E-ISSN:2456-3110

Case Report

Oral Lichen Planus

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

Ayurveda management of Oral Lichen Planus

Kumawat P1*, Unadkat R2
DOI:10.21760/jaims.9.8.40

1* Priyanka Kumawat, Final Year Post Graduate Scholar, Dept of Shalakya Tantra, Institute of Teaching and Research in Ayurveda, Jamnagar, Gujarat, India.

2 Rajshree Unadkat, Reader, Dept of Shalakya Tantra, Institute of Teaching and Research in Ayurveda, Jamnagar, Gujarat, India.

Background: Oral Lichen Planus (OLP) is a chronic inflammatory disease that affects the mucus membrane of the oral cavity. It is a T-cell mediated autoimmune disease in which the cytotoxic CD8+ T cells trigger apoptosis of the basal cells of the oral epithelium. It is characterized by lesions consisting of radiating white, gray, velvety, thread-like papules in a linear, annular and retiform arrangement forming typical lacy, reticular patches, rings and streakes. Although the exact etiology of this disease is still unknown, but some factors are associated with it like dental materials, autoimmunity, food allergies, stress, trauma, bowel diseases, infectious diseases, genetics etc.

Aims and Objectives: To study the role of Ayurveda Chikitsa in the management of Oral Lichen Planus.

Materials and Methods: A female patient aged 41 years presented with complaints of oral lesion with burning, pain, occasionally bleeding from gums while brushing. Patient was diagnosed with disease Oral Lichen Planus. Patient was treated with administration of Deepana Pachana Aushadhis followed by Trivritta Churna, Guduchyadi Kwatha internally and with Rasayanadi Yoga being used as local application. After the two month’s treatment, a significant response seen in symptoms like burning, pain and bleeding from gums while brushing.

Result: There is a need to make treatments that are widely recognized, widely successful, and capable of withstanding systematic replication available. These treatments should be able to significantly reduce the volume, recurrence and impact of Oral Lichen Planus.

Conclusion: Ayurveda has great approach in curing the Oral Lichen Planus.

Keywords: Oral Lichen Planus, Rasayanadi Yoga, Trivritta Churna

Corresponding Author How to Cite this Article To Browse
Priyanka Kumawat, Final Year Post Graduate Scholar, Dept of Shalakya Tantra, Institute of Teaching and Research in Ayurveda, Jamnagar, Gujarat, India.
Email: 		Kumawat P, Unadkat R, Ayurveda management of Oral Lichen Planus. J Ayu Int Med Sci. 2024;9(8):262-267.
Available From
https://jaims.in/jaims/article/view/3550

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-15 2024-07-25 2024-08-05 2024-08-15 2024-08-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.32

© 2024by Kumawat P, Unadkat Rand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Lichen planus is a chronic inflammatory mucocutaneous disease which frequently involves the oral mucosa. In the majority of patients with Oral Lichen Planus (OLP) there is no associated cutaneous lichen planus or lichen planus at other mucosal sites. This may be called “isolated” OLP. This disease has most often been reported in middle-aged patients 30-60 years of age and is more common in females than in males. The clinical evaluation of the oral lesions is based on the six clinical forms described by Andreason:reticular, papular, plaque, atrophic, erosive, and bullous.[1]

Mucosal lesions, which are multiple, generally have a symmetrical distribution, particularly on the mucosa of the cheeks, adjacent to molars, and on the mucosa of the tongue, less frequently on the mucosa of the lips (lichenous cheilitis) and on the gums (the atrophic and erosive forms localized on the gums manifest as a desquamative gingivitis), more rarely on the palate and floor of the mouth.

The most common type is reticular form with the characteristic feature of slender white lines (Wickham’s striae) radiating from the papules. Patients with reticular lesions are often asymptomatic, but atrophic (erythematous) or erosive (ulcerative) Oral Lichen Planus is often associated with a burning sensation and pain. Although the etiology and pathogenesis of Oral Lichen Planus are not fully understood, Oral Lichen Planus has been associated with multiple disease processes and agents, such as viral and bacterial infections, autoimmune diseases, medications, vaccinations and dental restorative materials.[2]

