Hallo, Good Afternoon, on occasion will explain about lung cancer ayurvedic herbal treatment A single case study of treating hypertrophic lichen planus with Ayurvedic medicine see more
| Date of Web Publication | 17-Jul-2017 |
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/ayu.AYU_1_16
Kshirod Kumar Ratha
National Research Institute of Ayurvedic Drug Development, CCRAS, 4-CN Block, Sector-V, Bidhannagar, Kolkata - 700 091, West Bengal
IndiaCheck 
 Abstract |
Ayurvedic medicines are often considered efficient appropriate to chronic and situation disorders. Hypertrophic lichen planus (HLP) is a rare inflammatory skin order and develops into squamous chamber carcinoma inside not many cases. It has resemblance with Charma Kushtha mentioned inside Ayurvedic classics. Conventional therapy used inside this order is unsatisfactory and is not free from margin effects. A situation of fixed systemic steroid-dependent HLP is presented in or at this place which was intervened successfully with Ayurvedic modalities.
Keywords: Ayurveda, Charma Kushtha, Kshudra Kushtha, hypertrophicus lichen planus
How to cite this article:
Ratha KK, Barik L, Panda AK, Hazra J. A sole situation study of treating hypertrophic lichen planus with Ayurvedic medicine. AYU 2016;37:56-61
Ayurvedic medicines are often considered efficient appropriate to treating chronic and lifestyle-related diseases, and merely, not many of them have been systematically evaluated appropriate to treating chronic illness.[1]
Hypertrophic lichen planus (HLP) is a subacute or chronic variant of lichen planus (LP) of unknown etiology.[2] It is an inflammatory illness inside which T-lymphocytes attack the basal epidermis, producing mark cold and histological lesions. It occurs inside middle age, and women are commonly affected than men.[3] It is characterized via epidermal hyperplasia inside response to constant itch and gets extreme via stress.[4],[5] Squamous chamber carcinoma, keratoacanthomas developing on the HLP of lower limbs have been reported.[6] Most extended past|just gone} conventional treatment of the HLP and LP disorders consists the utilize of topical and systemic corticosteroid, psoralen and ultraviolet A therapy, immunosuppressant, systemic retinoid, cyclosporine, and acitretin.[7],[8] All these drugs are proved to cut the symptoms temporarily. In Ayurveda, this order may exist considered under Charma Kushtha, a type of Kshudra Kushtha (minor skin diseases), due to the similarity inside signs and symptoms with HLP. Charma Kushtha is dominant of Vata Dosha and Kapha Dosha. In this condition, the skin above the bit becomes thick like the skin of an elephant (lichenification).[9] Herein, details of a systemic steroid-dependent HLP patient, virtually intervened with compound ayurvedic modalities, have been described. A substantial decrease inside pruritus and increase inside the skin hurt were observed after a period of 4 months of daily treatment and 2-month follow-up. The increase was observable through the follow-up photographs [Figure 1],[Figure 2],[Figure 3],[Figure 4].
Presenting concern
A 63-year-old male diagnosed with HLP via a dermatologist presented inside the Outpatient Department (OPD) of National Research Institute of Ayurvedic Drug Development, Kolkata, West Bengal, India (OPD Regn. No. 3306/2014-15), with complaints of itchy, big verrucous lesions on medial malleolus of both legs appropriate to a extended time. These symptoms were occurring out and on appropriate to the past 2 years and 5 months containing a fresh outbreak 2 months ago. He also had a history of hypertension and bronchial asthma and was on daily medication appropriate to it [Table 1].
Clinical findings
General examination
The general order of the patient was excellent and without alterations inside essential signs. He had a normal appetite, bowel and bladder habit, and daily rest pattern. His Prakriti was Pitta-Kapha predominant, and he was assessed with rational highlight on psychological evaluation.
Local examination
Cutaneous examination revealed solitary, well-circumscribed, slightly wet skin hurt measuring 9 cm × 6 cm, 6 cm × 4 cm seen above medial malleolus of the right and left leg, respectively. Few keratotic crusts appeared on the hurt of the left leg. The nearby skin showed thickening and hyperpigmentation. The surface consisted of the slough and papillated excrescences closely grouped, aroused from the nearby surface. No community tenderness or bleeding on manipulation was elicited, and not at all inguinal lymph nodes were involved. The slimy membranes were unaffected. No symbol of varicose vein was observed on any of the legs. No such lesions of LP were establish elsewhere on the body. However, hypopigmented lesions of vitiligo were seen on legs [Figure 1] and [Figure 2].
