Lichen Planus

Lichen Planus

Lichen Planus

AYURVEDIC PERSPECTIVE OF LICHEN PLANUS 
Ayurveda considers digestion to be the primary factor in the pathology of disease. In the case of psoriasis, a compromised digestive system leads to an increase of pitta dosha into rasa dhatu. Pitta dosha is an ayurvedic principle of physiology representing the energy of transformation in the body. Rasa dhatu is the first tissue created from the process of digestion and is akin to plasma, serum, white blood cells and the lymphatic system.

VITIATION OF DOSHA IN LICHEN PLANUS
Lichen Planus is caused by vitiation of Vata and Kapha dosha. The vitiated doshas affect the skin and blood tissues. They also influence water element of the affected region on skin. Thus the skin which is influenced by affected doshas becomes discolored (Violet ), scaly and thin.
with new mature skin cells.
 According to ayurveda principles the vitiated vata dries the water element of skin and also initiate rapid growth of skin tissue. The vitiated Kapha dosha causes itching on the affected skin. The blood which is affected by vata and kapha adversely influences healing process

AYURVEDIC TREATMENT OF LICHEN PLANUS 
In treating  lichen planus, ayurveda recommends a comprehensive treatment strategy that involves strengthening your digestion and detoxifying and eliminating toxins. Addressing your diet, and not only how you eat, but also when and what, is important. Herbal formulas support digestion and aid in the detoxifying process.

Ayurvedic treatment of lichen planus  aims to rid the body of accumulated toxins. Ayurveda's primary purification and detoxification method is a process known as panchakarma, which uses a combination of therapies to cleanse the body and balance the doshas. Panchakarma may include therapeutic vomiting, purgation, enema therapy and nasal cleansing, as well as the use of medicated oils and steam baths. After the detoxification process, patients undergo a period of rest that may involve a special diet

THE AYURVEDIC HERBS AND MINERALS USED FOR LICHEN PLANUS ARE ::
Arogyavardhini vati   Mahamanjishthadi Qwath     Khadriarishta           Neem
Gandhak Rasayan     Saariva         Manjishta       Karanj          Tulasi  Haridra
Daruharidra   Chirayata       Vacha           Panchatikt Ghrit Guggulu     
Kaishore Guggulu     
Neem-Karanj Oil       Bakuchi Oil     Mahamarichyadi oil    chandanide Oil

MODERN CONCEPT OF LICHEN PLANUS

  • Lichen planus is a chronic recurrent rash that is due to inflammation. The rash is characterized by small, flat-topped, many-sided (polygonal) bumps that can grow together into rough, scaly plaques on the skin. There may also be a rash in the lining (mucous membranes) of the mouth or vagina.
  • Lichen planus is a very curious and poorly understood skin condition. Its name is descriptive in that to some it resembles a simple plant, a lichen, that grows on rocks and tree bark, while planus is Latin for flat.
  • Lichen planus is a chronic recurrent rash of unknown cause with no established cure.
  • Lichen planus generally affects adults and can involve any portion of the body, but it has a predilection for the wrists, ankles, and oral and genital tissues.
  • Lichen planus can be quite itchy.
  • Lichen planus may spontaneously resolve.
  • Lichen planus is managed with a variety of Ayurvedic Herbs & Panchakarma Therapies

CAUSES OF LICHEN PLANUS

  • It is  known as immune system disorder , so the cause is unknown.
  • Patients with extensive lichen planus seems to be more likely to have Hepatitis C virus infection of the liver.
  • Some drugs that contains Arsenic , Bismuth  may produce an eruptio which appears identical to lichen planus.
  • Long term use of medications like Quinacrine or Quinidine ( Quinidine Gluconate , Quinidine Sulfate ) , which are anti-malarial.
  • Certain microscopic organisms and worms may produce hypertrophic Lichen Planus of the lower legs and other skin and systemic disturbances.
  • Lichenoid eruptions may occur in graft Versus Host disease in the patients who have received bone marrow transplant.

CLASSICAL FEATURES OF LICHEN PLANUS

  • Classical Lichen Planus is shiny , flat topped , firm papules varying from pin point size to larger than acentimeter.
  • They are purple coloured and pften are crossed by fine white lines called “Wickham’s Striae”.
  • They may be closed together or widespread or grouped in lines or rings.
  • It is very itchy most of the the time but it may be symptomless sometimes.
  • Lichen planus may affect any area but the most common areas are front of the wrists , lower back and ankles.
  • New lesions may appear while others are clearing. As the papules of Lichen planus gets clear they are often replaced by areas of greyish brown discolouration , especially in darker skinned people. This is known as post inflammatory hyperpigmentation and can persist for months.

THE COMMON LICHEN PLANUS DISORDERS ARE
Oral Lichen Planus 
When lichen planus affects the mouth, it most commonly causes the appearance of small blue-white spots, which may be tender or mildly painful. They are typically found on the sides of the tongue or the insides of the cheek, though in rare cases they can appear on the gums. The skin lesions usually occur in lines and form a small lacy network, which can cause some mild enlargement of the affected area. Oral lichen planus is associated with an increased risk of developing oral cancer.
Lichen planus pigmentosus
In some patients oval greyish brown marks appear on the face and neck or trunk and limbs without an inflammatory phase. It may be the same or similar to erythema dyschromicum perstans. A skin biopsy reveals lichenoid features,which are absent in a similar condition called idiopathic macular pigmentation.
 Vulval lichen planus 
As in the mouth, lichen planus may cause painless white streaks.