In modern, topical corticosteroids being used as first line of treatment. Further calcineurin inhibitors (e.g., cyclosporine, tacrolimus), retinoids, steroid-sparing agents (e.g., azathioprine, hydroxychloroquine), ormycophenolatemofetil can also be used. In Ayurveda, the disease with symptoms similar to those of Oral Lichen Planus has been delineated in the name of Mukhapaka and has been described in Shalakya Tantra. Mukhapka comes under heading of Sarvasara Mukha Rogas in Shalakya Tantra. Acharya Sushruta has depicted three Sarvasara Mukha Rogas that is Vataja Mukhapaka, Pittaja Mukhapaka, Kaphaja Mukhapaka,[3]

but in later chapter Acharya has included Raktaja Mukhapaka under Pittaja Mukhapaka thus mentioning four Mukhapakas whereas Acharya Vaghbhatta has described eight types of Mukhapakas Vataja, Pittaja, Kaphaja, Raktaja, Sannipataja, Urdhwaguda, Pootyasyata and Arbuda.[4]

In general, Ayoga, Atiyoga and Mithyayoga of Kala, Buddhi and Indriyartha are the causative factors for any disease. In other words, the causes of the diseases relating to both mind and body are three fold non-utilization, excessive utilization of time and wrong utilization, brain work, and objects of sense organs. Hence, the etiological factors of Mukharogas do the Vikriti of Bodhaka Kapha. Madhura and Amla Rasa are the main etiological factors that do the Vikriti of Bodhaka Kapha. Due to the above etiological factors, chiefly Kapha Pradhana Prakupita Doshas results in Mukharogas. In Mukharogas, mainly Kapha and Rakta Dushti occurs, so Raktamokshana is the main Chikitsa, Koshthashuddhi by Virechana, Kavalagraha, Gandusha, Nasya, Shirovirechana, Pratisarana, Dhooma, Agnikarma, Ksharakarma are also helpful in Mukharogas. As Oral Lichen Planus presents the reticulate, congestive and ulcerative clinical signs, it seems to have involvement of Pitta, Rakta and Kapha Dosha predominantly. Hence Deepana-Pachana, Mridu Virechana, Pratisarana, Kapha Shamaka medicines been considered as a main line of treatment in this particular case.

Case Report

A 41 year old female patient came to OPD of Shalakya Tantra with the complaints of Oral lesion with pain, burning sensation and occasional bleeding while brushing since 6 months. She was nondiabetic, normotensive, afebrile and conscious. She was fine before 6 months, then she gradually developed the oral lesions which in first 3 months was asymptomatic and then gradually she developed pain and burning in the lesions while occasional bleeding from gums since last 3 months. She was treated with topical corticosteroids for 3 months. But she did not get much relief, so she approached us in Shalakya Tantra OPD and was diagnosed with Oral Lichen Planus and treatment was started. In past history, patient was taking cortico-steroids drugs for the same disease. No any surgical history and systemic disease found.


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In personal history, patient is vegetarian with average appetite, irregular bowel, normal micturition, normal sleep and no addiction.

Examination of oral cavity  

Oshtha (Lips): NAD

Dantamula (Gingiva):

  • Colour: Reddish, Inflammed, White lines IRT

Figure 1: Colour of Gingiva in respect to quadrant
jaims_3550_01.JPG

  • Contour: Altered IRT

Figure 2: Contour of Gingiva in respect to quadrants
jaims_3550_01.JPG

  • Food Impaction: Absent
  • Pus Formation: Absent
  • Bleeding: IRT

Figure 3: Bleeding in gingiva in respect to quadrants
jaims_3550_01.JPG

  • Gingival Buccal Sulcus: White lines and erosive oral lichen planus lesion at right upper gingivo-buccal sulcus and left lower gingivo-buccal sulcus
  • Danta (Teeth): NAD
  • Jivha (Tongue): NAD
  • Talu (Hard & Soft Palate): NAD
  • Gal (Oro-Pharynx): NAD

Samprapti Ghataka

Table 1: Samprapti Ghataka of Vyadhi

DoshaPitta, Kapha, Rakta
DushyaRasa, Rakta
Agni Mandagni or Vishamagni
SrotasRasa-Raktavaha Srotas
Sroto-DushtiSanga, Vimarga-gamana
AdhisthanaMukha
SadhyasadhyataKriccha Sadhya

Intervention

Table 2: Management of Vyadhi

SNDrugDoseRoute of administrationDuration
1.Musta Churna6 gm BD before mealOral with Luke warm waterFor first 05 days
2.Eranda Bhrishta Haritaki6 gm HS after night mealOral with Lukewarm waterFor first 05 days
3.Trivritta Churna5 gm HS after night mealOral with Luke warm waterAfter 5 days,
For 1 week
Then alternate day for 1 month
4.Guduchi Kwatha20 ml BD before mealOrallyWas started after 7 days, for 1.5 months
5.Rasayanadi Yoga2 gm each BD After mealLocal Application with HoneyWas started after 7 days, for 1.5 months
Rasayana Churna
Chopchini Churna
Khadira Twaka Churna

Follow up: Follow up was taken for 1 month after completion of the treatment.

