International Journal of Homoeopathic Sciences 2024; 8(3): 93-99

E-ISSN: 2616-4493
P-ISSN: 2616-4485
www.homoeopathicjournal.com Homoeopathic approach to lichen planus: A
IJHS 2024; 8(3): 93-99
Received: 17-05-2024 case report
Accepted: 25-06-2024

Dr. Kalika Adhikrao Devakate Dr. Kalika Adhikrao Devakate

(1) M.D (Hom), Professor and
Head of Department,
Department of Homoeopathic DOI: https://doi.org/10.33545/26164485.2024.v8.i3b.1202
Materia Medical at K.E.S.
Chandrakant Hari Keluskar Abstract
Homoeopathic Medical Aim is to study the effectiveness of Individualized Homoeopathic Medicine in management of
College, Alibag, Raigad, cutaneous Lichen Planus.Along with this to assess the patient pre-treatment & post treatment for
Maharashtra, India cutaneous lichen planus on lichen planus severity index, and to compare the pre-treatment & post-
(2) Student of PhD, treatment severity on basis of lichen planus severity index.
Homoeopathic Materia Medica
at Dr. G. D. Pol Foundation Keywords: Lichen planus, individualized homoeopathic medicine, RADAR, Thuja
Y. M. T. Homoeopathic
Medical College, Hospital &
PG Institute, Khargar, Navi
Introduction
Mumbai, Maharashtra, India Lichen planus is an inflammatory disease of skin and mucous membranes characterized by
(3) Maharashtra University of intense inflammation at the interface between epidermis/epithelium and dermis/corium.It
Health Science, Nashik, typically presents as a symmetrical eruption of itchy, flat-topped pink or purple papules or
Maharashtra, India plaques. The prevalence of cutaneous lichen planus is approximately 0.2% to 1% of adult
world wise. Women are more frequently affected than men at a ratio of 1.5:1. Most cases
develop between the ages of 30-60 years. Homeopathy provides a rapid and long lasting cure
in patients suffering from Lichen planus. Below is one such case which highlights the
importance of individualization for selecting similimum & treating the patient & not disease.

Materials and Methods

This case of Cutaneous Lichen Planus is treated with Individualized Homoeopathic
Medicines. The totality of symptoms was taken and repertorized using RADAR
Software.Lichen Planus Severity Index a New Valid Scoring System is used to assess the
severity of Cutaneous Lichen Planus pre and post treatment. Case taking according to
standard case report form proforma to form totality with special emphasis on individualizing
case.

Case Report
A 20-year-old female came in OPD with complaints of Itching with uneasiness, dryness and
erythematous, violaceous, papular eruptions over
Corresponding Author: 1. Right leg over medial side of knee since 1 week.
Dr. Kalika Adhikrao Devakate 2. Left axilla since 4 days.
(1) M.D (Hom), Professor and 3. Right & left side of abdomen since 4 days.
Head of Department,
Department of Homoeopathic
History of chief complaints
Materia Medical at K.E.S.
Chandrakant Hari Keluskar Small Papular rash with itching started on right leg one week back, day by day it goes on
Homoeopathic Medical increasing over left axilla and Right & left side of abdomen within 4 days. Now the colour of
College, Alibag, Raigad, eruptions are changing from red to bluish purple colour. Eruptions are with intense itching,
Maharashtra, India burning and dryness. Aggravation during bath, at night, after bath, Amelioration after
(2) Student of PhD,
Scratching.
Homoeopathic Materia Medica
at Dr. G. D. Pol Foundation Patient said,” At first glance I felt it as chicken pox eruption then again thought of Herpes
Y. M. T. Homoeopathic zoaster as my sister was suffered from herpes last month. This intense itching makes me feel
Medical College, Hospital & uneasy. Can’t concentrate on work, can’t sleep due to this intense itching and dryness of
PG Institute, Khargar, Navi skin. I feel better by scratching but again intense desire to scratch which makes me disturbed.
Mumbai, Maharashtra, India
Itching get worse during bath and after bath. Itching is intense at night. It should get cleared.
(3) Maharashtra University of
Health Science, Nashik, If it would have been coming and going then its ok for me but it is going on increasing day
Maharashtra, India

