A 39-years-old businessman, Mr. D.J. aged (Patient identification number: 21391) visited Life Force on 19th July 2013 to get treated Lichen planus on his skin. He complained having hyperpigmented eruptions since one year that was increasing since two months. It was a great deal of concern as being a business it was affecting his confidence and overall personality. The eruptions were present on his hands, back, chest, abdomen, and legs which were very itchy, and the itching would lead to burning. His eruptions were small, but multiple in nature covering a large affected area. He had taken conventional treatment for six months that did not help him in any way, hence he had stopped taking any treatment for eight months. 

The patient also complained acidity since two years. The symptoms of nausea, headache, and vomiting were quite significant at least once in a week. He was taking antacid since six months as and when required.  

Physical Generals:

By diet, he was a vegetarian and had a good appetite. Generalities like sleep and thirst were normal and adequate. Thermally, he was sensitive to the hot weather. 

Past History:

There was no major illness in the past.

Family History:

There was no history of any skin disease in the family. Mother was diabetic, she had a thyroid disorder and also had hypertension.    

Self And Family Set-Up:

The patient was a shipping business along with his wife who would help him in the business. He had a son and a daughter, and everyone in the family would get along well with each other. 

By nature, he was calm and a quiet listener. He had stress regarding his business, but could easily manage it. 

Prescription:

Dr. Shah evaluated his case and prescribed him medications for two months. He educated him about the disease, its nature, and the long-term treatment it might take to recover completely. Necessary instructions in regards to the diet and skin care were advised. 

Follow-Ups: 

The patient visited us for his first follow-up on 5th September 2013. He mentioned that the Lichen Planus was increasing gradually after starting the treatment. He was quite upset and mentioned that he was following all the instructions advised to him, in spite of which the disease was spreading. The itching was also consistent and was more towards the evening. There was also no substantial relief from acidity. The patient was explained that Lichen Planus being an autoimmune disease had a tendency to spread. He was advised to follow a healthy lifestyle and avoid stress which could trigger the spread. 

The next follow-up was reported on 24th December 2013. There had been a gap of a few days in the medications. The patient sadly exclaimed that the spots had been still spreading in spite of taking the treatment for five months. The itching was however reduced, and he had a significant relief from acidity. The case was reviewed by Dr. Shah, and the next batch of medicines was prescribed accordingly.

The follow-up dated 6th March 2014 was a remarkable one. The patient smilingly mentioned 40% relief in the eruptions which were flattening down. There was no itching and no new eruptions seen since the past two months. Acidity was also under control, and he did not need to take antacids in the past three to four months. 

The follow-ups between July 2014 and March 2015 were positive with consistent and gradual recovery. When the patient visited on 17th June 2015, he was having new spots on the chest and abdomen. He mentioned that he had been traveling wherein he suffered from the episodes of cold and cough for which he had taken antibiotics for the same. The itching had increased, especially at night which prevented him from going to sleep. He also underwent an annual check-up where eosinophilia was 16.8 (high). He was explained that high levels of eosinophils also are a reason for itching which was increased. The medicines were prescribed and were advised not to keep the skin dry which itself may trigger itching.  

The eruptions and itching were quite manageable and things were getting better until November 2015. However, in December 2015 new eruptions again starting erupting. The patient had again taken a course of antibiotics for an acute cough. He was informed about the contraindicated medicines for Lichen Planus and was advised to avoid taking over-the-counter medications for acute ailments. He was advised to use home remedies to take care of the acute phase or take homeopathic medicines if things get worse. 

The patient’s relief from Lichen Planus was better by 60% as informed in the follow-up dated 25th April 2016. The eruptions had reduced, and there was no itching. Active eruptions still remained on the forearms. The patient wanted medications for four months as he was traveling overseas. His acidity was also better by 80%, and he would get it only after eating spicy food and not eating on time. 

The patient was consistently better even when he was traveling. The follow-up given on 27th December 2016 showed a drastic improvement of 80%. There were only a few hyperpigmented spots remaining. The treatment was taken regularly for a period of six months till June 2017, after which Dr. Shah declared the patient as cured and there was no treatment required anymore.                       

Conclusion:

This case highlights that auto-immune cases like Lichen Planus have a tendency to spread if its triggering factors are not avoided even during the course of treatment. The patient was regular in taking medicines and following-up regularly with the clinic. Chronic, extensive, and multiple eruptions take a long time to recover as compared to small and a few recently detected eruptions. 

-Case study was done by Dr. Kanchan, Associate doctor to Dr. Rajesh Shah