Pathya-Apathya

Table 3: Advice to patient

PathyaApathya
Trinadhanya, Yava, Mudga, Kulattha, Jangala Mamsa Rasa, Karvellaka, Parvala, Komal Muli, Hot water, Tambula, Tikta and
Katu Rasa, Kapha and Rakta Shodhaka Ahara is useful in Mukharogas.
Therapeutic procedures like Swedana, Virechana, Vamana, Gandusha, Pratisarana, Kavala, Raktamokshana, Nasya, Dhumapana.		Amla Rasa Dravyas, Abhishyandi Ahara, Matsya, Dadhi, Kshira, Guda, Masha, Ruksha, Kathina Padartha Sevana, Guru Ahara, Diwaswapna, use of cold water, Adhomukha Shayana and Snana.

Table 4: Criteria for Assessment[5]

Clinical signsScore of signs
1. Reticulate/Plaque Type(R)0 = none
1 = white streaks or patches
2. Congestive/Atrophic (E)0 = none
1 = lesions < 100 mm²
2 = lesions 100 mm² to 300 mm²
3 = lesions > 300 mm²
3. Ulceration (U)0 = none
1 = lesions < 100 mm²
2=lesions 100 mm² to 300 mm²
3=lesions > 300 mm

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Table 5: Results

Day 1Grade 1 (R), Grade 3 (E), Grade 3 (U)
After 1 weekGrade 1 (R), Grade 3 (E), Grade 3 (U)
After 2 weekGrade 1 (R),Grade 2 (E), Grade 2 (U)
After 3 weekGrade 1 (R),Grade 2 (E), Grade 1(U)
After 4 weekGrade 1 (R),Grade 1(E), Grade 0(U)
After 1.5 MonthGrade 1 (R),Grade 1(E), Grade 0(U)
After 2 MonthGrade 1 (R),Grade 0 (E), Grade 0(U)
Follow upGrade 1 (R),Grade 0 (E), Grade 0(U)

Figure 4: Photos showing before and after treatment condition of Vyadhi

jaims_3550_02.JPG
jaims_3550_03.JPG
Before Treatment

jaims_3550_04.JPG

jaims_3550_05.JPG
After Treatment

Discussion

Mode of action

  • Nidana Parivarjana: It is the most important and foremost line of treatment to break the pathogenesis of any In this patient, there was indulgence of often junk food, Kapha Vardhaka Aahara Vihara like, intake of Dadhi in morning daily, sleeping in day for 2 hours and partial activeness throughout the day. These all factors were stopped during the treatment and proper Pathya Ahara Vihara were advised.
  • Deepana-Pachana: Deepana-Pachana is useful to combat the pathogenesis of Oral Lichen Planus. Patient was having Mandagni, so Musta Churna was started for 05 days before meals. As Musta possess both Deepana and Pachana property helps in maintenance of Agnisandeepana Karma.
  • Anulomana: Anulomana Dravya acts by converting Apakwa Mala into Pakwa Mala and evacuates Pakwa Mala outside the body.As patient was having constipation, as an Anulomana Dravya Eranda Bhrishta Haritaki in night after meals was advised to patient.
  • Nitya Mridu Virechana: Trivritta is Madhura, Tikta, Katu Rasa, Ruksha Guna, Ushna Virya and Katu Vipaka. Madhura Tikta and Kashaya Rasa are Pitta Shamaka in nature they are Soumya. Katu, Tikta and Kashaya Rasa will cause Kapha Shamana and Trivritta being Sukha Virechana Dravya it causes Vata Anulomana, thus act as Tridoshashamaka.
  • Pitta Rakta Kapha Shamka drugs and Rasayana: Rasayana is mentioned as Samanya Chikitsa and cures the disease by nourishing Rasaadi Dhatus. Guduchi possesss the Rasa: Tikta and Kashaya, having Vipaka: Madhura and Veerya as Ushna, which basically combates the pathoghenesis occuring due to involvement of Doshas: Kapha, Pitta and Rakta. Internally Guduchi is most effective Rasayana-Rejuvenative herb. It works well on the seven Dhatus - tissues and keeps the system balanced. Ultimately helps in immune stimulation, enhances cellular detoxification mechanism and repair damaged non proliferating cell, which breaks the pathogenesis of disease.

