Introduction

Lichen planus is an inflammatory skin condition, characterized by an itchy, non-infectious rash on the arms and legs. It consists of small, many-sided, flat-topped, pink or purple bumps. Considered to be an autoimmune disease, it typically occurs in people over the age of 30 years. It occurs more in females than in males. People with liver diseases, such as hepatitis C or cirrhosis are more susceptible to lichen planus. Mouth is a common site of inflammation and clinical manifestation of lichen planus and the condition is known as oral lichen planus.

Signes et symptômes

Itchy, discoloured patch or patterns of shiny, raised, red, pink, or purple, flat-topped bumps on skin inside cheeks & tongue.

Papules, approximately 3 to 5 mm in diameter.

White streaks may sometimes appear on the papules, called Wickham’s striae. Intense itching may occur, especially at night.

The first attack can continue for weeks, and even months, while recurrences can go on for years. Recurrence is common in cases of oral lichen planus.

Oral lichen planus

• White streaks appear on the inside of the cheeks. The gums, tongue, and lips may also be affected.
• The streaks are not usually painful or itchy but they do not resolve.
• Redness and blistering of the gums.
• Sore mouth ulcers can develop and recur.
• Loss of taste, metallic taste in mouth.
• Dryness of mouth.

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Causes

The exact cause of lichen planus is still not known.

It is considered to be autoimmune disorder, where the immune system mistakenly attacks healthy tissues.

Hereditary factors do not play any role in this condition.

It is not an infectious condition

It is not related with malnourishment/deficiencies. However, spicy foods, citrus juices, and tomato products may aggravate symptoms if there are open sores in the mouth.

Some causes of lichen planus are thought to involve the following:

Medications – Lichen planus can occur as a reaction to certain medicines, including:

• Beta-blockers, which are common drugs used to treat cardiovascular problems
• anti-inflammatory medications
• antimalarials
• thiazide diuretics
• phenothiazines, a group of tranquilizing drugs with antipsychotic actions

Mercury tooth fillings: Some studies have found a link between lichen-planus-type changes in the mouth and an allergic reaction to mercury tooth fillings.

Lichen planus can also be part of Grinspan’s syndrome, a syndrome characterized by hypertension, diabetes, and oral lichen planus.

Physiopathologie

The classic histopathologic features of Oral Lichen Planus include liquefactive degeneration of the basal cell accompanied by apoptosis of the keratinocytes, a dense band-like lymphocytic infiltrate at the interface between the epithelium and the connective tissue, focal areas of hyper-keratinized epithelium (which give rise to the clinically apparent Wickham’s striae) and occasional areas of atrophic epithelium where the rete pegs may be shortened and pointed (a characteristic known as saw tooth rete pegs). Eosinophilic colloid bodies (Civatte bodies), which represent degenerating keratinocytes, are often visible in the lower half of the surface epithelium. Degeneration of the basal keratinocytes and disruption of the anchoring elements of the epithelial BM and basal keratinocytes (e.g., hemi desmosomes, filaments, fibrils) weaken the epithelial connective tissue interface. As a result, histologic clefts (Max–Joseph spaces) may form and blisters on the oral mucosa (bullous LP) may be seen at clinical examination. B cells and plasma cells are uncommon findings.

Diagnostic

Physical examination due to its appearance.

A punch biopsy of skin

Traitements

Lichen planus is not a curable condition.

Fortunately, oral lichen planus causes few problems and treatment is not usually required. Oral hygiene can be poor among people with oral pain, which makes it even more important to maintain good oral hygiene.

In needed cases, treatment for lichen planus may include antihistamines, phototherapy, or steroid creams/tablets.

Antihistamines may be used to treat itching in severe cases of lichen planus.

For lichen planus that occurs in the mouth, steroid lozenges are used or mouthwashes if mouth ulcer symptoms become uncomfortable.

Corticosteroids will be needed in severe cases as tablets.

Pronostic

Usually, mild lichen planus on the skin clears up on its own in some months to years.

