Case Studies: Lichen Planus

Patient Name: Mr. DN

Age: 61 yrs

Presenting complaints

• Dry skin lesions in association with itching mainly on upper and lower B/L extremities 7 years

• Reddish, sand-like rashes throughout out the body

• Scaly lesions on plantar and palmar areas. 

HISTORY OF PRESENTING COMPLAINTS:

A 61-year-old male, complaining of dry skin lesions in association with itching mainly on upper and lower B/L extremities. The condition started in 2015 as white patches on the elbow, pinna, and knee associated with itching and a dusty, scaly appearance. Consulted and took allopathic treatment for the same. Gradually the symptoms got reduced but not cured completely; from 2015 to 2018, he continued the medication. During that time, the symptoms were fewer. Later on in 2019, he took Ayurvedic treatment, including internal purification, internal medications, and external applications. From that he got much relief, and he continued the medications. From JULY 2021 he stopped all medications, and the symptoms were fewer but not completely cured. The condition flared up in December 2022.

VITAL PARAMETERS

BP -120 /80 MM HG                           HT – 170 KM

PR -72 /MIN                                         WT -80.5 KG

DIET – VEGETARIAN

EXERCISE – WALKING

APPETITE—GOOD

MICTURITION – REGULAR

BOWEL – REGULAR

SLEEP–SOUND

GENERAL EXAMINATION

 GAIT – NORMAL

 GENERAL CONDITIONS – NORMAL

 CARDIOVASCULAR SYSTEM – S₁S₂ HEARD

 CENTRAL NERVOUS SYSTEM: INTACT, ORIENTATION

 RESPIRATORY SYSTEM – AEBE, NVBS HEARD

 PER ABDOMINAL – WNL, NO ORGANOMEGALY

CLINICAL EXAMINATION : INTEGUMENTARY SYSTEM

• INSPECTION

LOCATION – B / L LIMBS (UPPER & LOWER ) TRUNK

DISTRIBUTIONS – SYMMETRICAL , NO SPECIFIC PATTERN

COLOR – REDDISH TO BLACK

SHAPE AND SIZE – SMALL PAPULE TO MACULE IN SIZE

BORDER – POPULAR RASHES , ROUND AND WELL SHAPED

• PALPATION

TENDERNESS – NIL

 SURFACE TEXTURE – ROUGH

 SCALING –  + +

 ELEVATION – PALPABLE  

 MILD ERYTHEMATOUS

• SPECIFIC FOR RASH DESCRIPTION:

 EXCORIATION  + +

EROSION – ABSENT

WEEPING – MILD

CRUSTING – MILD, SCALY

BLOOD VESSELS NOT VISIBLE

ODOUR – NO FOUL SMELL 

• DARAVIDHA PAREEKSHA

PRAKURTI: VATA – KAPHA

VIKRUTHI: VATA –KAPHA

DUSTYA: RASA RAKTHA MAMSA

SARAM: TWAK SARAM

SAMHANANAM: PRAVARAM

PRANAMANA: PRAVARAM

SATHMYA: MADHYAMAM

SATHWA: MADHYAMAM

AHARASAKTHI : MADHYAMAM

ABHYAVAHARANA SAKTHI : MADHYAMAM

JARANA SAKHTHI : MADHYAMAM

VYAYAMA SAKHTHI – AVARAM
 VAYA –VARDHAKHYAM

PRAMANA – MADHYAMAM 

• ASTHAVIDHA PARIKSHA :

NADI – SADHARANA                                  SABDA – SPASHTAM

MALA – SADHARANA                                SPARSHA – ANUSHNASEETHAM  

MUTRA – SADHARANA                            DRIK –ANAVILAM

JIHWA – NIRLIPTHAM                             AKURTHI  – MADHYAMAM 

• NIDHANA PANCHAKA:

AHARA – MITHYA AHARAM , VIRUDHAHARAM

VIHARAM – DIVASPURNAM , ALPAVGAYAM

PURVARUPA, KHARASPARSHAM, VIVARNATHA , KANDU , ROUKSHYAM

RUPAM – SWETHA TAMRA VARNAM , MORE ON UPPER BODY RUKSHAM AND SCALY.

UPARAYAM – SNEHAM (ABHAYAGAM)

ANUPASAYAM – RUKSHANAM

• SAMPRAPTI GHATAKA

DOSHA – KAPHA, VATA

DUSHYA: TWAK, RASA, RAKHTHA & MAMSA

AGNI – DATHWAGNI , JATARAGNI

AMA-SAMA

SROTHAS – RASA, RAKTHA MAMSA  & ANNAVAHA

SROTHODUSHTIPRAKARA – ATIPRAVARTHI , SANGAM

SADHYASADHYATHA – YAPYAM

SAMPRAPTHI FLOW CHART

                                 Mithyahara – Viharam

                                                       ↓

                                     Vata –Kapha Duthi

                                                       ↓

                                     Sarvasareeragatham

                                                       ↓  

                          Twak, Raktha, Mamsa, dhatu dusthi
                                                       ↓ ( SROTORODHA )

                                              Kledotpathi

                                                       ↓

                                       Kandu, Kota, Raga

DIAGNOSIS

                     Sidhmam (Ayurveda)

                     Lichen Planus (Modern)