LICHEN PLANUS

• Lichen planus is a sub-acute or chronic dermatosis that involve skin, mucous membranes, hair follicles and nails. At least two third of cases occur between the ages of 30 and 60 years
• The four P’s – Purple, Polygonal, Pruritic , Papule is the abbreviation used to recall the constellation of symptoms and skin findings that characterize lichen planus. The disease has a predilection for the flexor surfaces of the forearm, legs, trunk and the genitalia including the glans penis

• The cause of Lichen planus is unknown, but several aetiologies have been proposed. It is likely that both endogenous – genetic and exogenous- environmental components such as drug or infection may interact to elicit the disease
• The prevalence of chronic liver diseases, including primary biliary cirrhosis, alcoholic cirrhosis, hepatitis B, and hepatitis C is increased
• HLA-B 8 is more common in patients with oral Lichen planus as the sole manifestation and HLA-B w 35 is more strongly associated with cutaneous lichen planus

• Lichen Planus may affect the skin, mucosa, scalp, genitalia, and nails and presents with varying symptoms. The condition is chronic and usually manifests with several relapses
• Cutaneous eruption is characterized by small, flat topped, shiny, polygonal, violaceous papules that may coalesce into plaques. The papules often show a network of white lines known as Wickham’s striae. Itching is usually pronounced and Koebners phenomenon is commonly seen
• Oral lesions of lichen planus are frequently found, either as sole manifestation of the disease or associated with cutaneous involvement. Most often consist of a lacy, reticular network of coalescent papules over the buccal or glossal mucosa
• Nails are involved in 10% cases and show roughening, longitudinal ridging, thinning and dystrophy. Pterygium formation is a frequent finding
• In Genital lichen planus, Papules are seen on glans penis or vulvovaginal area with pruritis, burning sensation and dyspareunia

Differential Diagnosis

• Classic lesions : Lichenoid drug eruption , lichen nitidus, secondary syphilis, pityriasis lichenoides
• Hyperkeratotic lesions: Lichen simplex chronicus, prurigo nodularis , Lichen amyloidosis, warts
• Linear lesions : Lichen striatus , linear epidermal naevus, linear psoriasis
• Annular lesions : Granuloma annulare, Psoriasis, secondary syphilis
• Oral lesions should be differentiated from candidiasis , apthous ulcer, Pemphigus

• Appearance of typical papule of Lichen planus is usually sufficient for diagnosis
• Dermoscopy : detection of Wickham striae
• Histopathology findings: Basal epidermal keratinocyte damage and lichenoid – interface lymphocytic reaction

Internal Medicines

• Patolamooladi Kashaya (max 6 days)
• Manjishtadi kashaya
• Drakshadi kashaya –reduces discolouration
• Sonitamritam kashaya
• Patolakaturohinyadi kashaya
• Khadirarishta + Nimbamrutasava
• Abhayarishta + Aragwadharishta
• Madhusnuhi rasayana
• Rasa sindhoora

Procedures

• Snehapana – Aragwadha mahatiktaka grita
• Virechanam with vellerugu taila / Avipathi choorna
• Aragwadhadi Takradhara
• Shashtika pinda swedam – Normalize skin texture
• Patolamooladi choorna + shastika choorna - udgarshana
• Sudhadoorvadi keram - ext application
• Neeli tailam - ext application
• Ayyapala taila - ext application
• Eladi choorna udwartana
• Yashti + Triphala gharshana
• Gugguulu marichadi – ext application