7. PAPULAR INFLAMMATIONS OR DISEASES


Lichen planus is a non-contagious affection of the skin, characterized by the development of small, flattened papules, which frequently present a distinct central depression or umbilicus….


Lichen Planus.

Lichen planus is a non-contagious affection of the skin, characterized by the development of small, flattened papules, which frequently present a distinct central depression or umbilicus.

Lichen planus is an eruption of pimples, remarkable for their color, their figure, their structure, their habits of isolated and aggregated development, their habitat, their local and chronic character, and for the melasmic stains which they leave behind them when they disappear.

The color of the pimples is a dull crimson-red, more or less livid, and suffused with a purplish or lilac tinge.

In figure the papulae are flattened, smooth, and depressed on the summit, angular in outline, but slightly elevated, and of a size ranging between one and three lines in diameter; the flatness is rendered more conspicuous by the summit of the papule being occupied by a thin, horny, semi-transparent lamina of cuticle, depressed on the surface, and marked by the aperture of a follicle, which represents a sort of hilum. In structure, the papule of lichen planus is a hyperaemia with exudation, surrounding a follicle and surrounding a thin layer of horny, transparent cuticle; while the aperture of the follicle and its conical epidermic plug are visible in the center of the horny plate. The horny covering is in no wise a scale; it rises and falls with the papule and neither separates not exfoliates.

Lichen planus presents two principle forms of manifestation- discrete and aggregate.

The habitat of the eruption is also characteristic of the identity of lichen planus. It is pretty constantly met with on the front of the forearm, just above the wrist; in the hollow of the loins; on the lower half of the abdomen; on the hips; around the knees, particularly over the mass of the vastus internus muscle; on the forearms and calves of the legs, and in women around the waist and in the grooves occasioned by the garters. We have seen it also, but less frequently, on the palms of the hands and soles of the feet; and in two instances on the tongue, the buccal membrane, and the mucous lining of the fauces.

Lichen planus is essentially chronic and local in its habits. In distribution it is generally symmetrical, but occasionally is limited to one side of the body; sometimes occurring on one side in the upper extremity, and on the other in the lower. It has no constitutional symptoms of its own, and frequently prevails with very little disturbance of any kind.

Of course, the totality of the characters above noted are not to be found in every case. The characteristic feature, however, are the flattened umbilical papules. This central depression may not be noted in every papule; and when a number of them have run together and coalesced, it is commonly absent, and met with only on those in the neighborhood of, but which do not form a part of, the patch.

The duration of the affection is indefinite. It may undergo resolution, and the papules disappear after three or four months; or, especially when the eruption is extensive, may resist the best-directed treatment for a year or more.

Etiology.- No one has thus far offered a plausible explanation of the causes of lichen planus. It is undoubtedly a constitutional affection, but whether due to certain unknown changes in the blood, or to a reflected irritation from some special internal organ, is entirely unknown.

Diagnosis.- In general aspect the affection may be mistaken for a papular syphilide, or a papular eczema, but hardly for any other than those two diseases, except it be the lichen ruber of Hebra. The positive features, however, that have been detailed above do not occur in the diseases mentioned, and are sufficient of themselves to establish the diagnosis.

The prognosis of lichen planus is favorable, as there is little or no evidence that it tends either directly or indirectly to shorten life. The duration of a given eruption, however, is very uncertain, except that, in a general way, the more extensive the lesions the longer they may be expected to remain.

Treatment.- Locally, chrysarobin, thirty grains, with one ounce of traumaticin (liquor gutta percha). This should be painted on the spots daily until a considerable degree of local irritation is produced. Sedative applications should then be applied for a few days, and the skin allowed to recover from the effect of the drug. A single course of this sort will cause most of the spots to disappear.

When there is much itching, temporary relief is afforded by the application of cloths wrung out in hot water. Should the itching prove obstinate, a weak carbolized oil and lime water lotion, or grindelia robusta, dr. j. to water may be used.

The following ointment has proven very beneficial in many cases, to relieve the itching of lichen planus and eczema:

Rx Chloral hydratis, dr. ss.

Camph. pulv., dr. ss.