Lichen Sclerosus
Lichen sclerosus is the medical term used to describe chronic inflammation of the skin, usually of the sex organs and the anus. Lichen sclerosus (LIKE-in skler-O-sus) is a skin disorder that can affect men, women, or children, but is most common in women. It usually occurs on the vulva (the outer genitalia or sex organ) in women, but sometimes develops on the head of the penis in men. Occasionally, lichen sclerosus is seen on other parts of the body, especially the upper body, breasts, and upper arms
Lichen simplex chronicus
Hyperpigmented, lichenified plaque with accentuated skin lined caused by repeated rubbing of the area. Lichen simplex chronicus (LSC) is a localized, well-circumscribed area of lichenification (thickened skin) resulting from repeated rubbing, itching, and scratching of the skin. It can occur on normal skin of individuals with atopic, seborrheic, contact dermatitis, or psoriasis.
Erosive lichen planus
Affects the labia minora (inner lips) and introitus (entrance to the vagina). The  affected mucosa is bright red and raw. The labia minora can shrink and stick to each other or to the labia majora (the outer lips). Erosive lichen planus can be very painful, preventing sexual intercourse. It can also scar, closing over the vagina.
Vaginal lichen planus
Sometimes lichen planus affects deeper within the vagina where it causes     desquamative vaginitis. The surface cells in the vagina peel off and cause a mucky discharge. The eroded vagina may bleed easily on contact.
Penile lichen planus
Classical papules are the most common form of lichen planus on the penis and mostly occur in a ring around the glans (the tip of the penis). White streaks and erosive lichen planus are much less common on the penis.
Other mucosal sites 
Erosive lichen planus uncommonly affects the eyelids, external ear canal, oesophagus, larynx, bladder and anus.

Lichen planopilaris
Follicular lichen planus, also known as lichen planopilaris, results in tiny red spiny papules around a cluster of hairs. Rarely, blistering occurs in the lesions. Permanently bald patches may develop
Lichen planus of the nails 
Lichen planus affects one or more nails in 10% of cases, sometimes without involving the skin surface – if all nails are abnormal and nowhere else is affected it is called twenty nail dystrophy. The nail plate tends to thin and may become grooved and ridged. The nail may darken, thicken up or lift off the nail 
Lichen planus of the nails
Lichen planus affects one or more nails in 10% of cases, sometimes without involving the skin surface – if all nails are abnormal and nowhere else is affected it is called twenty nail dystrophy. The nail plate tends to thin and may become grooved and ridged. The nail may darken, thicken up or lift off the nail bed (onycholysis). Sometimes the cuticle is destroyed and forms a scar (pterygium). The nails may shed, stop growing altogether and rarely, completely disappear.
Actinic lichen planus 
Actinic lichen planus only affects sun exposed sites such as face, neck and the backs of the hands.
Bullous lichen planus
Bullous lichen planus is rare; blisters appear within lichen planus papules or by themselves, generally on the lower legs.
Skin Cancer
Longstanding erosive lichen planus may result in skin cancer like Squamous cell carcinoma of the mouth –oral cancer- , vulva – vulvar cancer-, and penis – penile cancer-. This should be suspected if there is an enlarging lump or an ulcer with thickened edges. Cancer from other forms of lichen planus is rare.
List Of Cutaneous (Skin) Conditions - Lichenoid Eruptions

  • Annular lichen planus
  • Atrophic lichen planus
  • Bullous lichen planus (Vesiculobullous lichen planus)
  • Erythema dyschromicum perstans (Ashy dermatosis, Dermatosis cinecienta)
  • Hepatitis-associated lichen planus
  • Hypertrophic lichen planus (Lichen planus verrucosus)
  • Idiopathic eruptive macular pigmentation
  • Inverse lichen planus
  • Keratosis lichenoides chronica (Nékam's disease)
  • Kraurosis vulvae
  • Lichen nitidus
  • Lichen planus actinicus (Actinic lichen niditus, Actinic lichen planus, Lichen planus atrophicus annularis, Lichen planus subtropicus, Lichen planus tropicus, Lichenoid melanodermatitis, Lichenoid melanodermatosis, Summertime actinic lichenoid eruption)
  • Lichen planus pemphigoides
  • Lichen planus pigmentosus
  • Lichen planus–lichen sclerosus overlap syndrome
  • Lichen ruber moniliformis
  • Lichen sclerosus (Lichen sclerosus et atrophicus)
  • Lichen striatus (Blaschko linear acquired inflammatory skin eruption, Linear lichenoid dermatosis)
  • Lichen verrucosus et reticularis
  • Lichenoid trikeratosis
  • Lichenoid dermatitis
  • Lichenoid reaction of graft-versus-host disease
  • Linear lichen planus
  • Peno-gingival syndrome
  • Ulcerative lichen planus
  • Vulvovaginal gingival syndrome
  • Vulvovaginal lichen planus
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