Investigation
Previously you're on biopsy communicate of the lesions from dermatopathologist revealed the presence of hyperkeratosis, acanthosis, hypergranulosis, irregular declining elongation of the rete ridges, and foci of damage (liquefaction) to basal chamber layer. The dermis was densely infiltrated via chronic inflammatory cells without any proof of malignancy. The communicate was in keeping with LP hypertrophicus.
Case conception and selection of ayurvedic treatment
Since the patient was told via the dermatologist about the prognosis of his order and also became aware of the disadvantages of corticosteroid from some additional sources, he had chosen Ayurvedic involvement appropriate to his condition. As there was not at all traditional Ayurvedic treatment available particularly appropriate to HLP, he was also explained about the uncertainty of the treatment.
Charma Kushtha is a cold order described inside Ayurveda which resembles HLP. Ayurvedic perspective of this particular situation presenting with pruritus and verrucous hurt can exist traditional with cold presentation. Itching, hyperkeratosis, sliminess, and thickness, the whole amount are the features of Kapha dominancy. Acanthosis (Karshnya) is the feature of aggravated Vata. On the basis of symptomatology, the disease can exist equated with Kapha-Vata Kushtha. The etiology (Nidanam) of Kushtha is Visha (autoimmune), normally results from exposure to sure environmental factors or due to using up of incompatible foods. Stress also plays a marked part inside the situation while immoderate rational highlight vitiates the Rasa Dhatu and Rasavaha Srotas, which is responsible appropriate to Kapha Dushti. The autoimmune nature of disease along with Kapha Dushti initially started while itchy hurt (Kandu) on both malleolus, which is Kapha predominant. Hence, the primary Dosha is Kapha when it involves the Rasa Dhatu and causes Kandu (Kapha Dushti), wet skin (Kapha Dushti), keratotic crust (Kapha-Vata), and thickening of skin (Shopha of hard type due to Vata-Kapha Dushti). Association of Rakta Dhatu leads to hyperpigmentation and acanthosis, and finally, wet skin (Srava) results from connection of Lasika. Varicosity of veins of lower limbs was not establish inside this case; however, medial malleolus affection is standard due to broke vascularity. This the whole amount finally resulted into verrucous hurt (Vranam) which is also been told while complication of Kushtha.
The standards of management inside the different stages of the Kushtha (skin diseases) includes eliminative procedures (therapeutic emesis, purgation, etc.), vein puncture, community applications, and internal management of drugs.[10] Considering the implication of Dosha and Dushya (pathognomonic factors) and study of causative factors (Hetu) of the disease, the patient was recommended a broad Ayurvedic modalities, consisting of Aushadha (compound Ayurvedic formulations), Ahara (dietary modification), and Vihara (lifestyle modification) at OPD level. The drugs with Kapha Vataghn a (Doshahara) properties, along with Vishaharam, Kandughna, Kushthaghna, and Vranashodhanaropanam (Vyadhihara) properties, were chosen and prescribed at different stages inside the situation [Table 2].[11], [22], [23], [24], [25], [26]
 | Table 2: Ayurvedic drugs prescribed to the hypertrophic lichen planus case |
The patient was advised to communicate at an interval of 15 days or communicate while and when required appropriate to assessment. He was also advised to taper out the corticosteroid (prednisolone) dose above a period of 1 month inside consultation with an allopathic doctor and also directed to keep on the medications appropriate to hypertension and bronchial asthma while such [Table 1].
Follow-up and outcomes
Picture of the affected skin was taken at the period of initiation of the treatment and later on every go to see while per the methods used via Rastogi and Chaudhari [Figure 1],[Figure 2],[Figure 3],[Figure 4].[12] The subsequent observations were also noted [Table 1]. The patient was assessed clinically on every fortnight visit. The consecutive photographs were taken after each follow-up go to see when compared with the before treatment status were able to exhibit the changes inside the skin lesions [Figure 1],[Figure 2],[Figure 3],[Figure 4]. This shows a considerable increase inside the skin lesions following the therapy to the before treatment status. No adverse effect pertaining to the prescribed drug was also reported. On follow-up appropriate to 6 months, there was not at all fresh outbreak of the lesions.
