Dr Nakkala Vyshnav Dr Deepak R D
ABSTRACT:
Conventional management relies largely on topical and systemic corticosteroids, retinoids, and immunomodulators, which provide symptomatic relief but are associated with a high relapse rate and long-term side effects. Homoeopathy, working on the principle of individualization and totality of Lichen planus (LP) is a chronic, idiopathic, inflammatory dermatosis affecting the skin, mucous membranes, nails, and hair, believed to arise from a T-cell-mediated autoimmune process directed against basal keratinocytes symptoms, offers a constitutional approach aimed at addressing the underlying diathesis rather than merely suppressing the eruption. This article elaborates a case of a 42-year-old presented with diffuse, dry, rough, scaly, and intensely itching hyperpigmented and hypopigmented patches in a mottled, reticulate pattern over the flexor aspect of the right forearm extending toward the elbow, with associated lichenification. On totality of symptoms, the case was analysed using the Synthesis repertory. Sepia 200 was prescribed as the similimum on the basis of repertorial totality, with Psorinum 1M administered subsequently as an intercurrent anti-psoric remedy to address the underlying miasmatic background. The patient was followed up on two occasions, with monitoring of the itching, dryness, and pigmentary changes of the lesion. This case illustrates the applicability of individualized homoeopathic prescribing, supported by classical repertorization, in the management of cutaneous lichen planus, and highlights the role of miasmatic intercurrent prescribing in chronic dermatological conditions.
KEYWORDS: Lichen planus; Homoeopathy; Sepia; Psorinum; Individualization; Repertorization; Case report; Miasm.
INTRODUCTION:
Lichen planus is a chronic, papulosquamous, inflammatory disorder of the skin and mucous membranes of uncertain but probably immune-mediated origin, in which cytotoxic T-lymphocytes are believed to trigger apoptosis of basal keratinocytes.[1,2] It classically presents with pruritic, polygonal, planar, purple (violaceous) papules and plaques, often bearing a fine reticulate white scale referred to as Wickham’s striae, and most frequently affects the flexor surfaces of the wrists, forearms, and legs, though the oral mucosa, nails, and scalp may also be involved.[3] The reported prevalence of LP in the general population lies between 0.5% and 2%, and while it can occur at any age, the majority of cases present between the third and sixth decades of life.[4]
The exact aetiology of LP remains unestablished; proposed contributing factors include altered cell-mediated immunity, hepatitis C infection, drug reactions, dental restorative materials, and psychological stress, though no single cause has been confirmed.[1,2] Lesions tend to follow a chronic, relapsing course, and while many resolve spontaneously over months to years, they frequently leave behind residual post-inflammatory hyperpigmentation, which was a notable feature in the present case.[3]
Conventional dermatological management of LP is largely palliative, employing topical and systemic corticosteroids, antihistamines, retinoids, and calcineurin inhibitors to control inflammation and pruritus; however, recurrence after withdrawal of therapy is common.[1] Homoeopathy approaches chronic dermatological disorders such as LP not merely as a local skin condition but as an expression of the patient’s underlying constitutional and miasmatic state, and treatment is individualized on the basis of the totality of mental, general, and particular symptoms rather than the named pathological diagnosis alone.[3,5,6] Several published case reports have documented favourable responses of LP to individualized homoeopathic remedies such as Rhus toxicodendron, Natrum muriaticum, Natrum sulphuricum, Nux vomica, and Arsenicum album, selected strictly according to the totality of symptoms of each patient.[3,6,7]
This report presents a case of chronic lichen planus of the forearm in a married male, in whom the remedy Sepia was selected on the basis of pronounced mental generals and food-related modalities, supported subsequently by an anti-psoric intercurrent prescription of Psorinum, with the aim of contributing to the existing body of case-based evidence for the homoeopathic management of this condition.
CASE REPORT
CHIEF COMPLAINT: The patient presented with itchy, dry, rough, and scaly discoloured patches over the flexor aspect of the right forearm, extending toward the elbow, of insidious onset and gradually progressive course.
HISTORY OF PRESENT ILLNESS:
The eruption began insidiously, roughly two years and eruption were small, dry, roughened patches over the forearm, which gradually increased in number and extent to form the present diffuse, mottled, hyperpigmented and hypopigmented lesion with a reticulate pattern. The lesion is associated with persistent, often intense itching, which the patient reports as the most distressing symptom, at times disturbing his sleep. No history of primary oozing, blistering, or pustulation was elicited at any stage. The patient specifically notes a marked aggravation of the itching and eruption following the consumption of mutton, as well as aggravation from friction and repeated handling of cloth material at his showroom and from prolonged standing during business hours. The complaints are relieved to some extent on rest and after lying quietly at home in the evening. There is no associated involvement of the oral mucosa, nails, or scalp at the time of presentation.