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by day which makes me worry. When I was in 7 th to 9th std., of father and I convinced him about my studies. After few
I had experienced a horrible fungal infection, it was so badly days he didn’t asked me about that but on that day he was so
affected. I took treatment from most of all skin specialist angry and he kicked out my Mom from home at midnight
from Panvel but didn’t get relief for 2-3 yrs. consistently, at and she went to Aunt's house that day. Next day I gathered
the last one allopathic doctor gave me five injections since some relatives and convinced my Dad, then they cooled
then felt better. But that experience was so scarring and down and Mom came back to home. But I get scared of
terrible that even after 3-4 yr. If I get some itching I went to quarreling.
that thoughts of terrible suffering, so I always remain alert Father always quarrel with Mom and this is increased since
for fungal infection and I take at most care. Daily after bath his retirement, as he is spending more time at home.”
I sit in front of fan to get dry completely then I wear cloths,
which much fear is there in my mind because of that painful General and Local examination
itching and suffering for 2-3 years of fungal infection.” 1. General examination
Built - Average built Weight - 49.20 kg Height - 5’3
Past history Gait - Normal Tongue - Moist and pink Clubbing - Absent
H/o fungal infection on back when patient was in 7 th to 9th
std. 2. Local examination
1. Eruption over right leg over medial side of knee:
Family history Total involved body surface area (BSA) calculated using
Mother, father, 1 younger sister. Wallace rule of 9 is 1%.
Mother has lichen planus on face. a. Erythematous papules, solid elevated flat topped
Father Diabetic type II. circumscribed reddish glistening lesion, less than 0.5cm
in diameter.
Personal history  Total no of lesions counted - 23
 Appetite: Good, can tolerate hunger. b. Violaceous plaque, solid violaceous flat topped, palteau
 Desire: Cravings for chocolates and salt like lesions that occupies a large surface area in
 Perspiration: Profuse comparison with its height above the normal skin level
and has diameter larger than 0.5 cm.
Location - more at covered parts  Total no of lesion counted - 07
Stain and smell - offensive smell, no stain.
Circumstances / time - only on exertion. 2. Eruption over left axilla
 Sleep: Disturbed due to itching Total involved body surface area (BSA) calculated using
 Dreams: Cats, falling from height Wallace rule of 9 is 1.5%.
 Thermals: Chilly. Has to take covering during sleep in a. Erythematous papules, solid elevated flat topped
all seasons. circumscribed reddish glistening lesion, less than 0.5cm
in diameter.
Gynaecological and Obstetric history  Total no of lesions counted - 60.
 LMP - 22 Nov 2023; Menstrual cycle - Regular with b. Violaceous papule, solid, elevated, circumscribed, flat-
interval of 28-36 days, flow for 4-5 days; Colour - topped, violaceous lesion with a glistening surface and
Bright red less than 0.5 cm in diameter. Purple, planar, polygonal,
 GPAL - G0 P0 A0 L0 pruritic papules.
 Total no of lesion counted - 12.
Life - Space including mental state c. Violaceous plaque, solid Violaceous flat topped,
(When asking about her personal life space, patient asked plateau like lesions that occupies a large surface area in
her friend to sit outside.) comparison with its height above the normal skin level
Patient said, “I’m in relationship since 5/6 yrs and we both and has diameter larger than 0.5 cm.
are running a garment shop. I am looking for all financial  Total no of lesion counted - 05.
and bank activities and he is working in shop personally.
There was a big loss in covid period, so I am worried about 3. Right side of abdomen
business and financial things related to business settlement. Total involved body surface area (BSA) calculated using
One more thing is affecting me is quarrels between parents Wallace rule of 9 is 3.37%.
and quarrelsome nature of my father. Since he has been a. Erythematous papules, solid elevated flat topped
detected diabetes, he is losing control over anger and there circumscribed reddish glistening lesion, less than 0.5cm
is always disputes and quarrels in the house. My dad in diameter.
harassing a lot to my mom on each little things. That’s  Total no of lesions counted - 50
troubling me a lot. b. Violaceous papule, solid, elevated, circumscribed, flat-
Actually my parents don’t know about my relationship or topped, violaceous lesion with a glistening surface and
else dad will give more trouble to my mom, that’s what less than 0.5 cm in diameter. Purple, planar, polygonal,
worrying me a lot. My Dad should not know about my pruritic papules.
relationship otherwise they will give much more trouble to  Total no of lesion counted - 15
my mom, and that’s affecting me a lot, Till I will not c. Violaceous plaque, solid Violaceous flat topped,
complete my education and will not be settled in our life, I plateau like lesions that occupies a large surface area in
don’t want to reveal about my relationship to my parents. comparison with its height above the normal skin level
Two months back my father got to know about my and has diameter larger than 0.5 cm.
relationship from one of my relative but we denied in front  Total no of lesion counted - 07.

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4. Left side of abdomen scared a lot with that unpleasant experience.