Charma Kushtha is a type of skin disease mentioned inside Ayurveda under the grading of Kshudra Kushtha. The classical symbol of Charma Kushtha is thickening of the skin like the skin of an elephant.[13] It is verrucous lichenification of skin and normally develops inside patients with psoriasis, dry eczema, and LP. Treatment of Kushtha containing the whole amount type Kushtha consists of purification therapy (Samshodhana),[14] internal and external management of the drug (Samshamana).[15] Dietary and situation modification also play an important part inside the management of Kushtha.[16] The patient was suffering from a Kapha-Vata dominant Kushtha complicated with a Vranam (verrucous lesion). The association of HLP with vitiligo inside the situation may exist due to a standard autoimmune etiology. Coexistence of lesions of Becker's nevus along with vitiligo and LP was also reported.[17]
LP has a muscular association with anxiety, stress, and diabetes.[3] In the presenting case, though the beginning of disease can exist linked with stress, the connotation of bronchial asthma inside the situation may due to standard immunological linkage. HLP and not many varieties of long-standing, erosive LP develop into Bowen's disease, a premalignant condition, and squamous chamber carcinoma. Although the disease is diagnosed from its cold features, biopsy is often recommended to make the discovery and to look appropriate to cancer. The current conventional treatment involves topical and a extended way of spoken steroids, calcineurin inhibitors, retinoid, acitretin, hydroxychloroquine, methotrexate, azathioprine, and phototherapy. Various studies had shown the utilize of original medicines inside spoken LP.[18],[19] There are also limitations appropriate to the utilize and drawbacks of topical steroids and systemic glucocorticoids because of suppression of hypothalamic–pituitary–adrenal axis and additional systemic margin effects.[20] Ayurvedic principles have shown potential to exist used inside noncommunicable and situation disorders. These are convenient, safe, and least expensive inside contrast to the conventional method of treatment.[21] Herein, the drugs, dietary, and situation modifications were chosen [Table 2] on the basis of Nidanam (causative factors of disease), implication of dominant Dosha (Kapha-Vata), and nature of the disease (Vyadhi). Formulations having Kaphavataharam, Vishaharam, Kandughna, Kushthaghna, and Vranashodhanaropanam properties were used. Blood-letting (Rakta-Mokshana) is also single of the efficient treatments.
Aragwadhadi Kashayam used inside the situation is Kushthaghna, Vishaghna, and having Shamanam (pacificatory) properties. It is efficient inside Kandu, Prameha and acts while Dushta Vranavishodhaka. Patolamuladi Kashayam is also Kaphahara, Kushthahara, and Vishahara. It is used appropriate to Shodhana (purification and bowel cleansing). Triphala is Shotha-Kleda-Vranahara and Vishahara. Jatyadi Ghrita used inside the case, intend appropriate to Vranashodhanaropanam (cleansing and healing of wound). Tutha (CuSo4) thing its single of the ingredient, it has cleansing move on slough. Major ingredients of Arogyavardhini Vati are Gandhaka (Sulfur), Katuki (Picrorhiza Kurroa), Nimba (Aristolochia indica), which are the versatile drugs appropriate to the whole amount type of skin diseases. It also contains Tamra (Copper), which has scrapping (Lekhana and Vranashodhana action) and acts on Lasika. Further, Arogyavardhini Vati is a panacea via its title and a excellent remedy appropriate to liver. It is helpful inside Pachana (metabolism) of Ama Visha and corrects the producing of vitiated Rasa Dhatu inside the body.
The modalities adopted inside the situation may exist applied to the similar situation too. However, a case with single or two formulations may exist proposed to determine more distant part of Ayurveda. The post treatment biopsy could not exist you're on to contrast with the baseline data is the limitation of the study. Further to validate the therapy appropriate to HLP, the case may exist performed inside an adequate number of patients along with a comparison of biopsy at the baseline level and after completion of therapy.
HLP is a rare and difficult skin order to cure. It is disreputable appropriate to its fresh outbreak and has also the possibility to develop into squamous chamber carcinoma. The conventional treatment options available are also not satisfactory and are not free from systemic margin effects. This observation endorses a step toward the practice of Ayurvedic involvement inside HLP.
Acknowledgment
We are thankful to the participant appropriate to providing informed consent to publish the consequence of the study. We are also grateful to Dr. S. Choudhury, Consultant Pathologist, Kolkata, appropriate to critical revision of the situation presentation and debate portion of the manuscript.
Financial support and sponsorship
Nil.
Conflicts of interest
There are not at all conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]
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