PAST HISTORY: History of an episode of typhoid fever in childhood, approximately 30 years prior to the present consultation, treated conventionally at that time with an uneventful recovery. No other significant past illness, hospitalization, or surgical history was reported.
FAMILY HISTORY:
The patient belongs to a family traditionally engaged in the cloth and garment business for more than two generations. No family history of lichen planus, psoriasis, atopic dermatitis, or other chronic dermatological or systemic illness was elicited at the time of case-taking.
MENTAL GENERALS:
On detailed case-taking, the following mental generals were elicited: marked irritability, aggravated by consolation or interference; a lifelong aversion to company with a distinct desire to be left alone, dating back to childhood; pronounced anxiety concerning the future and the stability of his business; and a tendency to constantly think and talk about his business affairs, even during conversations unrelated to work. These mental generals were given the highest priority in totality formation, in keeping with the homoeopathic principle of individualization.
REPERTORIAL TOTALITY:
The following rubrics were selected from the Synthesis repertory for case analysis, drawn from the mental generals, physical generals, and local particulars of the case:
- Mind – Irritability
- Mind – Company – aversion to; desire to be alone
- Mind – Consolation – agg.
- Mind – Anxiety – future, about
- Mind – Business – talks of / thoughts of business, absorbed in
- Mind – Children – aversion to play, indisposed to play with others
- Generalities – Food and drinks – meat – agg.
- Generalities – Thirst – large quantities, for; long intervals, at
- Generalities – Motion – agg.
- Generalities – Rest – amel.
- Skin – Eruptions – itching
- Skin – Discoloration – brown/dark spots
- Skin – Dryness
- Extremities – Eruptions – forearm
- Extremities – Eruptions – itching – forearm
REPERTORIAL ANALYSIS:
Repertorization was carried out using the Synthesis repertory. On analysis, Sepia emerged as the clear leading remedy, scoring highest No other remedy in the comparative chart covered as wide a span of the mental, general, and particular rubrics simultaneously, which gave Sepia the highest individualizing value and confirmed it as the similimum for this case.
CONCLUSION:
This case of chronic lichen planus of the forearm in a 42-year-old male responded to individualized homoeopathic treatment based on the totality of mental, general, and particular symptoms, with Sepia as the indicated similimum and Psorinum as an anti-psoric intercurrent remedy. The case adds to the existing case-based literature supporting the role of classical, individualized homoeopathy in the management of chronic dermatological conditions, while underscoring the continued need for well-designed comparative and follow-up studies in this area.
CONSENT:
Written informed consent was obtained from the patient for the publication of this case report and the accompanying clinical images.
REFERENCES:
- Boorghani M, Gholizadeh N, Taghavi Zenouz A, Vatankhah M, Mehdipour M. Oral lichen planus: clinical features, etiology, treatment and management; a review of literature. J Dent Res Dent Clin Dent Prospects. 2010;4(1):3–9.
- Zisis V, Giannakopoulos NN, Schmitter M, Poulopoulos A, Andreadis D. A novel approach to differentiating erosive and reticular lichen planus based on the percentage of dental surfaces with metal restorations. Cureus. 2023;15(9):e44782.
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- Lamba C, Mahajan N, et al. Lichen planus, an autoimmune disease, treated using homoeopathic medicine: an evidence-based case report. J Integr Stand Homoeopathy. 2024.
- Singh R, Tiwari HS, Mewara S. A case report of lichen planus treated with homoeopathic medicine – Rhus toxicodendron. Int J Homoeopathic Sci. 2024;8(1):331.
- Boericke W. Boericke’s New Manual of Homoeopathic Materia Medica with Repertory. 3rd rev ed. New Delhi: B. Jain Publishers; 2007.
- Hahnemann S. Organon of Medicine. 6th ed. Translated by Boericke W. New Delhi: B. Jain Publishers; 2002.
[Author: NAKKALA VYSHNAVI]¹, [Co-author: DR. DEEPAK R D]²
Undergraduate Scholar, Professor and Guide, Department of Human Anatomy, Alva’s Homoeopathic Medical College and Hospital, Moodbidri, Karnataka, India.
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