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  • Pratisarana[6] is application of medicinal powder, Kalka, medicated oil etc. to the oral cavity in case of wounds in buccal cavity and throat. For significant drug absorption to occur across the oral mucosa, the drug must have a prolonged exposure to the mucosal surface. Rasayana Churna can be used it as a best rejuvenation therapy, as it has properties like, Anti-depressant, Anti-xylotic,[7] Immunomodulatory, Anti-diabetes, Anti-hypertensive, Anti-inflammatory, Anti-toxic effects, Anti-arthritic, Anti-cancer effects, Anti-microbial effect, and Anti-oxidant effect. Chopchini: Bhavaprakasha researched on the drug and noted its use on a large scale. The drug has potent effect in skin disorder, Vata Roga, Dhatu Daurbalya, Granthi Vikara, Vatarakta, Karshya, Shotha, Sandhishotha, it can used as antimicrobial, carminative, painkiller etc. Khadira: (A. catechu) is having Tikta, Kashaya Rasa, Sheeta Virya which alleviates Pitta and Kapha. Acharya Charaka mentioned it as best Kustahara Dravya in Agryaprakarana. It has also the properties of Switraghna. Kandugna, Kushthagna, Krimihara. The decoction has the important ingredients like catecnin (flavonoid), catechu tannic acid. There by Khadira helps for better absorption. Kashaya Rasa of Khadira holds Twakprasadaka and Raktashodhaka properties which ultimately leads to Raktaprasadana and reduction of Vaivarnyata of skin thus proved best immune-modulatory drug for skin diseases.[8]

Conclusion

Pathology and definitive cure are still not known, Ayurveda provides good line of treatment which can be seen from above mentioned case report. Rasayana, Virechana, Pratisarana are examples of effective treatments for this disease, according to Ayurveda. This condition is said to have manifested due to the vitiation of Pitta, Rakta and Kapha Doshas. Drugs from Ayurveda lower the possibility of negative side effects. Thus, we can draw the conclusion that Ayurvedic treatment for Oral Lichen Planus treats the problem systemically and relieves the underlying cause of the Dosha.

ADR Declaration

No any adverse drug reaction was noticed during the treatment and follow up period.

Limitation of Study

As above mentioned, is a single case report there is need of study in larger population for establishing good protocol.

References

1. Cheng Y-SL, Gould A, Kurago Z, Fantasia J, Muller S. Diagnosis of oral lichen planus: a position paper of the American academy of oral and maxillofacial pathology.Oral Surg Oral Med Oral Pathol Oral Radiol.(2016) 122:332–54. doi: 10.1016/j.oooo.2016. 05.004
2. Mignogna MD, Lo Russo L, Fedele S. Gingival involvement of oral lichen planus in a series of 700 patients.J Clin Periodontol.2005 Oct;32(10):1029-33.
3. Sushruta, Sushruta Samhita, with Nibandhasangraha commentary by Dalhana, Nidanasthana 16 Mukharoga Nidana/64, page no. 336.Ed. by Vaidya Yadavaji Trikamaji Acharya, Chaukhambha Sur Bharati Prakashana, Varanasi, Reprint 2003.
4. Vagabhatta-Astangahridayam with Nirmala Hindi Vyakhya by Dr. Brhamanand Tripathi, Uttartantra Chapter 21 Mukharogavigyaniyam/64-65, page no850; Ed. Chukhambha Sanskrita Prakashana, Delhi,2009.
5. Available from- https://www.researchgate.net/figure /Scores-of-REU-signs-for-oral-lichen-planus-28_tbl1_334249513
6. Shastri Ambikadutt. Sushruta Samhita Edited with Ayurveda Tatva Sandipika Hindi commentary. Vol.- 1. Varanasi; Chaukhambha Sanskrit Sansthan; Reprint 2019. Chikitsasthana 40/70. p.186
7. Deole, Y. S., Ashok, B. K., Thakar, A. B., Chavan, S. S., Ravishankar, B., Chandola, H. M. 2011. Evaluation of anti-depressant and anxiolytic activity of Rasayana Ghana Tablet (A compound Ayurvedic formulation) in albino mice. AYU (An International Quarterly Journal of Research in Ayurveda), 32(3):375–375.
8. Bhavaprakash of Bhavamishra, volume 1, commentary by Dr Bulusu Sitaram, forworded by Prof k. C. Chunekar, Chaukhamba orientalia, Varanasi shloka no 31-32, vatadi varga.


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