- Dr Sunitha Devi Vannemreddy M.D(Hom)
Lichen planus is a cell mediated immune response of unknown origin. It is fairly common skin rash that thought to be triggered by autoimmune system. There may be several contributing factors and each case is different. Main causes includes viral infection, allergen or stress and genetics.It may be found with other diseases with altered immunity such as ulcerative colitis, alopecia areata, vitiligo, dermatophysotos, morphea, lichen sclerosis and myasthenia gravis. Lichen planus has been found to be associated with Hepatitis C virus infection, chronic active hepatitis and primary biliary cirrhosis.
Many people get lichen planus. This disease can develop on one or several parts of the body. It appears on skin or on oral cavity. Lichen planus can change the way of person’s fingernail and toe nails look. It can also appear on genitals and on scalp too.
It may be uncomfortable but in most of the cases lichen planus is not a serious problem. Lichen planus is not contagious. You cannot get this disease from someone else and you cannot give it to anyone. Lichen planus is not a type of cancer.
Lichen planus can occur in anyone at any age, skin form of lichen planus occurs in men and womenequally but oral form of LP develops twice more in women. It is very rare in young and elderly people and most commonly occurs in middle aged people.
Other risk factors include having other family member with lichen planus, viral diseases like hepatitis c, or being exposed to chemical or allergens like certain antibiotics, arsenic, gold, iodide compounds, diuretics and certain kinds of dyes.
Signs and symptoms:
Common symptoms of lichen planus includes:
· Purplish coloured lesions or bumps with flat tops mostly found on wrist, inner forearm and ankles.
· Blisters, which become scabby after bursting.
· Thin white lines over the rash (wickham’s striae).
· Itching at the site of the rash.
Description of lichen planus well known as “6ps” includes,
Planar (flat topped), purple, polygonal, pruritic, papules and plaques.
This rash after regressing likely to leave an area of hyperpigmentation that slowly fades.
Lesions initially developing on flexural surfaces of the limbs, with generalized eruption developing after a week or more and maximal spreading within 2-16 weeks.
Pruritus of varying severity, depending on type of lesion and extent of involvement.
Oral lesions may be asymptomatic, burning or even painful. Ulcer formation with intense burning and painful. Won’t allow talking and chewing anything and burning on taking food. Sometimes bleeding in nature.
In cutaneous lesions, lesions typically resolve within months to 18 months; chronic disease is more likely oral lichen planus or with large, annular, hypertrophic lesions and mucus membrane involvement.
Structures involved in lichen planus:
· Mucous membranes like affecting the lining of gastrointestinal tract like mouth, pharynx, oesophagus, stomach and anus, larynx and other mucosal membranes.
· Cutaneous type, involves extremities, face and nape of neck. Sometimes occurs in palms and soles (intertriginous area); which is called as “ inverse lichen planus”
· Genitalia; causes lesions on glans penis or skin of scrotum in males. Vulva or vagina in females. Symptoms includes lower urinary tract infection associated with stenosis of urethra, painful sexual intercourse and itching.
· Scalp; which is also known as planopilaris and peripilaris. Characterised by violaceous, scaly, pruritic papules. It also causes scarring alopecia if not treated.
Occasionally, lichen planus is known to occur with other conditions like,
· Lupus erythematosus: lesions are usually large, hypopigmented, atrophic and red to blue coloured with minimal scarring. Telengectasia may be present.
· Lichen sclerosus: lichen planus overlaps on lichen sclerosis by sharing the both symptoms more or less equally.
Clinical presentation of Lichen planus are;
· · Hypertrophic LP
· Atrophic LP: mostl present as atrophic oral lichen planus may also manifest as desquamative gingivitis.
· Erosive or ulcerative LP: it is the second most common oral lichen planus. It is characterised by oral ulcers with persistent, irregular areas of redness, ulcerations and erosions covered with yellow slough. Gums also involved described as desquamative gingivitis.
· Follicular LP
· Annular LP
· Linear LP
· Reticular LP: the most common presentation of oral LP. It is characterised by net like or spider web like appearance of lacy white lines called as “wickham’s striae”
· Vesicular and bullous LP: appears as fluid filled vesicles which projects from the surface.
· Actinic LP
· Lichen planus pigmentosus
· Lichen planus pemphigoides: characterised by the development of tense blisters atop lesions of lichen planus or the development of vesicles de novo on uninvolved skin.
· Keratosis lichenoides chronica: it is a rare form of dermatosis characterised by violacious popular and nodular lesions, often arranged in linear or reticular pattern on dorsal and, feet, extremities and buttocks.
· Lichenoid keratosus: also known as benign lichenoid keratosus, a cutaneous condition characterised by brown to red scaling maculopapules, found on sun exposed skin of extremities.
Lichen planus lesions are diagnosed clinically by “lichen” like appearance.
A biopsy can be used to rule out conditions that may resemble lichen planus.
Direct immunoflouroscence study reveals globular deposits of immunoglobulin M (IgM) and compliment mixed with apoptotic keratinocytes.
Lichen Planus is self limiting disease that usually resolves within 8-12 months. Mild cases treated with topical steroids and severe cases especially those involve scalp, nails and mucous membranes needs intensive therapy.
In Allopathy, first line of treatment is corticosteroids, vitamin D3 anologues and antibiotics.
Cosmetic treatments includes, laser surgery, cryotherapy and phototherapy.
Patients with wide spread Lichen planus will be responds with, Narrow band or broad band UV-B therapy and Psoralen- ultraviolet –A (PUVA therapy) treatment.