Moderate cases subside within some weeks to months with treatment.

Some cases where the disease affects mucous membranes are resistant to treatment and prone to recur.

Complications

Permanent brown or grey marks on the skin

In rare cases, persistent skin lesions and mouth ulcers may increase the risk of developing cancer by a small amount.

Disease & Ayurveda

Charmakushtha

Nidana

Unwholesome diet with opposite potency

Routine et comportement inappropriés

Taquiner et humilier d'autres personnes bienveillantes

Vol

Mauvaises actions qui provoquent un stress émotionnel facteurs comme le repentir/la peur/l'anxiété

Kapha-Vaatadoshakopanidana - causes de la viciation de tous les kapha et Vaatadosha

Purvaaroopa

Absence de transpiration

Perte de la sensation tactile

Samprapti

Due to the causative factors, vitiated doshas (mainly kapha& Vaata) vitiate rasadhatu and reaches skin. It settles on the skin and develop into thick and hard skin rashes.

Lakshana

Hasticharma    – thick skin like that of elephant

Kharasparsam - Dur/transparent au toucher

Divisions

Non mentionné

Pronostic

Akrichram ou yaapyam

Chikithsa

Samana

Pralepa avec lekhanadravya

External application of ghrita after aamapachana

Gandoosha/Kabalagraha

Sodhana

Snehana

Swedana

Nasya

Dhoomapana

Virechana

Ksharakarma

Médicaments couramment utilisés

        Aragwadhadi kashayam

Patolamooladi kashayam

Gulguluthiktakam Kashayam

Gandhak Rasayan

Madhusnuhi Rasayan

Thriphalachoornam

Arogyavardhini vati

Jathyadi ghrutam

Marques disponibles

AVS Kottakal

AVP Coimbatore

Vaidyaratnam oushadhasala

Remèdes maison

While lichen cannot be cured, some home remedies have been said to relieve symptoms.

Turmeric has been suggested as a remedy for oral lichen planus as it has shown effects on the immune system that could help reduce the inflammation that contributes to the condition.

A recent pilot study demonstrated promising results for this herbal treatment.

Other suggested treatments include:

• applying certain oats, to the skin
• chewing sage
• applying aloe vera gels to the skin
• essential oils
• borax

However, there appears to be little to no evidence supporting the safety and effectiveness of these treatments.

It is better to follow a course of treatment prescribed by a medical professional.

 Régime alimentaire

• À éviter

Red meat, fried non-veg items, and sea foods

Les repas lourds et les aliments difficiles à digérer provoquent des indigestions.

La malbouffe et les plats épicés - perturbent la digestion et réduisent la biodisponibilité du médicament.

Boissons gazeuses - rendent l'estomac plus acide et perturbent la digestion

Refrigerated and frozen foods – causes weak and sluggish digestion by weakening agni (digestive fire)

Caillé - provoque le vidaaha et, par conséquent, de nombreuses autres maladies

• A ajouter

Des repas légers et des aliments faciles à digérer

Gramme vert, soupes, babeurre bouilli avec du curcuma, du gingembre et des feuilles de curry.

Aliments fraîchement cuits et chauds traités avec des graines de cumin, du gingembre, du poivre noir, de l'ajwain, etc.

Comportement :

Avoid sedentary lifestyle. Be active.

Il est préférable d'éviter une exposition excessive à la lumière du soleil, au vent, à la pluie ou à la poussière.

Maintenir une alimentation et un sommeil réguliers.

Évitez de forcer ou de retenir les envies naturelles comme l'urine, les selles, les vomissements, le hoquet, etc.

Évitez autant que possible le stress et les déséquilibres émotionnels. 

postures de Yoga

Ardha mathsyentra asanam

Halasanam

Vakrasanam

Dhanurasanam

Tous les exercices et les efforts physiques doivent être décidés et effectués uniquement sous la supervision d'un expert médical.

 Articles de recherche

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541468/