Total involved body surface area (BSA) calculated using
Wallace rule2 of 9 (3/4 portion of abdomen) is 3.37% Secretive
a. Erythematous papules, solid elevated flat topped When she want to answer about her relationship she asked
circumscribed reddish glistening lesion, less than 0.5cm her accompanied friend to sit outside the cabin. She doesn’t
in diameter. want to reveal the secret of her relationship neither to her
parents not to her friends, until she will be settled in her life
 Total no of lesions counted - 36 financially.
b. Violaceous papule, solid, elevated, circumscribed, flat-
topped, violaceous lesion with a glistening surface and Physical general symptoms
less than 0.5 cm in diameter. Purple, planar, polygonal,  Diarrhoea menses before.
pruritic papules.  Leucorrhoea menses after.
 Leucorrhoea yellow, water like.
 Total no of lesion counted - 12  Dreams of falling from height.
c. Violaceous plaque, solid Violaceous flat topped,  Skin eruptions suppressed.
plateau like lesions that occupies a large surface area in  Chocolate desires.
comparison with its height above the normal skin level  Salt desires.
and has diameter larger than 0.5 cm.
 Total no of lesion counted - 14 General modalities
 Skin itching worse at night.
Provisional Diagnosis
Annular Lichen Planus 2. Totality of symptoms
 Ailments from quarreling
1. Analysis and Evaluation of symptoms  Anxiety about business
Method used - Kentian method  Fear ordeals of
Mental general symptom  Secretive
 Ailments from quarreling (Since of retirement of father  Diarrhoea menses before
quarreling incidences increased in the home which is  Leucorrhoea menses after
affecting her mental peace)  Leucorrhoea yellow, water like
 Anxiety about business (since business loss in covid she  Dreams of falling from height
is worried about business and finance of business of  Skin eruptions suppressed
garment shop which she is running along with her  Skin itching worse at night
studies)  Chocolate desires
 Fear ordeals of (meaning of word ORDEAL - a severe  Salt desires.
trial or experience - a difficult and unpleasant situation
- painful to go through.) 3. Repertory used
Synthesis, treasure edition 2009v.
The experience of fungal infection which she was suffered Repertorization done by Radar Software.
for long 2-3 years and it was not responded for any
medicines and that was so painful and terrible to suffer. She

Fig 1: Repertorial Chart

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Prescription

Name of medicine with Potency Thuja 200

Thuja 200,
in 40 sized globules,
Dose and Repetition with Duration
4 pills three times a day for one days.
Followed by placebo for ten days.
Physician’s Sign, Date and Time 19/12/2023

General Management and Auxiliary measure

Don’t use any external application.

Follow-ups - Patient was followed up regularly every 10-30 days interval.

Treatment (includes Medicine with Sign with Time and

Date Symptoms and Signs
potency, Dose and Repetition) follow up plan
Itching ++,
Burning slightly reduced, Come for follow up after
28 Dec 2023 Placebo for 10 days
Bluish discoloration+, 10 days
Itching disturbs sleep.
Itching as it is. Thuja 1 M, in 40 sized globules, 4 pills tds Come for follow up after
8 Jan 2024
Bluish discoloration changed to redness. for 1 day, followed with placebo for 10 days 10 days
Itching+ reduced,
Dryness is still there.
Burning reduced much, Itching only at axilla, Come for follow up after
18 Jan 2024 placebo for 30 days
Itching only at night, 30 days
Sleep is not sound- feels body is at rest but mind is
on.
Much better for Itching and burning also,
Itching sometimes at night when any mental stress. Thuja 1 M, in 40 sized globules, 4 pills tds Come for follow up after
14Feb 2024
Since 2 days urge for stool 3-5 times per day, stool for 1 day, followed with placebo for 30 days 30 days.
consistency is normal with no weakness.
Eruptions reduced, Itching reduced, no burning.
Thuja 1 M, in 40 sized globules, 4 pills tds Come for follow up after
2oMarch 2024 Dis-colouration reduced. Physical
for 1 day, followed with placebo for 10 days 10 days.
Weakness and fatigue.
Eruptions reduced. Eruptions Slight on knee. Come for follow up after
26March 2024 Placebo 30 days
No burning, no dryness. 30 days.
Only slight discoloration. Come for follow up as
24April 2024 Placebo 10 days
No eruptions, no itching, no burning, no dryness. required.

Results

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Discussion Calculation of pre-treatment lichen planus severity

Clinical symptoms were assessed by applying Lichen Planus index
Severity Index - A New Valid Scoring System.

Table 1: Assigning a body surface area factor

Location % involvement Body surface area factor
Knee 1% 1 (1% - 20%)
Axilla 1.5% 1 (1% - 20%)
Rt. Side of abdomen
6.75% 1 (1% - 20%)
Lt. Side of abdomen

Table 2: Lesion count and percentage

EP VP VPL HP PIH Total
Knee 23 00 07 00 00 30
Axilla 60 12 05 00 00 77
Rt.side of abdomen 50 15 07 00 00 77
Lt.side of abdomen 36 12 14 00 00 62
Total Lesion counts 169 39 33 00 00 241
Total percentage of lesion counts 70.12% 16.18% 13.69% 00 00

Table 3: Assigning area involving factor (AIF)

