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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 5  |  Issue : 2  |  Page : 58-61

Lichenoid dermatitis treated with Ayurveda therapies: A case report


1 Department of AYUSH, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
2 Department of Oral and Maxillofacial Pathology, RKDF Dental College, Bhopal, Madhya Pradesh, India
3 Department of Kaya Chikitsa, RD Ayurvedic College, Bhopal, Madhya Pradesh, India

Date of Submission14-Oct-2021
Date of Acceptance13-May-2022
Date of Web Publication28-Jun-2022

Correspondence Address:
Dr. Danish Javed
Department of AYUSH, All India Institute of Medical Sciences, Saket Nagar, Bhopal - 432 020, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_92_21

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  Abstract 


Lichenoid dermatitis is a type of chronic eczema. Eczema can be correlated with Vicharchika (~wet eczema) described in Ayurveda. In acute conditions, this disease responds well to treatment, but in chronic presentations, it is difficult to manage due to its recurrent nature. Panchakarma (~five biopurification therapies) is well-known measure to improve the quality of life and prevention of recurrence in chronic diseases. In this case report, a 27-year-old male patient presented with chronic lichenoid dermatitis having symptoms of Kandu (~itching), Daha (~burning sensation), Ruja (~pain), Pidaka (~papules/eruptions), Srava (~discharge), Vaivarnya (~discoloration), and Rukshata (~dryness) treated with Ayurvedic interventions. Virechana (~therapeutic purgation) along with Ayurvedic oral medicines and wholesome dietary regimen were given for 12 weeks. Encouraging relief in various symptoms was observed after treatment. Rasayana (~rejuvenation) was also given to patient for prevention of recurrence. The patient has shown well tolerance and satisfactory adherence to treatment. No adverse event was reported during the course of therapy. After three months of treatment, disease progression was fully stopped and lesions resolved completely.

Keywords: Eczema, lichenoid dermatitis, Vicharchika


How to cite this article:
Javed D, Anwar S, Gupta D. Lichenoid dermatitis treated with Ayurveda therapies: A case report. J Ayurveda Case Rep 2022;5:58-61

How to cite this URL:
Javed D, Anwar S, Gupta D. Lichenoid dermatitis treated with Ayurveda therapies: A case report. J Ayurveda Case Rep [serial online] 2022 [cited 2022 Aug 13];5:58-61. Available from: http://www.ayucare.org/text.asp?2022/5/2/58/348703




  Introduction Top


Eczema or dermatitis is a common chronic skin lesion which is known for immunoglobulin-E-mediated delayed type of hypersensitivity against allergens, prostaglandins, helper T cells mechanism resulting to altered epidermal barrier characteristic producing pruritus.[1] As per the data of year-2019, Bihar and Meghalaya are highly affected states in India, while Madhya Pradesh ranks 8th position in burden of dermatitis.[2] Eczema can be acute, subacute, or chronic in nature. In acute dermatitis (or eczema), erythematous eruptions (papules and vesicles) are present sometimes associated with swollen blister-like appearance (scaling, flaking, peeling, crusting, and fissuring-like skin).[3] In chronic dermatitis, skin is darker, lichenified and excoriated. Eczema or dermatitis can be correlated with Vicharchika or Kshudra kushtha (~minor skin disease) in Ayurveda. It is considered Rakta pradoshaja vikara (~blood related disorder) with dominance of Kapha (~phlegm).[4] Acharya Charaka has mentioned Kandu (~itching), Pidika (~eruptions), and Bahu srava (~excessive/copious discharge) as main symptoms of Vicharchika, which resembles acute lesion. However, Sushruta's description is quite close to subacute or chronic dermatitis with symptoms such as Vaivarnya (~discoloration), Raji (~linear lesions/streaks), Ruja (~pain), and Rukshata (~dryness), etc.[5]


  Patient Information Top


A 27-year-old, non-diabetic, non-hypertensive male patient, engineer by profession, working at a multinational company visited to Ayurveda department of a tertiary care hospital with complaints of scaly rashes and papulo-macular lesions with intense pruritus at both elbow, dorsum of both hands and foot (more lichenified over right foot) for the past three years [Figure 1]a. There was mild blood discharge on itching from lesion of the right foot. He was taking consultation from dermatologist and was on allopathic medication (Topisal 3% Ointment, Hydromax CT cream, Fudic Cream, Tenovate Cream) for the past two years. However, no significant improvement was noticed, thus he consulted for Ayurveda treatment. Patient had a history of smoking (4–5 cigarettes/day for the past five years) and excessive tea and coffee consumption. There was no history of diabetic mellitus, cardiovascular diseases, hypo- or hyperthyroidism, tuberculosis, autoimmune disease, sexually transmitted diseases, HIV, hepatitis B, bronchial asthma, anemia, or any major psychiatric diseases. Routine blood investigations were within normal ranges. No history of similar illness was found in any of the family members or relatives. He was under mild stress due to difficulty in normal routine work and fear of disease progression. Histopathological examination was done by taking skin biopsy from the dorsum of the right and left foot [Figure 2]. On the basis of clinical and histopathological findings, the case was diagnosed by a dermatologist as chronic dermatitis or eczema. This condition can be compared with Vicharchika in Ayurveda.
Figure 1: Clinical picture before (a) and after treatment (b)