Lichen planus and Homeopathic treatment:
Homeopathy is deep acting constitutional treatment which helps in stabilizing the person in emotional, mental and physical plane. Inheritance is the condition in which some diseases runs along the family. Homeopathy helps in the limiting the progression of the disease by acting on miasmatic level which lessen the impact of the disease. Autoimmune conditions are self acting conditions against its own immunity. So with the homeopathic treatment, these autoimmune conditions are somewhat limited in its progression and symptomatic relief by strengthening the person’s immunity.
Homeopathy helps in relieving the symptoms and reducing the impact of the condition and also helps in reducing the recurrence of the disease.
Homeopathic treatment also helps in relieving the side effects of corticosteroids and other allopathic medications used for the treatment of lichen planus.
Lichen planus caused by allergens like gold, chemicals and medications are effectively treated by homeopathic medication.
So homeopathic medication helps in effective treatment of lichen planus, by relieving from the symptoms, reduces the recurrence of the disease. It also helps in lightening of the pigmentation left by the disease.
Rubrics to be useful in treatment of Lichen planus:
Skin, Lichen planus
Skin, discoluration, purple
Skin, eruptions, purple.
Skin, eruptions, papules
Skin, eruptions, blisters
Skin, eruptions, blisters, scalding of skin from
Skin, eruptions, itching
Skin, eruptions, chronic
Extremities, eruptions, forearm
Extremities, eruptions, wrist
Extremities, eruptions, ankles
Skin, eruptions, dark
Skin, eruptions, desquamating
Skin, eruptions, crusty
Mouth, ulcers, irregular
Mouth, ulcers, painful
Mouth, ulcers, painful, burning
Mouth, ulcers, painful, sore and smarting
Mouth, ulcers, painful, biting
Mouth, ulcers, painful, touch to
Mouth, ulcers, gums, discharging of blood
Some of the indicated remedies for lichen planus:
Antimonium crudum, Anthrakokali, Arsenicum album, Arsenicum iodum, Borax, Juglans cinerea, Kali bichromium, Merc sol, Plantago, Sulphur, Sulp.iodatum, chininum arsenicosum, thallium metallicum and Thuja.
Antimonium crudum: One of the best homeopathic remedy for both oral and cutaneous lichen planus. Cracks in the inner corner of mouth with canker sores in the mouth. No thirst with slimy mucus. Tongue is white coated or white washed. Best remedy for thick, hard and honey coloured scabs. Papules with burning and itching aggravated by cold bathing and night.
Anthrakokali: Best remedy for the treatment of lichen planus if eruptions on hands and feet. It shows effect on popular eruptions especially on hands and legs. It helps in the treatment of papules on scrotum in males. It is a best remedy for the lichen planus over the skin of tibia.
Arsenicum: It is one of best remedy for the treatment of lichen planus associated with great exhaustion and anxiety. Great anguish and restlessness associated with skin complaints. Fear of death is prominent in this drug. Popular eruptions which are dry and scaly, worse by cold weather and scratching. Ulceration of mouth with dryness and heat sensation in mouth.
Borax: Best remedy for oral lichen planus with rashes inside cheeks and on tongue. Aphthae, white fungus like growths in mouth. Painful gum boils. Ulcers bleed on touch and eating. Mouth is tender and hot with bitter taste in mouth.
Juglans regia: It is best remedy for lichen planus which affects the scalp. Scalp is red with violent itchy eruptions. Chanker like ulcers and with more itching in the night. Associated with enlarged axillary glands which suppurates.
Kali bichromicum: it has more affinity towards mucous membranes like oral cavity. Mapped tongue which is red, shining and dry. Sensation of hair on the tongue. Also useful in skin ulcer with punched out edges. Associated with prostration and burning pain.
Merc sol: Best remedy for oral lichen planus. Especially effective in the treatment of lichen planus where gums are involved. Gums spongy, recede and bleed easily. Sore pain on touch and on chewing. Furrow in upper surface of tongue. Tongue is moist, coated yellow with teeth indented, feels as if burnt, with ulcers. Complaints worst at night with great thirst.
Plantago: Best remedy if whole oral cavity affected with lichen planus. Toothache with soreness and sensitive to touch. Swollen cheeks. Profuse saliva. Complaints are worse by touch and cold air and relieved by pressure. External application of Plantago mother tincture relives the pain.
Sulphur: Best remedy for Lichen planus with papules and extreme skin dryness. Eruptions are dry, scaly and unhealthy. Every little injury suppurates. Complaints of skin eruptions after local medication. Papular eruptions with hand nails. Excoriation in folds of skin. Complaints are with itching and burning and worse by scratching and washing.
Sulp.iodatum: Best remedy for lichen planus on face and arms. Popular eruptions on face. Itching at nose and ears. Arms covered with itching eruptions.
Chininum arsenicosum: It is indicated in oral lichen planus after affections of malaria and neuralgia. Tongue is thickly furred, yellow and slimy coated with bitter taste. Complaints associated with profound prostration and loss of appetite after malaria.
Thuja: Best homeopathic remedy for lichen planus of pigmented variety. Eruptions only on covered parts with profound itching, worse after scratching. Very sensitive to touch. Brown spots on hands and arms. Nails crippled, brittle and soft.
With these some indicated remedies for the treatment of lichen planus.
Constitutional treatment with homeopathy not only relieves the complaints of lichen planus, it also helps in reducing the recurrences.