Morphological type Lesion in percentage Area involving factor
EP 169/ 241 X 100 = 70.12% 51%- 75% = 3
VP 39/ 241X 100 = 16.18% 0%- 25% = 1
VLP 33/241 X 100 = 13.69% 0% -25% = 1
HP 00 00
PIH 00 00

Table 4: Multiplication factor (MF)  C = AIF Vp X MF Vp = 1 X 2 = 2

1. Hyperpigmented hypertrophic papules and plaque (Hp)  D = AIF Ep X MF Ep = 3 X 1= 3
-4  E = AIF PIH X MF PIH = 0 X 0 = 0
2. Violaceous Flat Plaques (Vpl) - 3
3. Violaceous flat papule (Vp) -2 Final lichen planus score index
4. Erythematous papules (Ep) - 1 (LPSI) = (A + B + C + D + E) X BSA Factor
5. Postinflammatory hyperpigmentation (PIH) - 0 = (0+ 3 + 2 + 3 + 0) X 3 = 8X3 = 24

Table 5- Final Lichen Planus severity index calculation Calculation of post-treatment lichen planus severity
 A = AIF Hp X MF Hp= 0 X 4= 0 index
 B = AIF Vpl X MF Vpl = 1 X 3 =3

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Table 1: Assigning a body surface area factor 2

Location % involvement Body surface area factor
Knee 1% 1 (1% - 20%)
Axilla 1.5% 1 (1% - 20%)
Rt. Side of abdomen
6.75% 1 (1% - 20%)
Lt. Side of abdomen

Table 2: Lesion count and percentage

EP VP VPL HP PIH Total
Knee 00 00 00 00 18 18
Axilla 00 00 00 00 25 25
Rt.side of abdomen 00 00 00 00 50 50
Lt.side of abdomen 00 00 00 00 33 33
Total Lesion counts 00 00 00 00 126 126
Total percentage of lesion counts 00 00 00 00 100

Table 3: Assigning area involving factor (AIF)

Morphological type Lesion in percentage Area involving factor
EP 00 00
VP 00 00
VLP 00 00
HP 00 00
PIH 100 76 % - 100 % = 4

Table 4 - Multiplication factor (MF) also attached, which shows marked improvement of
 Hyperpigmented hypertrophic papules and plaque (Hp) symptoms after the course of treatment.
-4 Pre & Post treatment analysis was done using Lichen Planus
 Violaceous Flat Plaques (Vpl) - 3 severity index score. For determining the casual attribution
 Violaceous flat papule (Vp) -2 of clinical outcome after Homoeopathic intervention.
 Erythematous papules (Ep) - 1 Pre-treatment score was 24 and Post treatment score was 00,
 Postinflammatory hyperpigmentation (PIH) - 0 it suggesting the possible association between the medicine
& the outcome, & this indicates positive role of
Table 5 - Final lichen planus severity index calculation individualized role of homoeopathic medicine which was
 A= AIF Hp X MF Hp = 0 X 4= 0 exact simillimum for the patient.
 B= AIF Vpl X MF Vpl = 0X 3 = 0 Patient had complete recovery of symptoms & restoration of
 C = AIF Vp X MF Vp = 0 X 2 = 0 her normal skin within period of 4 months.
 D = AIF Ep X MF Ep = 0 X 1= 0 So this case report was helpful in analysing the effectiveness
 E = AIF PIH X MF PIH = 4 X 0 = 0 of individualized homoeopathic medicine Thuja in treating
annular lichen planus.
Final lichen planus score index Hence, this case report evidently suggest effectiveness of
(LPSI) = (A+B+C+D+E) X BSA Factor individualized homoeopathic medicine in treating cutaneous
= (0+ 0 + 0 + 0+ 0) X 3 = 0X3 = 00 lichen planus & also efficacy of remedy Thuja in this case.
This case also highlights the importance of individualization
Conclusion for selecting similimum & treating the patient & not disease.
Kentian method of evaluation was selected & totality of
symptoms were constructed, as it contains striking, Acknowledgments
prominent mentals & physical generals. Declaration of patient consent
After using Radar software & repertorization & in reference Author certify that she has obtained appropriate consent
with materia medica, Thuja was selected as similimum for from patient. Patient has given the consent for her
this patient. As it covered characteristic mental generals & documents related with the treatment and photographs, to be
physical generals including general modalities. reported in the journal.
In 6th edition of Organon of Medicine, aphorism 154, Dr.
Hahnemann states that, ‘the most suitable medicine contain References
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3. Haslett C, Chilvers ER, Boon NA, Colledge NR,

editors. Davidson’s Principles & Practice of Medicine.
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How to Cite This Article

Kalika Adhikrao Devakate. Homoeopathic approach to lichen planus:
A case report. International Journal of Homoeopathic Sciences 2024;
8(3): 93-99.

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