Dr Divya K S
ABSTRACT
Lichen planus is a chronic inflammatory disorder affecting the skin and is clinically recognized by the presence of intensely pruritic, violaceous and flat-topped papules or plaques. The condition may persist for prolonged periods and can significantly affect a patient’s comfort and daily activities.
A 35-year-old male presented with a one-year history of severe itching associated with skin eruptions involving the back, upper limbs and lower limbs. The lesions were dry, violaceous and hyperpigmented. A marked aggravation of itching and eruptions was observed following consumption of meat, whereas application of cold water over the affected areas provided relief. The patient also exhibited prominent emotional characteristics, particularly violent anger and marked disappointment when unable to accomplish his desired goals. He was chilly thermally and had a desire for non-vegetarian food.
After detailed case taking, symptom evaluation and repertorial analysis, Bryonia alba was selected as the indicated homoeopathic medicine. Bryonia alba 200 was administered in three doses at an interval of three days, followed by placebo. During follow-up, there was progressive reduction in itching, cessation of new eruptions and flattening of the previously active lesions. At the subsequent follow-up, the patient reported complete disappearance of itching and no further development of eruptions, with considerable fading of the residual pigmentation and improvement in the texture of the affected skin.
KEYWORDS: Lichen planus, pruritus, cutaneous eruption, Bryonia alba, homoeopathy, case report.
CASE REPORT
A 35-year-old male businessman attended for consultation with complaints of severe itching and skin eruptions involving the upper limbs, lower limbs and back for approximately one year. The itching was intense, and the eruptions were described as dry, violaceous and hyperpigmented.
A significant aggravation of the complaints was noticed after consumption of meat. The patient obtained temporary relief when the affected areas were washed with cold water.
HISTORY OF CHIEF COMPLAINT
The skin complaints initially appeared as small, intensely itchy lesions over the lower limbs. Gradually, the eruptions extended to the arms and back and became darker and rougher in appearance.
The severity of itching and the eruptions increased considerably after eating meat. Washing the affected areas with cold water provided temporary relief.
The onset of the skin condition occurred during a period characterized by considerable emotional stress and disappointment associated with failure to achieve professional targets.
PAST HISTORY
The patient had a previous history of recurrent digestive disturbances and gastric hyperacidity.
He had already undergone allopathic treatment for the skin complaints but reported no significant improvement following the treatment.
FAMILY HISTORY
- Father: Hypertension and coronary artery disease; receiving allopathic treatment.
- Mother: History of chronic skin complaints diagnosed as allergic dermatitis; had received allopathic treatment.
- Others: Apparently healthy.
PERSONAL HISTORY
- Diet: Mixed
- Appetite: Adequate
- Thirst: Adequate
- Desire: Non-vegetarian food
- Aversion: Not specified
- Micturition: 5–7 times/day
- Bowel: Once daily
- Perspiration: Generalized
- Sleep: Refreshing
- Thermal state: Chilly
LIFE SPACE INVESTIGATION
The patient was described as an ambitious and stubborn individual who had a strong inclination towards achievement from childhood. He disliked failure and experienced considerable frustration whenever he was unable to accomplish a particular task or target.
As he grew older, his ambitious nature became closely associated with his professional life. He worked hard and was particularly concerned about financial stability and professional success. Business losses, failure to reach targets and unexpected difficulties were followed by disappointment, irritability and episodes of violent anger.
His temperamental characteristics were also evident in his family life. Disturbances in his usual routine or unexpected changes in family plans made him irritable and could lead to anger.
The skin complaints developed during a period of significant emotional strain and disappointment concerning unmet professional expectations.
LOCAL EXAMINATION
The skin examination revealed multiple extensive violaceous and hyperpigmented papules with a flat-topped appearance and lichenified plaques. The lesions were distributed over the upper limbs, lower limbs and back. Evidence of repeated scratching, diffuse scaling and post-inflammatory hyperpigmentation was present.
ANALYSIS OF SYMPTOMS
Common Symptoms
- Eruptions involving the extremities and back
- Severe itching
- Hyperpigmented skin lesions
Uncommon Symptoms
- Violent anger
- Disappointment following failure to achieve goals
- Aggravation after eating meat
- Relief from washing with cold water
- Chilly thermal state
EVALUATION OF SYMPTOMS
Mental Generals
- Violent anger on provocation or during stress
- Disappointment when unable to accomplish goals
Physical Generals
- Chilly patient
- Desire for non-vegetarian food
- Complaints aggravated by meat
Particulars
- Dry, violaceous and hyperpigmented eruptions
- Severe itching
- Eruptions over upper limbs, lower limbs and back
- Relief from washing the affected parts with cold water
PROVISIONAL DIAGNOSIS
Generalized Cutaneous Lichen Planus – Exanthematous/Generalized Type
The clinical diagnosis recorded in the case was cutaneous lichen planus, based on the characteristic appearance and distribution of the lesions.
