Lichen Planus
Lichen Planus is a chronic inflammatory and immune –mediated disease , that affects the skin , nails and mucous membranes . This condition is characterized by Polygonal , flat –topped , violaceous papules and plaques with overlying , reticulated , fine white scales , commonly affecting dorsal hands , flexural writs and forearms , trunk , Anterior lower legs and oral mucosa.
There is a broad clinical range of this, the skin and oral cavity remain as the major sites of involvement .The cause is unknown , but it is thought to be the result of an autoimmune process with an unknown initial trigger.
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 through out the body
- Scaly lesions on plantar and palmar areas.
HISTORY OF PRESENTING COMPLAINTS :
A 61 years old male , complaining of Dry skin lesions in association with itching mainly on upper and lower – B /L extremities.The condition started from 2015 as white patches on elbow , pinna and knee associated with Itching and 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 less. Later on 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 less , but not completely cured. The condition got flared up on December 2022.
VITAL PARAMETERS
BP -120 /80 MM HG HT – 170 KM
PR -72 /MIN WT -80.5 KG
DIET – VEGETERIAN
EXERCISE – WALKING
APPETITE –GOOD
MICTURITION – REGULAR
BOWEL – REGULAR
SLEEP- SOUND
GENERAL EXAMINATION
GAIT – NORMAL
GENERAL CONDITIONS – NORMAL
CARDIO VARCULAR 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
- COLOUR – REDDISH TO BLACK
- SHAPE AND SIZE – SMALL PAPULE TO MACULE IN SIZE
- BORDER – POPULAR RASHES , ROUND AND WELL SHAPED
PALPATION
- TENDERNES – NIL
- SURFACE TEXTURE – ROUGH
- SCALING – + +ELEVATION – PALPABLE
- MILD ERYTHEMTOUS
SPECIFIC FOR RASH DESCRIPTION :
- EXCORIATION + +
- EROSION – ABSENT
- WEEPING – MILD
- CRUSTING – MILD, SCALY
- BLOOD VESSELS NOT VISIBLE
- ODOUR – NO FOUL SMELL
DARAVIDHA PAREEKSHA
- PRAKRUTI: 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 :
NIDANA: 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
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 )
TREATMENTS GIVEN
Here we had given 14 days of in Patient treatments with internal medication and external therapies along with pathya ahara .
DAY | DATE | TREATMENTS GIVEN |
1 | 01/01/2023 | CHOORA PINDA SWEDAM -RUKSHAM |
2 | 02/01/2023 | DHANYMLADHARA- RUKSHAM DHANYAMLA PINDA SWEDAM – RUKSHAM |
3 | 03/01/2023 | DHAYAMLADHARA (RUKSHAM) DHANYAMLA PINDA SWEDAM (RUKSHAM) |
4 | 04/01/2023 | ABHYANGAM WITH CHEMPARATHYADI + ELADI + PATOLA KERA GHRITHAM SNEHAPANAM WITH MAHATHIKTHAKA GHRUTHAM (40 ML ) D 1 TAKRADHARA ( LEGS ) – TRIPHALA |
5 | 05/01/2023 | ABHYAGAM SNEHAPANAM WITH MAHATHIKTHAKA GHRITHAM : 80 ML TAKRADHARA LEGS ( D 2 ) |
6 | 06/01/2023 | ABHYAGAM SNEHAPANAM WITH MAHA THIKTHAKA GHRITHAM: 150 ML TAKRADHARA LEGS (D 3) |
7 | 07/01/2023 | ABHYANGAM SNEHAPANAM WITH MAHATIKTHAKAGHRITHAM: 150 ML TAKRADHARA ( UPPER BODY ) (D 4) |
