HOMEOPATHY FOR LICHEN PLANUS

Lichen planus is a rash characterized by intensely itchy polygonal papules with a violaceous hue involving the skin and less commonly the mucosae, hair, and nails.

It affects all age groups but is most common between the ages of 30 and 60. Children and infants are not commonly affected. There are no gender or racial predispositions.

Etiology

·       The cause is unknown but an immune pathogenesis is suspected as there is an association with some autoimmune diseases such as myasthenia gravis, and with thymoma and graft-versus-host disease.

·       Rashes with clinical and histological features of lichen planus can occur in chronic active hepatitis, hepatitis B and C infections.

·       Patients taking drugs, the most common culprits being gold and other heavy metals, sulphonamides, penicillamine, antimalarials, antituberculos drugs, and thiazide diuretics, also develop rashes.

·       They also occur in those handling color developers.

Pathogenesis

There is hyperkeratosis, a prominent granular layer, basal cell degeneration and a heavy T lymphocyte infiltration in upper dermis. Degenerating basal cells may form colloid (apoptotic) bodies. The T cell-basal cell interaction leaves a ‘sawtooth’ dermo-epidermal junction. The picture suggests an immune reaction to an unknown epidermal antigen.

Clinical features

Distribution site:

·       Wrists (volar/flexor aspect of wrist)

·       Ankles

·       Oral mucous membrane

·       Shins

·       Lower back and genitalia

Signs and symptoms include:

·       Shiny, violaceous flat-topped papules and plaques

·       Purplish papules, purplish nodules on skin at sites of friction

·       Sore or painful or asymptomatic

·       Polygonal

·       Severe pruritus. The patients rub rather than scratch, so that excoriations are uncommon.

·       Fine lacy white markings on top of papules known as Wickham striae. These striae are most prominent in the oral mucosa.

·       Scratching and trauma induce new lesions (Koebner phenomenon)

·       On the scalp it can cause cicatricial alopecia

Nail lichen planus

·       Nail involvement is seen in 10% of patients

·       Longitudinal ridging of the nail plate, with nail plate thinning

·       Scarring of the matrix that causes pterygium (a wing-like permanent nail dystrophy) and anonychia.

·       Rarely the papules split the nails and give the ‘tented nail’ or ‘pup tent sign’.

Oral mucosa lichen planus

·       Common sites are buccal mucosa, tongue, gingiva, lips

·       White striae in mouth present on a spectrum ranging from a mild, white, reticulate eruption of the mucosa to a severe, erosive stomatitis.

·       Ulcers to severe erosive stomatitis, erosive gingivitis.

·       White streaks, often forming a lacework, on the buccal mucosa are highly characteristic.

·       Erosive stomatitis may persist for years and may be linked to an increased risk of oral squamous cell carcinoma.

·       Occasionally lichen planus lesion from oral mucosa extend to larynx/esophagus, results in dysphagia and formation of benign strictures.

·       In young men lichen planus are restricted to genitalia and/or mouth.

·       In female erosive lichen planus of the genitalia with desquamative gingivitis.

Homeopathy medicines

Homoeopathy today is a growing system and is being practiced all over the world. Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels. When Lichen planus  is concerned there are many effective medicines are available in Homoeopathy, but the selection depends upon the individuality of the patient, considering the mental and physical symptoms.

Agaricus  muscarius

Papular, pustular, and edematous lesions. Eruption of small pimples like with red areola and violent itching and burning. Sensation in various parts as if ice cold needles were piercing the skin.

Anthrakokali

Papular eruptions on hands and feet. Intense itching.

Antimonium crudum

Scaly, pustular eruption with burning and itching, worse at night. Rough scaling skin with horny patches. Great tenderness in horny patches. Thick, hard, honey-colored scabs. Itching when warm in bed. Dry skin. Itching of scalp and falling out of hair. Tongue coated thick white, as if whitewashed. The edges may be red and sore. Sensitive to cold bathing. Nails discolored and deformed.

Arsenicum album

Itching, burning, swelling; edema, eruption popular, dry, rough, scaly; worse cold and scratching. Malignant pustules. Ulcers with raised and hard edges, surrounded by a red and shinning crown; with the bottoms like hard, or of a blackish-blue, with burning pains or shooting, principally when the parts affected become cold. Great anguish and restlessness. Changes places continually. Fear of death.

Arsenicum iodatum

Dry, scaly, and itching lesions. Marked exfoliation of skin in large scales, leaving a raw exuding surface beneath.

Borax

For oral lichen planus. Ulcers inside the cheeks and on tongue. Mouth hot and tender. Bitter taste in the mouth on eating or on swallowing the saliva. Dry cracked or puffy indented tongue. Ulcers, bleed on eating or by touch.

Dulcamara

Pruritus, always worse in cold, wet weather. Vesicular eruptions. Humid eruptions on face, genitals, and hands. Thick brown-yellowish crusts, bleeding when scratched. Warts, large, smooth, on face and palmar surface of hands.

Juglans cineraria Q

Eruption resembling eczema simplex on upper chest, with itching pricking when heated by over-exertion. Pustules on thighs, hips, and nates, with itching and burning, a few pustules on body, face, and arms. Itching in spots, now here, now there, on head, neck, and shoulders, with pricking, burning and redness. Itching on arms, better from scratching.

Kali arsenicosum

Intolerable itching, worse from undressing. Dry, scaly, wilted skin.  Itching worse from warmth. Numerous small nodules under skin.

Kali bichromicum

Papular eruption, with burning pains. Hands become covered with deep, stinging cicatrice. Ulcer with punched-out edges, with tendency to penetrate and tenacious exudation.

Ledum palustre

Eruption of small pimple like red millet seed over the body. Intense itching of feet and ankles, worse scratching and warmth of bed. Eruption only on covered part. Edematous swelling.

Mercurius sol

For oral lichen planus. Irregular ulcers inside the cheeks. The edges are not well defined. Unhealthy and dirty appearance of cheek. Profuse salivation. Offensive odor from the mouth. Metallic taste in the mouth. Increased thirst for water.

Plantago major

For oral lichen planus. Swelling of cheeks. Profuse flow of saliva. Dirty taste. Tongue coated white, with dirty, putrid, clammy taste. Breath putrid.

Sulphur

Dry, scaly, unhealthy skin; every little injury suppurates. Itching, burning; worse scratching and washing. Dirty, filthy people, prone to skin affections. Very red lips and face. Skin affections after local medication. Pruritus, especially from warmth, in evening, often recurs in spring-time, in damp weather. Aversion to being washed, always worse after bath. Craving for sweets.

Sulphur iodatum

Lichen planus. Arms covered with itching rash. Hair feels as if erect.  Papular eruption on face. Obstinate skin affections; painless enlargement of glands, and infiltration of tissues with thickening and induration after inflammation.

Thuja occidentalis

Dry skin with brown spots. Brown spots on hands and arms. Very sensitive skin to touch. Sweetish and strong perspiration. Lichen planus of pigmented variety.