DIFFERENTIAL DIAGNOSIS
The following conditions were considered in the differential diagnosis:
- Psoriasis vulgaris – Typically presents with well-defined erythematous plaques and silvery scales.
- Lichen simplex chronicus – Characterized by thickened skin resulting from persistent scratching.
- Papular eczema/Atopic dermatitis – May present with intense itching, excoriation and lichenification.
INVESTIGATIONS
- Skin biopsy: For histopathological assessment.
- Complete blood count: To assess for eosinophilia or evidence of systemic inflammation.
REPERTORIAL TOTALITY
- Mind – Anger – violent
- Mind – Ailments from – disappointment
- Generals – Food and drinks – meat – desire
- Generals – Food and drinks – meat – aggravation
- Extremities – Eruptions – lower limbs
- Extremities – Eruptions – upper limbs
- Back – Eruptions
- Skin – Eruptions – itching
DIFFERENTIAL REMEDIAL DIAGNOSIS
The remedies considered during the clinical and repertorial analysis were:
- Bryonia alba
- Causticum
- Lycopodium
- Natrum muriaticum
BASIS OF PRESCRIPTION
Following analysis of the characteristic symptoms and repertorial totality, Bryonia alba was selected as the final remedy.
Rx
- Bryonia alba 200 – 3 doses, one dose once in 3 days
- Placebo – 2 dram 4-4-4
DISCUSSION
The present case represents a chronic dermatological condition in which the patient’s individual characteristics were considered along with the local manifestations. The analysis did not rely solely on the appearance of the skin lesions; particular attention was given to the associated mental and general features and the modalities of the complaint.
The characteristic features included violent anger, disappointment associated with failure to achieve goals, a chilly thermal state, desire for non-vegetarian food, aggravation following consumption of meat and relief from cold-water washing.
These features, together with the distribution and nature of the eruptions, formed the basis for constructing the prescribing totality. Repertorial analysis resulted in a differential remedial consideration of Bryonia alba, Causticum, Lycopodium and Natrum muriaticum. Bryonia alba was subsequently selected as the final remedy according to the documented case analysis.
Following the prescription, the recorded follow-ups demonstrated progressive clinical improvement. Initially, itching decreased and new eruptions ceased. Subsequently, the active lesions flattened, followed by marked improvement in pigmentation and skin texture.
As this report describes a single patient and does not contain documented investigation results or a control comparison, the observed clinical improvement should be interpreted cautiously. A single case cannot establish the efficacy or causal effectiveness of a particular treatment. Further properly designed clinical research would be required to evaluate this observation.
CONCLUSION
This case illustrates the application of individualized homoeopathic case analysis in a patient presenting with generalized cutaneous lichen planus and severe pruritus.
The prescribing totality was constructed from the patient’s characteristic mental, general and particular symptoms. Bryonia alba 200 was selected following repertorial and clinical evaluation.
The documented follow-up showed progressive improvement, including reduction and eventual cessation of itching, absence of new eruptions, flattening of active lesions and marked improvement in post-inflammatory pigmentation and skin texture.
This case highlights the importance of comprehensive case taking, identification of characteristic symptoms, repertorial analysis and systematic follow-up in the evaluation of chronic clinical cases.
DECLARATION OF PATIENT CONSENT
The supplied case record does not contain a separately documented statement of patient consent. Appropriate written informed consent should be obtained before publication of the case and any clinical photographs.
CONFLICT OF INTEREST
No conflict of interest is documented in the supplied case record.
REFERENCES
- DermNet NZ. Lichen planus. Provides information on clinical features, distribution, diagnosis, differential diagnosis and course of cutaneous lichen planus.
DermNet NZ – Lichen Planus - Arnold DL, Syed HA, Krishnamurthy K. Lichen Planus. StatPearls. Updated October 29, 2024. Covers clinical presentation, diagnosis, histopathology, differential diagnosis and management.
NCBI Bookshelf – Lichen Planus - Solimani F, Forchhammer S, Schloegl A, Ghoreschi K, Meier K. Lichen planus – a clinical guide. Journal of the German Society of Dermatology. 2021;19(6):864–882. This is a peer-reviewed clinical review of lichen planus.
PubMed – Lichen planus: a clinical guide - Gorouhi F, Davari P, Fazel N. Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk factors, diagnosis, and prognosis. ScientificWorldJournal. 2014;2014:742826.
PMC – Full-text article - Apgar B, et al. Diagnosis and Treatment of Lichen Planus. American Family Physician. Discusses diagnosis, biopsy, differential diagnosis and treatment of lichen planus.
American Family Physician – Diagnosis and Treatment of Lichen Planus
Dr Divya K S
Email : divyashivanna1@gmail.com
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