Lichen striatus is a rare benign linear dermatosis of unknown origin affecting paediatric age group. Homoeopathy with it’s holistic approach provides a better response in such condition. One such case report is presented below. Patient attended Paediatric OPD with his mother, chiefly for complaints of linear thickened elevated pruritic skin lesion in his left lower limb. After detailed case taking and repertorisation he was prescribed Flouric acid as constitutional medicine in higher potency and repeated as per the need of the case. Patient started to show improvement in form of reduction in thickness and length of lichen striatus.
Keywords: lichen striatus, Homoeopathy, Flouric acid, Case report, constitutional medicine.
Lichen striatus is a rare, benign, self-limiting linear dermatosis of unknown origin predominantly affecting Paediatric age group of 5-15 years. There is no race and sex predilection. The etiology of lichen striatus is unknown. The most commonly accepted hypothesis is the combination of genetic predisposition with environmental stimuli as causative factor. In few studies atopy was a predisposing factor and in few it was reported along with some autoimmune disorder1. An environmental etiology of infection, trauma, seasonal variation has also been suggested2. Familial episodes of lichen striatus in few cases suggest a genetic predisposition3. As it is a self limiting condition there is good prognosis with complete recovery. There are cases where it is symptomatic and not resolving for years are in need of treatment. Homoeopathic therapies are routinely used for management of skin diseases however there is lack of evidence in this regard and needs evidence to support the effectiveness through research.
CLINICAL PRESENTATION AND DIAGNOSIS:
Usually it is asymptomatic but in few cases it is pruritic. Appears as a sudden eruption of small pink or skin colored or hypo pigmented lichenoid papules forming continuous or interrupted linear band on limbs or trunk. It evolves within several days to weeks. Lesion extends from a few centimeters to involve full length of extremity and is usually unilateral, single but in few cases it is bilateral and multiple in number. It resolves spontaneously in 3-12 month with a range of 4 weeks to 1 year but in few case where it is pruritic and persisting for years together and constantly increasing in length needs treatment. It is diagnosed clinically on the basis of appearance and characteristic developmental pattern that follows lines of Blaschko4.
HOMOEOPATHY IN LICHEN STRIATUS:
Homoeopathic with its holistic approach is effective in treatment of various dermatological conditions, as it covers nature of the patient and underlying miasm which is responsible for unresolving lichen striatus. There are various other specific medicines to resolve thickened hypertrophied skin like silicea5, thiosinaminum, thuja6 etc.
A 9 year old boy was brought by his mother for the complaints of unilateral, linear, hypertrophied, skin colored pruritic rash ascending upward gradually from lateral aspect of left foot to posterior aspect of leg till buttock in left lower limb. There is even scaling of skin and bloody discharge on scratching. It started when he was 9 month old. There is no history of trauma, infection preceding the complaints. Itching is aggravated on dust exposure, application of water and at night. Scratching leads to bleeding at times. He does not want to wear short pant because others will notice it and ask about it. There is no other associated complaints. Clinically it is diagnosed as lichen striatus.
PAST HISTORY: patient is apparently healthy and does not get any acute infections. Rarely he has got fever and rhinitis for which he was given allopathic medicine. For the presenting complaints they were advised surgery for cosmetic purpose but de were not willing to do it and came for homoeopathic treatment.
FAMILY HISTORY: no history of similar complaints in family. Paternal and maternal grandparents are diabetic and hypertensive. Younger brother is having asthma.
ALLERGIC HISTORY: complaint (itching) is aggravated by dust.
GENERALS: Moderately built and nourished. He is having good appetite and thirst, desires for sweets, bowel and bladder habit is regular, sleep is good, perspiration is profuse and offensive and thermally hot patient.
He is very active, extrovert, talkative, jesting, has got lot of energy, plays but does not gets tired at all. He even lifts heavy weight but does not feel tired.
ANALYSIS OF THE CASE
After analyzing the case characteristic mentals, physicals and particulars were considered for framing the totality. Miasmatic evaluation for presenting symptom was done with the help of “the chronic disease” by Dr Samuel Hahnemann. Case showed the predominance of syco-syphilitic miasm. Considering symptomatology Kent’s repertory was selected and repertorised. Repertorial result is given in table 1.
After analyzing reportorial result and miasm, Flouric acid 1M was prescribed in first visit (21/11/2018). Patient showed improvement in subsequent follow up. The details of the follow up are given in table 2.
Name of the remedy Symptoms (9)
Fluoric acid 14/7
Rhus tox 11/5
Baryta carb 9/6
Merc sol 10/4
Carb. An 9/4
DATE FOLLOW UP & PRESCRIPTION
10/12/18 Thickness of lesion decreased
Consistency has become soft
Generals are good
Rx: Flouric acid plain
for 2 weeks
24/12/2018 Thickness of lesion decreased
Decreasing in length from above downwards
Generals are good
Rx: Fluoric acid plain
For 2 weeks
7/1/2019 Thickness of lesion decreased
At some area peeling of skin noticed
Lesion slightly elevated from skin surface
Itching increased-participated in school sports
Generals are good
Rx: Fluoric acid 1M
PL TID for 2 weeks
DISCUSSION AND CONCLUSION:
Homoeopathy treats the person as a whole. Lichen striatus is usually a self limiting condition but in few cases due to underlying strong miasm it persistant for years. In such cases Homoeopathic medicine covering underlying miasm along with the constitutional totality helps in recovery. After repertorisation of selected totality many medicines were competing with each other, namely, lachesis, fluoric acid, baryta carb, silicea, rhus tox, etc., but after referring to material medica fluoric acid was prescribed which remained in subsequent follow up as the patient was responding well to the medicine.
Fluoric acid was not only found as homoeopathic similia in this case, it is even a good remedy for resolving hard indurated tissue, violent itching of skin7. Further follow up are not available as their family shifted to different district.
Homoeopathic therapies are routinely used for management of various skin diseases however there is lack of evidence in this regard and needs evidence to support the effectiveness through research. There is a need to conduct further research to assess efficacy of homoeopathic treatment and the extent to which it can resolve unresolved lichen striatus. As this study is a single case study, research should be conducted on a large scale to find statistical significance of effectiveness of homoeopathy and the present case need to be followed up to know the extent to which thickening, length and lichenification can be resolved with Fluoric acid.
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2. Shepherd V, Lun K, Strutton G. Lichen striatus in an adult following trauma. Australas J Dermatol. 2005 Feb. 46 (1): 25-8. [Medline].
3. Yaosaka M, Sawamura D, Litoyo M, Shibaki A, Shimizu H. lichen striatus affecting a mother and her son. J Am Acad Dermatol. 2005 Aug. 53 (2): 352-3. [Medline].
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5. Arya Singh Bhopal, Siddiqui V A, P Rupali, Dixit. Treatment of post burn hypertrophic scar with homoeopathic medicine. Indian Journal of Research in Homoeopathy. June 2013. DOI: 10.4103/0974-7168.116634.
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7. Clarke J H. A Dictionary of Practical Materia Medica. B Jain publishers, New Dellhi, 2009 reprint edition, Vol 1(782-786).