Acidi carbolici, m.x.

Balsum peru., dr.j.

Menthol, grs. xx.

Ung. zinci oxidi, q.s.ad. z3j.

M.fl. unguent., Sig. Apply morning and night.

As regards internal treatment the old school rely almost entirely upon arsenic, giving preference to Fowler’s solution.

The patient should be liberally fed and well hygiened.

Homoeopathic Remedies.

Antimon crud is the principal internal remedy.

Others are indicated as follows:

Agaricus musc.- Eruption of small pimples with red areolae and violent itching. Sensation in various parts as if ice cold needles were piercing the skin. In light complexioned persons and drunkards.

Arsen. alb.- In chronic cases. Burning itching, painful after scratching. Great weakness and prostration. Oppression of breathing.

Chinin. ars.- In the diffused form with threatening marasmus. Chronic intestinal derangements.

Iodine.- Small dry, red pimples on the arms, chest and back, with jerking sensation while appearing.

Rough, dry skin. Emaciation. Ravenous hunger.

Kali bichrom.- Papular eruptions on the forearms. Rheumatic pains in the limbs. In fat light complexioned individuals.

Ledum.- Eruption of pimples on the forehead as in brandy drinkers. Eruption of small pimples like red millet seeds over the body. Excessive itching on the backs of both feet, worse after scratching, and by warmth of bed. Relieved after scratching the feet sore.

Nux juglans.- Red pimples on face, neck, shoulders and back. Little tubercles with hard scurf on the in-step.

Potassium iodide.- Lichen on the face and shoulders. Sensitive swelling of the thyroid gland, great general debility.

Sarsaparilla.- Red dry pimples. Burning itching with chilliness.

Staphisagria.- Itching pimply eruption over the face and behind the ears, with rough skin. Burning of the eruption after scratching.

Sulphur iodide.- Red pimples on the nose, chin and arms, with itching. In chronic cases.

Lichen Ruber.

To Hebra is due the description of an eruption to which he applied the name above given. It, like lichen planus, is a papular affection, but the papules present a different aspect, and they are acuminate, not flattened. They do not exhibit the central hilum. The papules rarely if ever undergo spontaneous resolution, but persist throughout the entire period of the disease, which, as a rule, terminates with the patient’s death. The papules at first are discrete, and each is decked with a minute adhering scale. New papules continue to form, and in time considerable patches, raised, red, and scaly, come into existence.

The prognosis is essentially grave. A few cases have been reported cured, but in the majority the disease lasted until death terminated the patient’s existence.

Externally we may seek with some measure of success to procure resolution of the lesions by active substitutive treatment, involving the use of iodine, bichloride of mercury, carbolic acid, strong alkaline applications, etc.; but whether either or all of them is capable of retarding the usual termination is problematical.

There are several varieties of lichen given by different authors, but, as they are but forms of either the two above mentioned or lichen simplex, we will omit them, especially as they will be referred to in the description of the various lesions of the skin, and simply give a description of lichen simplex.

One case, reported in one of out journals I would like to mention, as showing the efficacy of a well chosen homoeopathic remedy.

The case, as reported, is as follows:

Cure of Lichen Urticarious by Thuja.

A gentleman brought his fourteen year old son for treatment for a skin affection that had defied two able specialists. He had been treated both internally and externally and strictly dieted- but without effect. The lichen was wont to come periodically in the warm weather; the patient literally tears himself because of the irritation. The rash was much worse on the left side, that being the side on which he was vaccinated. Thuja 30, was ordered in very infrequent doses. The spots continued to appear for a week after taking the powders, then they disappeared and he has remained quite free from them, although eating freely of meat, fish and fruit. It may be remarked that the cure took effect during warm weather, and that the urticarious lumps were described as worse in the warmth.

Melford Eugene Douglass
M.E.Douglass, MD, was a Lecturer of Dermatology in the Southern Homeopathic Medical College of Baltimore. He was the author of - Skin Diseases: Their Description, Etiology, Diagnosis and Treatment; Repertory of Tongue Symptoms; Characteristics of the Homoeopathic Materia Medica.