatory skin disorder, characterised by an itchy, shiny, violaceous, flat-topped, papular eruption over different part of body. Since conventional mode of medicine doesn’t completely cure the lesion but suppresses it, in the same or the other form. Homoeopathy on the contrary has a significant role in treatment of LP on the basis of totality of symptoms (individualisation) and holistic approach. In case of LP, homoeopathic medicines target the altered immunity of the body and bring it back to normally over period of time. A case of LP of 28 years old male is presented in this article who responded commendatory with single medicine Rhus toxicodendron depending on totality of symptoms repertorial result. Reduction in size and number of eruptions was observed over a period of five month.

Method – A detailed case taking was done and LP was diagnosed on the basis clinical history, physical examination and biopsy report. Individualised homoeopathic medicine was given on the basis of totality of symptom with aid of repertorisation.

Result- The patient recovered remarkably with homoeopathic therapy.

Conclusion- Homoeopathy has treated a difficult to treat condition, i.e. LP, in a relatively less time, where conservative treatment fail to give positive results.

Keywords: lichen planus, Rhus toxicodendron, homoeopathy, repertorial totality, single medicine

Abbreviations: LP- lichen planus, OPD – out patient department, T/R – thermal reaction, H/O – history of, RADAR – rapid aid to drug aimed research, TDS – thrice daily, HOPC – history of presenting complaints

Introduction

LP is a chronic inflammatory and immune-mediated disease that affects the skin, nails, hair and mucous membrane. It is characterised by polygonal, flat topped, violaceous papules and plaques with overlying reticulate fine white scale.⁽¹⁾

Case Profile

A 28 years old hindu male reported in OPD (19H2496) on 22.2.19, with complaints of L.P. over scalp since 2 years.

HOPC:

Patient was apparently well 2 years before, when, gradually, he started complaining of intensely itchy, small, erythematous, flat-topped, slightly purplish eruptions over scalp.

Mental general:

Restlessness with continued change of position
Fear of dark
Feeling of despair

Physical general:

T/R – chilly
Great restlessness, felt better for a time, after change of position
Desire for milk

Associated complaints: Lower back pain

F/H: Father – diabetic; Mother – died H/O hypertension

Clinical finding

Local examination: (Figure 1)

Site- scalp
Character- LP, like eruptions-itchy, slightly purplish with vesicles⁽¹⁾.
Number- multiple
Discharge- slightly sticky

Provisional diagnosis

Lichen planus, on the basis clinical history, physical examination and biopsy report⁽¹⁾. (Figure 2)

Analysis and evaluation of symptoms:

Symptom	Analysis	Intensity
Restlessness, both physically and mentally.	mental general	++
Fear of darkness	mental general	++
Feeling of despair	mental general	+
Desire for milk	physical general	++
Lower back pain	characteristic particular	+
Itchy, erythematous, vesicular eruptions over scalp	characteristic particular	++

Totality of symptoms:

Restlessness both physically and mentally.
Fear of darkness
Feeling of despair
Desire for milk
Lower back pain
Itchy, erythematous, vesicular eruptions over scalp

Miasmatic analysis:

Symptom	Miasmatic analysis
Restlessness both physically and mentally	Psora
Fear of darkness	Psora
Feeling of despair	Psora – syphilis
Desire for milk	Psora
Lower back pain	Psora
Itchy, erythematous, vesicular eruptions over scalp	Psora-sycosis
Chilly	Psora

In this case, as per analysis, psora is the dominant miasm with syphilitic background. ⁽²⁾

Repertorisation:

Considering the generals were marked in the case, Kentian approach was taken into consideration and case was repertorised with the help of Synthesis repertory from RADAR 10.0 version. ⁽³⁾

Figure 3 –Repertorisation sheet from RADAR 10.0 version

First prescription with justification:

Rhus toxicodendron 30 was prescribed after repertorisation and due consultation of materia medica⁽⁴⁾on 22.2.19; considering that Rhus toxicodendron patient is physically as well mentally restless and its pathogenetic effects primarily causes vesicular eruptions. 30 potency in repeated doses was selected as patient was having intense itching with oozing eruptions with considerable backache.

Table 1: Follow-up with prescription and justification

Date	Symptoms	Prescription with justification
4.3.19	Few new eruptions appeared and there is slight improvement in old eruption. Itching and discharge from eruptions decreased. Lower back pain reduced around 30-35%	Rhus toxicodendron 30/ TDS for 14 days As improvement was evident and amelioration going on medicine was repeated, considering that lichen planus is chronic inflammatory immune mediated condition, hence it was repeated.⁽⁶⁾
22.4.19	Further improvement in old eruptions but new eruption continued to form. Itching remarkably reduced. Discharges dried up. Back pain relieved.	Rhus toxicodendron 200/ 1 dose⁽⁵⁾ stat Phytum /TDS for 14 days As new eruptions were appearing medicine was given in next higher potency.
6.5.19	Old eruption begins to start fading. No new eruption. Low back pain resolved around 80%.	Phytum/TDS for 14 days As improvement was evident and amelioration going on with no new eruptions, patient was kept on wait n watch.
24.5.19	Relief in all symptoms	Phytum/TDS for 14 days As improvement in all symptoms, patient was kept on wait n watch.
7.6.19	Relief in all symptoms and general condition became better (figure-4)	Phytum/TDS for 30 days Patient recovered and he was advised to come back in case of relapse, placebo was given for a month.

Discussion and conclusion:

After repertorisation, Rhus toxicodendron was prescribed initially there was slight improvement in old eruption but a few new eruptions appeared so the potency was increased which resulted into drying up of discharges and disappearance of old eruptions as well new eruptions appeared during treatment course. Itching was completely resolved and new hair follicle begins to form over affected area. The prescribed medicine not only improved the symptomatology but also improved other general symptoms of the patient as reported by him in follow ups.

Homoeopathy is a system of medicine which treats the patient as a whole and not the disease through selection of simillimum, as stated by Hahnemann in his Lesser writings. This case has relevant evidence of LP being treated effectively from single homoeopathic medicine.

References:

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