An inflammatory disease of the skin characterized by an eruption of flat, angular, shining, umbilicated papules. Of a dull red color, and isolated at first, they may coalesce into linear or irregular patches, assuming a purplish hue and sometimes covered with thin scales.
Lichen planus is an uncommon skin complaint. It is thought to be due to an abnormal immune reaction provoked by a viral infection or a drug. Inflammatory cells seem to mistake the skin cells as foreign and attack them.
Lichen planus may cause a small number of skin lesions or less often affect a wide area of the skin and mucous membranes. In 85% of cases it clears from skin surfaces within 18 months but it may persist longer especially when affecting the mouth or genitals.
Etiology and Pathology
This disease is clearly of neurotic origin, the commonest cause being nervous exhaustion from anxiety, overwork, strain and worry, deficient or improper food and digestive disturbances. It is a disease of middle adult life, rare in children, although it has been observed in the very young and the very old. Microscopic examination shows that the hair-follicles and sebaceous glands are not affected. The characteristic feature is the marked definition of the affected papillae and subpapillary layer from the normal tissue beneath. The papules are found chiefly at the mouth of the sweat-glands, although the glands themselves are seldom involved, and appear to be due to a circumscribed cell-infiltration of a lymphoid nature in the papillary layer of the corium.
Signs and Symptoms
Classical lichen planus is characterized by shiny, flat-topped, firm papules (bumps) varying from pin point size (‘guttate’) to larger than a centimetre. They are a purple colour and often are crossed by fine white lines (called ‘Wickham’s striae’). They may be close together or widespread, or grouped in lines (linear lichen planus) or rings (annular lichen planus). Linear lichen planus can be the result of scratching or injuring the skin. Although sometimes there are no symptoms, it is often very itchy.
Lichen planus may affect any area, but is most often seen on the front of the wrists, lower back, and ankles. On the palms and soles the papules are firm and yellow. Very thick scaly patches are particularly itchy and are most likely to arise around the ankles (hypertrophic lichen planu).
New lesions may appear while others are clearing. As the lichen planus papules clear they are often replaced by areas of greyish-brown discolouration, especially in darker skinned people. This is called postinflammatory hyperpigmentation and can persist for months.
The flat, angular, smooth, shining, umbilicated, purplish papules are never seen in any other disease, and there should be no difficulty in the diagnosis of a typical case. But even in atypical cases, enough of these characteristic symptoms are present to differentiate similar appearing cases of psoriasis, papular eczema or lichen ruber. For further differentiation from lichen ruber, see that disease.
Lichen Planus – HOMEOPATHIC TREATMENT & MEDICINES
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat Lichen planus but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat Lichen planus that can be selected on the basis of cause, sensations and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of Lichen planus:
Pimples, vesicles, and pustules. Sensitive to cold bathing. Thick, hard, honey-colored scabs. Scaly, pustular eruption with burning and itching, worse at night. Excessive irritability and fretfulness, together with a thickly-coated white tongue, are true guiding symptoms to many forms of disease calling for this remedy. All the conditions are aggravated by heat and cold bathing. Cannot bear heat of sun. Loss of appetite. Desire for acids, pickles. Thirst in evening and night. Eructation tasting of the ingesta. Heartburn, nausea, vomiting. After nursing, the child vomits its milk in curds, and refuses to nurse afterwards, and is very cross. Gastric and intestinal complaints from bread and pastry, acids, sour wine, cold bathing, overheating, hot weather.
Itching, burning, swellings; śdema, eruption, papular, dry, rough, scaly; worse cold and scratching.Among these the all-prevailing debility, exhaustion, and restlessness, with nightly aggravation, are most important. Great exhaustion after the slightest exertion. This, with the peculiar irritability of fiber, gives the characteristic irritable weakness. Burning pains. Unquenchable thirst. Burning relieved by heat
Skin eruptions are prominent. Skin sore and cracked then red and scaly, it became moist, on margin of tetter burning vesicles, the tetter worse after perspiring much, the perspiration, with the secretion from the eruption, stiffened the linen and stained it greenish-yellow, the pain sometimes so great that violent motion of the arms was impossible, there were always new vesicles and larger extent of redness after increased burning and itching.
Dry, scaly, itching. Marked exfoliation of skin in large scales, leaving a raw exuding surface beneath. Ichthyosis. Enlarged scrofulous glands. Venereal bubo. Debilitating night-sweats. Thin, watery, irritating, excoriating discharge from anterior and posterior nares; sneezing. Hay-fever. Irritation and tingling of nose constant desire to sneeze (Pollanin).Chronic nasal catarrh; swollen nose; profuse, thick, yellow discharge; ulcers; membrane sore and excoriated. Aggravation by sneezing.
Itching on ears, nose, and in urethra. Papular eruption on face. Cold-sores on lips. Boils on neck. Barber’s itch. Acne. Lichen planus. Arms covered with itching rash. Hair feels as if erect. Obstinate skin affections, notably in barber’s itch and acne. Weeping eczema.
No itching, exudation forms into a hard, lemon-colored crust. Suppressed eruption causes brain disease. Elevated eruptions, as large as peas. Delirium, with singing, dancing and funny gestures. Everything appears strange and terrible. Confounds present with the past; feels like a child. Stupid feeling. Melancholy, with indifference. Mistrustful. Thirst; burning pressure; hiccough. Throbbing in pit of stomach, which has become raised to size of fist. Desire for unnatural things, like coal (Alum; Calc). Indigestion, with insensibility, frothing at mouth.
Antim crud., Ars-alb., Ars-iod., Jugl-c., Kali-bi., Sul-iod are the homeopathic medicines known to work best in cases of Lichen Planus.
- Harrison’s Principles of Internal Medicine, 14th ed, McGraw-Hill
- Davidson’s Principles and Practise of Medicine, 17th ed, 1996, Churchill Livingstone
- New Manual of Homeopathic Materia Medica & Repertory, William Boericke, 2nd revised ed., 2001, B. Jain