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Figure 2: Photomicrograph showing histopathology of lesional skin of the dorsum of the (a) right foot and (b) left foot (H and E, ×4)

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Clinical findings

The patient was thin built with a body weight of 65 Kg and a height of 5 feet, 4 inches. The body mass index was 24.6 kg/m2. On vital examination, pulse rate was 73/min, blood pressure was 114/81 mmHg, afebrile, and respiratory rate was 21/min. On local examination, hard, dry, fissured, hyperpigmented, and blood oozing lesion was found on the right foot dorsal aspect and around ankle; soft erythematous papulo-macular lesion was present on dorsum of the left foot. At elbows and dorsum of both the hands, small rashes of atopic dermatitis were present. Mild tenderness was present in foot lesions.


  Timeline Top


Details about conservative treatment and purgation therapies are mentioned in [Table 1] and [Table 2].
Table 1: Conservative treatment (Prasamanam aushadhis)

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Table 2: Purgation therapy (Virechana)

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  Diagnostic Assessment Top


Psoriasis vulgaris, psoriasiform dermatitis, and lichen simplex chronicus were considered possible differential diagnosis. The histopathological examination was conducted to confirm the diagnosis. A skin biopsy was taken from the dorsum of the right foot on April 16, 2019. Microscopic examination of 0.3 cm × 0.3 cm soft tissue revealed hyperplastic, irregular and acanthotic parakeratinized stratified squamous epithelium with thin finger-like rete ridges and hyperkeratotic papillae reaching up to the upper one-third of epithelium and showed a collection of histiocytes. Two small intraepithelial subcorneal bullae were also seen containing acantholytic cells. The upper dermis was showing perivascular lymphocytic infiltration [Figure 2]. Findings were suggestive of lichenoid dermatitis. Another skin biopsy was taken from the dorsum of the left foot on April 19, 2019. This showed sparse superficial perivascular infiltrate of lymphocytes and eosinophils with moderate epidermal hyperplasia and mild focal spongiosis. Papillary dermis was edematous with dilated capillaries. Stratum granulosum was slightly thickened. Stratum corneum showed lamellated orthokeratosis with focal parakeratosis. The findings of this examination were suggestive of subacute spongiotic dermatitis consistent with chronic eczema, comparable to Vicharchika in Ayurveda. Complete blood count, fasting and postprandial blood sugar, liver function tests, renal function tests, thyroid profile, hepatitis B and hepatitis C antigen, and human immune deficiency virus-I and II reports were found within the normal limits.


  Therapeutic Intervention Top


First, conservative management was started for 15 days, namely Arogyavardhani vati, Kaishora guggulu and Patola katu rohinyadi kashaya [Table 1] and Virechana (~therapeutic purgation) was planned, and consent was taken from the patient [Table 2]. The conservative medications was restarted with addition of Brahma rasayana once in a day after Virechana therapy in the follow-up period.[6]

Pathya (~wholesome) and Apathya (~unwholesome)

As the patient was a regular smoker and also addicted to tea and coffee, it was advised to restrict their consumption during the course of treatment. Certain modifications on his lifestyle, diet, and sleep pattern were made. Light, hot, unctuous and easily digestible food were advised and spicy, cold, fast food, and nonvegetarian diet were restricted. Yoga and meditation such as Sukshma vyayama, Dirgha svasa pranayama, Omkar naad, and relaxation techniques were suggested to relieve stress.


  Follow-Up and Outcomes Top


Before starting the treatment and after Virechana, the symptoms were rated on Likert scale of 0–3.[7] Significant improvements in all the symptoms were noted at the end of the treatment [Table 3] and [Figure 1]b.
Table 3: Symptoms on the Likert scale before and after treatment

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  Discussion Top


Panchkarma procedures are proven to be beneficial in many allergic and immune-related pathologies such as urticaria, psoriasis, and bronchial asthma. Eczema usually considered a chronic dermatological disorder, highly recurrent in nature. Few Ayurvedic studies have suggested that Rasayana drugs should be supplemented in such recurrent conditions.[6] As most of the recurrent diseases including eczema are immune-mediated, Brahma rasayana has been preferred in the management. Brahma rasayana is a polyherbal formulation with action on cardio-vascular system, the central nervous system, and is proven antioxidant.[8],[9]

