Lichen Planus
1. PRELIMINARY DATA
- No.: 242/2026
- Patient's Name: QRS
- Address: Flat 2804, Golden Court, Pune.
- Occupation: Accountant (sedentary, stress from audits, irregular meals)
- Religion: Hindu
- Date: 10/09/2026
- Age: 46 Years
- Sex: Male
- Education: M.Com
- Status: Married
2. CHIEF COMPLAINTS AND ASSOCIATED TROUBLES
| LOCATION | SENSATION & PATHOLOGY | A/F & MODALITIES | CONCOMITANTS |
|---|
| Skin (wrists, ankles, oral mucosa, trunk) | Itchy violaceous flat-topped polygonal papules/plaques, Wickham's striae, oral white lacy lesions | < Stress, < Cold dry weather, < Scratching, < Night, > Warm applications, > Moisturizing, since 5 years (progressive, oral involvement last 2 years) | Severe itching, burning in mouth, fatigue, irritability |
| General | Dryness of skin | < After meals | Anxiety about spread, low mood |
3. PERSONAL PAST & FAMILY HISTORY
- Past History: Stress-triggered onset after job loss; suppressed with topical steroids (rebound flares); recurrent oral ulcers treated with gels; hepatitis B carrier status; frequent acidity.
- Family History: Mother has lichen planus & oral lesions. Father has diabetes. Sister has psoriasis.
- Developmental Landmarks: All milestones were reached at the appropriate age.
4. PATIENT AS A PERSON (PHYSICAL CHARACTERISTICS)
A. Physical Characteristics
- Appetite: Normal
- Desires: Warm drinks (+++), Spicy food (+)
- Aversions: Cold food
- Thirst: Moderate
- Elimination:
- Urine: Normal
- Stool: Regular
- Perspiration: Scanty
- Sleep: Disturbed by itching; wakes scratching
- Thermal State: Chilly patient (prefers warm)
B. Reactions - Physical Factors
- Weather: Aggravation in cold dry weather
- Position: Better warm room
5. MENTAL STATE (Psychodynamic & Life-Space)
- Nature: Irritable, anxious, perfectionist
- Anxiety: About appearance, chronic nature
- Fear: Fear of oral cancer, fear spread
- Dreams: Itching, being disfigured, criticism
- Other: Suppressed anger, feels unattractive
6. PHYSICAL GENERAL EXAMINATION
- Wt: 74 kg | Ht: 170 cm | Temp: 98.6°F
- RR: 18/min | Pulse: 82 bpm | B.P.: 132/84 mmHg
- Face: Tense
- Tongue: White lacy lesions on buccal mucosa
- Nails: Normal
- Skin: Violaceous papules/plaques on wrists/ankles/trunk |
7. SYSTEMIC EXAMINATION
- Skin: Polygonal purple papules, Wickham's striae, oral reticular white lines
- CVS: S1, S2 Normal
- Respiratory: Clear
- GIT: Normal
8. ANALYSIS AND EVALUATION OF SYMPTOMS
- Mental General: Irritability, anxiety about appearance/health, fear cancer (Grade 3)
- Physical General: Chilly, desire warm drinks, scanty sweat, itchy violaceous lesions (Grade 3)
- Particular: Lichen planus with itching/papules, < stress/cold, > warm (Grade 2)
9. SELECTION OF REPERTORY WITH REASON
- Repertory: Kent’s Repertory of Homoeopathic Materia Medica
- Reason: Chronic autoimmune skin/mucosal disorder with strong Mental Generals (anxiety, fear) and Physical Generals (thermal, itching) dominating; Kent suits skin rubrics for lichen planus.
10. TOTALITY OF SYMPTOMS FOR REPERTORISATION
- Irritability and anxiety
- Fear cancer/spread
- Desire warm drinks
- Chilly patient
- Itchy violaceous papules
- Wickham's striae
- Oral white lesions
- < Stress, cold dry
-
Warm applications
- Fatigue/irritability
- Family lichen planus
11. CONVERSION INTO REPERTORIAL RUBRICS
| SR. NO. | SYMPTOMS | RUBRICS WITH SUB-RUBRICS | PAGE NO. (Kent) |
|---|
| 1 | Irritability | Mind; IRRITABILITY | 57 |
| 2 | Anxiety health | Mind; ANXIETY; health, about | 6 |
| 3 | Fear cancer | Mind; FEAR; cancer, of | 42 |
| 4 | Desire warm drinks | Stomach; DESIRES; warm drinks | 486 |
| 5 | Skin eruptions lichen | Skin; ERUPTIONS; lichen | 1310 |
| 6 | Skin itching | Skin; ITCHING | 1308 |
| 7 | Chilliness | Generalities; COLD; agg. | 1348 |
12. SELECTION OF REPERTORIZATION (NUMERICAL ORDER)
| SR. NO. | REMEDIES | RUBRICS COVERED | TOTAL MARKS |
|---|
| 1 | Sulphur | 7/7 | 22 |
| 2 | Arsenicum Album | 6/7 | 18 |
| 3 | Graphites | 5/7 | 15 |
13. MIASMATIC INTERPRETATION
| PSORA | SYCOSIS | TUBERCULAR | SYPHILIS |
|---|
| Itching, irritability, chilly | Lichenoid lesions, mucosal | Family autoimmune | Destructive fear cancer |
Dominant Miasm: Psora-Sycotic
14. FINAL STEPS
- Provisional Diagnosis: Lichen Planus
- Differentiation of Remedies: Compared Sulphur with Arsenicum. Arsenicum has more anxiety/fear, chilly; Sulphur matches chronic lichen planus with itching/burning, hot/chilly mix, irritability/anxiety, desire warm drinks, < stress/cold. Graphites more oozing/cracking.
- Selection of Remedy (Materia Medica): Sulphur matches lichen planus with violaceous itchy papules, mucosal involvement, irritability/anxiety, chilly/hot patient, desire warm drinks (Ref: Allen’s Keynotes, Boericke).
- Selection of Potency: 200C (Chronic autoimmune skin/mucosal miasmatic case, sensitive constitution)
- Actual Prescription:
- Sulphur 200 — single dose (one dose only, wait & watch)
- Placebo — 4 pills twice a day for 8 weeks
15. FOLLOW-UP'S TABLE
| DATE | COMPLAINTS | REMEDY | ADVICE |
|---|
| 20/09/2026 | Itching reduced 70%, lesions flattening, no new spread | Placebo | Moisturize, avoid scratching, stress reduction |
| 20/01/2027 | Lesions mostly resolved, oral clear, confidence better | Placebo | Continue gentle care, report recurrence |