Rare presentation of Ulcerative Lichen Planus (Bars-e-Aswad Quroohi) – A Case Study

Abstract

Introduction: Lichen planus is a T-cell-mediated autoimmune inflammatory disorder of the skin and mucous membranes. It appears as pruritic, violaceous papules and plaques most found on the wrists, lower back, and ankles. This paper presents the case of 32 years old married female patient, who came to the National Institute of Unani Medicine OPD Bengaluru. Clinical presentation: Her chief complaints were severe pain, itching, and ulcerated lesions on the dorsal and plantar aspects of feet with loss of all the toenails for eight years. The lesions appeared as erythematous papules on dorsal surface of both big toes of feet and spread to the plantar aspect. Initially, lesions were violaceous, scaly and dry. Later, painful fissures developed with oozing of blood. As disease progresses, nails of feet are involved leading to anonychia. Diagnosis: The patient was diagnosed clinically as ulcerative lichen planus resembled to Bars-e-Aswad Qroohi in the Unani system of medicine. Interventions: The patient was treated with Joshanda Munzij Sauda (decoction) and Majoon Ushba (compound formulation) orally and Marham Asfeedaj for local application after foot bath from Safoofe Zaj. Outcome: Assessment of efficacy was done by physician global assessment (PGA) scales in three parameters (pruritus, pain, and fissure) before and after treatment. Conclusion: This Unani formulation effectively improves pruritus, pain, scaling, and fissures in Ulcerative lichen planus and may be considered for complimentary management of ULP.