Patola katu rohinyadi kashaya is mainly indicated in liver diseases, psoriasis, allergic dermatitis, pemphigus vulgaris, viral infections, etc. It pacifies Pitta and Kapha doshas. Nalpamaradi keram oil is mentioned in Ashtanga hridayam for topical application in various infective and allergic skin lesions. It is a polyherbal preparation containing Pancha kshiri vriksha (Vata [Ficus bengalensis L.], Udumbar [Ficus racemose L.], Ashwatth [Ficus religiosa L.], Pluksh [Ficus virens (Miq.) Corner], and Pippalbhed/Hibinuxvs [Thepasia populnea (L.) Sol. ex Correa]), Triphala (Amalaki [Emblica officinalis Gaertn], Vibhitaka [Terminalia bellerica (Gaertn.) Roxb], and Haritaki [Terminalia chebula (Gaertn). Retz]), Rakta chandana (Pterocarpus santalinus L.), Usheer (Vetiveria zizanioides [Linn.] Nash), Kushtha (Saussurea lappa [Decne.] Sch. Bip.), Manjishtha (Rubia Cordifolia Linn.), Haridra (Curcuma longa Linn.), etc., processed in the presence of coconut oil. It is helpful in preventing bacterial, fungal, or environmental allergens to breach the skin barrier.[10] Pancha valkala kwatha and Triphala kwatha also cleans and soothe the skin and prevent harmful biofilm, if applied locally.[11],[12] Arogyavardhani vati and Kaishora guggulu are blood purification agent and are used specially in skin disorders.[13],[14] This combination has been reported to be highly effective in serous erythroderma lesion.[13]

In this present study along with these Shodhana (~major purification therapies), the Prasamanam (~subsiding the disease) Aushadhi have supported in attaining better results in this case. The outcome infers that Ayurvedic management provides substantial relief and improves the quality of life of patients with conditions such as chronic eczema.


  Conclusion Top


The present observations provided some leads toward Ayurvedic management approaches in conditions such as lichenoid dermatitis. In chronic recurrent dermatological diseases, herbal or Ayurvedic medicines can be safely used for the long term without any harm. Considering the encouraging results of the treatment strategies, well-designed studies can be initiated to establish efficacies in a larger sample size.

Patient perspective

The patient was pleased after getting diminution in most of the symptoms.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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1.
Dhaliya R, Babu H. Ayurvedic visha hara (antitoxic) chikitsa in recurrent dyshidrotic eczema skin disease: A case report. J Ayurveda Integr Med 2021;12:156-60.  Back to cited text no. 1
    
2.
Global Burden of Disease Study 2019. Global Burden of Disease Study 2019 (GBD 2019) Results. India: Institute for Health Metrics; 2020. Available from: https://vizhub.healthdata.org/gbd-compare/. [Last accessed on 2022 Feb 07].  Back to cited text no. 2
    
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Sohn A, Frankel A, Patel RV, Goldenberg G. Eczema. Mt Sinai J Med 2011;78:730-9.  Back to cited text no. 3
    
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Talekar MT, Mandal SK, Sharma RR. Clinical evaluation of Trivṛta powder (Operculina turpethum Linn.) and Aragvadha Patra Lepa (paste of leaves of Cassia fistula Linn.) in the management of vicharchika (eczema). Ayu 2018;39:9.  Back to cited text no. 4
    
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Kaur M, Chandola HM. Effect of shirishadi decoction and snuhyadi lepa on the patients of vicharchika (eczema). Ayu 2009;30:16.  Back to cited text no. 5
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Kaur M, Chandola HM. Role of rasayana in cure and prevention of recurrence of vicharchika (eczema). Ayu 2010;31:33-9.  Back to cited text no. 6
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Urvashi MB, Prashant B, Amol PV. Ayurvedic management of Vicharchika w.s.r.to Eczema – A case study. Int J Ayu Pharm Chem 2018;9:69-74.  Back to cited text no. 7
    
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Rekha PS, Kuttan G, Kuttan R. Antioxidant activity of brahma rasayana. Indian J Exp Biol 2001;39:447-52.  Back to cited text no. 8
    
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Thangapazham RL, Sharma A, Gaddipati JP, Singh AK, Maheshwari RK. Inhibition of tumor angiogenesis by Brahma Rasayana (BR). J Exp Ther Oncol 2006;6:13-21.  Back to cited text no. 9
    
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Narahari SR, Aggithaya MG, Ryan TJ. Integrative dermatology: Applying knowledge of ayurvedic skin care and experience of the past 20 years at the bedside. In: Translational Ayurveda. Singapore: Springer; 2019. p. 141-60.  Back to cited text no. 10
    
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Patel P, Joshi C, Palep H, Kothari V. Anti-infective potential of a quorum modulatory polyherbal extract (panchvalkal) against certain pathogenic bacteria. J Ayurveda Integr Med 2020;11:336-43.  Back to cited text no. 11
    
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Jose AM, Adiga S, Ciraj AM, Shettigar KS, Velladath SU, Ramachandra L. Management of grade IV diabetic foot ulcer by vrana ropana chikitsa: A case study. J Med Sci 2021;41:247.  Back to cited text no. 12
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Singh SK, Rajoria K. Ayurvedic management of life-threatening skin emergency erythroderma: A case study. Ayu 2015;36:69-72.  Back to cited text no. 13
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Bharati PL, Agrawal P, Prakash O. A case study on the management of dry gangrene by Kaishore Guggulu, Sanjivani Vati and Dashanga Lepa. Ayu 2019;40:48-52.  Back to cited text no. 14
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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