8 | 08/01/2023 | ABHYAGAM SNEHAPANAM WITH MAHATIKTHAKAMGHRITHAM: 150 ML TAKRADHARA ( UPPER BODY ) D 5 SWEDANAM |
9 | 09/01/2023 | VIRECHANAM WITH AVIPATHI CHURNAM ( 40 GRAM ) IN WARM WATER PADABHYANGAM |
10 | 10/01/2023 | ABHYANGAM + NADI SWEDAM ( ELADI AVOIDED AS THERE IS DRYNESS) ANUVASAN VASTHI WITH NIMBAMRITHADI ERANDAM-100 ML D1 TAKRADHARA ( UPPER BODY ) D 6 |
11 | 11/01/2023 | TAKRADHARA (D 1) FULL BODY ANUVASAN VASTHI WITH NIMBAMRITHADI ERANDAM:100 ML (D 2) PADABHYANGAM |
12 | 12/01/2023 | TAKRADHARA (D2) FULL BODY ANUVASAN VASTHI WITH NIMBAMRITHADI ERANDAM :100 ML (D 3) PADABHYAGAM |
13 | 13/01/2023 | KASHAYA VASTHI (D1) MADHU- 75 GRAM SAINDHAVAM- 10 GRAM MAHATHITHAKA GRITHAM- 75 ML SATHAPUSHPA KALKAM -15 GRAM ERANDAMOOLAM KASHAYA – 300 ML MADHNAPHALA CHURNA- 5 GRAM THAKRADHARA (D 3) FULL BODY |
14 | 14/01/2023 | THAKARADHARA (D 4) FULL BODY ANUVASAN VASTHI WITH NIMBAMRITHADI ERANDAM: 100 ML ( D4) PADABHYANGAM |
15 | 15/01/2023 | ABHYANGAM WITH CHEMPARUTHYADI, PATOLA KERA GHRITHAM AND MAHATHIKTHAKAM GHRITHAM |
INTERNAL MEDICATION DURING INPATIENT STAY :
- CARDOCALM TABLET 2 BD PC ORAL
- LODHRADI CHURNAM 1 TSP AT BEDTIME WITH WARM WATER
DISCHARGE MEDICINE
- CARDOCLAM TABLECT 2 BD PC ORAL
- LODHRADI CHURNAM 1 TSP AFTER BREAKFAST
- MAHATHIKTHAKAM GHRITHAM 1 TSP ( BED TIME )
- CHYAVANAPRASAM 1 TSP ( BED TIME )
- MAHATHIKTHAKA GHRITHAM CREAM ( E / A )
- SATHADOUTHA GHRITHAM CREAM ( E /A AFTER SHOWER )
- PATOLA KERA GHRITHAM
- MAHATHIKTHAKAM GHRITHAM ( E/ A 30 MIN BEFORE SHOWER )
- CHEMPARUTHYADHI TAILAM
- AVIPATHI CHURAM 40 GRAM WARM WATER ( AFTER 1 MONTH)
AFTER 14 DAYS OF IN PATIENT TREATMENT , PATIENT HAS GOT 80 % IMPROVEMENT FROM THE SYMPTOMS . AFTER THE TREATMENTS HE WAS ADVISED TO TAKE MEDICATIONS ALONG WITH PROPER DIET AND LIFE STYLE MODIFICATIONS . AFTER 1 MONTH OF MEDICATIONS , HE WAS ADVISED TO DO SADHYOVIREHANAM WITH AVIPATHI CHURNAM AS PER THE PRESCRIBED DOSAGE .
HE FURTHER CONTINUED THE FOLLOW UP MEDICATIONS WITH STRICT DIETARY REGIMEN FOR NEXT 6 MONTHS BUT NO RECURRENCE OBSERVED.
OUTCOME SCALE
SKIN CONDITION BEFORE AND AFTER TREATMENT
NAME– MR . DN AGE & SEX – 61 YEARS , MALE
ROOM NO – DIAGNOSIS – SIDHMAM / LICHEN PLANUS
AREA | CHARACTER | ON EXAMINATION | |
ON DOA | ON DOD | ||
HEAD & FACE | REDNESS | 4 | 2 |
SCALING / PEELING | 6 | 2 | |
ITCHING | 0 | 0 | |
THICKNESS | 0 | 0 | |
TRUNK | REDNESS | 8 | 3 |
SCALING / PEELING | 6 | 3 | |
ITCHING | 8 | 4 | |
THICKNESS | 7 | 2 | |
ARMS (LEFT) | REDNESS | 8 | 3 |
SCALING / PEELING | 6 | 3 | |
ITCHING | 8 | 4 | |
THICKNESS | 7 | 2 | |
ARMS (RIGHT) | REDNESS | 8 | 3 |
SCALING / PEELING | 6 | 3 | |
ITCHING | 8 | 4 | |
THICKNESS | 7 | 2 | |
LEGS (RIGHT) | REDNESS | 8 | 3 |
SCALING / PEELING | 6 | 3 | |
ITCHING | 8 | 4 | |
THICKNESS | 7 | 2 | |
LEGS (LEFT) | REDNESS | 8 | 3 |
SCALING / PEELING | 6 | 3 | |
ITCHING | 8 | 4 | |
THICKNESS | 7 | 2 | |
After
Before
PREPARED BY :- DR AMAL PRASAD
BAMS ( MEDICAL OFFICER )
VERIFIED BY :- DR A .V . RAJEEV NAIR MD ( AYU )
( CEO & CHIEF PHYSICIAN )
