Jordi | Journal of Oral DiagnosisOnline SubmissionReview an ArticleSOBEP - Sociedade Brasileira de Estomatologia e Patologia Oral
Volume 2 - 2017


Original Article

DOI: 10.5935/2525-5711.20170001

Homeopathic treatment in oral lichen planus control: Case Report

Rafaela Savio Melzer B. F. Wastner; Fernando Luiz Zanferrari; Laurindo Moacir Sassi

Hospital Erasto Gaertner

Corresponding authors: Hospital Erasto Gartner
Marta Dering Sobrinho, 94 - Ferrari
Campo Largo - Paraná, Brasil. CEP: 83606330
E-mail: rafamelzer@hotmail.com

Article received on February 6, 2017.
Article accepted on February 9, 2017.

 

ABSTRACT

Lichen planus, considered an inflammatory disease of the stratified squamous epithelium of unknown aetiology, is a condition that often affects the oral mucosa. This pathology is more prevalent in female caucasian patients and the signs and symptoms range from asymptomatic to completely debilitating painful mucosal lesions.
OBJECTIVE: To report a case of a patient affected by lichen planus, whose treatment was homeopathic.
CASE REPORT: Female patient with pain complaints in oral mucosa and presence of whitish plaques in bilateral buccal mucosa that exacerbate during periods of stress. The lesions were controlled by homeopathy medication, which leaded to regression of the lesions and provided comfort to the patient.
CONCLUSION: The use of homeopathy in Dentistry is a new concept, which has been growing and proving to be effective, especially when related to autoimmune diseases, where the stress is a factor linked to the development/ exacerbation of the signs and symptoms.

Keywords: Mouth; Homeopathy; Lichen Planus, Oral

 

INTRODUCTION

Lichen planus (LP), considered an inflammatory disease of the stratified squamous epithelium of unknown aetiology, is a condition that often affects the oral mucosa, although may also affect other mucosa and skin. This pathology is more prevalent in female Caucasian patients between the 3rd and 6th decades of life1,2. The occurrence is rare in children and in men, although its report on the literature is becoming more common. The literature describes six clinical manifestations on the mouth: papular, reticular, plaque, erosive, atrophic and bullous1. It is also believed that stress or some kind of virus, i.e. hepatitis c virus, may be related to the appearance of the lesions 2. Some recent findings reveal that patients with oral lichen planus (OLP) have significantly higher levels of stress, anxiety and depression when compared to patients without the condition3. Signs and symptoms may range from completely asymptomatic cases to sensitivity, burning and debilitating pain of the mucosa and it is known that periods of remissions and exacerbations may occur3. Generally, the lesions are bilateral with frequent involvement of the oral mucosa, although tongue, vestibule and gums may also be affected4. The recommended treatment for OLP consists on topical corticosteroids in order to reduce symptoms and improve the quality of life of the patients. However, in case of persistent lesions, systemic corticosteroids are indicated2. Thus, considering the importance of this pathology and the high incidence in the population, the aim of this paper is to report a case of a patient affected by LP, whose treatment was homeopathic.


CASE REPORT

Female patient, 40 years old, attended the Department of Oral and Maxillofacial Surgery of Erasto Gaertner Hospital in 2007 with complains of burning and parestesia in the oral mucosa. Oral exam revealed the presence of whitish streaks on bilateral buccal mucosa, with pathological examination report compatible with LP. Therefore, Ignatia amara 6CH - I/30cc was prescribed and the patient was referred to a dermatologist for skin evaluation (Figure 1). One year later, the patient returned and revealed that due the appearance of vaginal mucosa lesions, was in medical treatment. On oral examination was noticed that the lesions remained stable. One year later, the patient returned with exacerbation of the lesions on the right buccal mucosa, which acquired erosive aspect (Figure 2). Therefore it was requested the anti-HCV test to evaluate a possible hepatitis C infection, which was not confirmed. Homeopathic clinical history was taken and the medication was replaced for Natrum muriaticum 12 CH - I/30cc. During the first month of treatment, there was exacerbation of lesion, followed by reduction of those and of burning mouth complaints. It was then prescribed Natrum muriaticum 30 CH - I/30cc, however, the patient did not follow the treatment and again presented symptoms. Then, was prescribed Natrium muriaticum 1SD, 2SD, 3SD and 4SD I/30cc, 5 drops directly on the tongue, twice a day. After three months, there was a reduction in the size of the lesion in the right buccal mucosa and was continued the homeopathic treatment with Natrum muriaticum 6SD, 7SD and 8SD I/30cc. In addition, the patient presented more calm and happy with the results achieved until that date and reporting less oral symptoms. After the beginning of the homeopathy, skin lesions in the right forearm region appear. The lesions in the oral cavity have returned after an episode of family dispute reported by the patient. In continuity with the homeopathic treatment, was prescribed Natrum muriaticum 13SD I/30cc and the lesions of the two affected sites have become asymptomatic in less them 1 month. After six months of stable and asymptomatic lesions, there was an episode of exacerbation of the oral lesions and the appearance of skin lesions in the fingers starting after the use of allopathic medication for cardiac arrhythmia. In 2012, homeopathy was already in concentration 31SD I/30cc and, in this same period, bilateral lesions in the oral mucosa had become symptomatic since the patient was investigating with the doctor a lump in the breasts. Ruled out the presence of breast pathology, the patient had no more complaints and oral lesions became asymptomatic again. Seven years since their first exam and using Natrum muriaticum 52SD I 30cc, lesions in the mouth and skin exacerbate after situations of stress, sadness and disappointment with her son. Currently, the patient is in regular follow-up, has stable LP lesions in oral mucosa and skin and is taking Natrum muriaticum 58SD I/30cc. The evolution of the case is shown on the timeline (Table 1).


Figure 1. Irregular plate with crusted surface on arm.


Figure 2. Presence of ulcerated mucosa in the right cheek.




DISCUSSION

The use of homeopathic treatment in LP has been described in the literature as a possible alternative to corticosteroids. Medications like Antim-crud., Ars-alb., Ars-iod., Jugl-c., Kali-bi., Sul-iod, Ign, Sepia, Sulphur and Thuja, for example, have already been tested and proved effective in controlling this pathology5,6. Mousavi et al7 in a single blind randomized control clinical trial with 30 patients with OLP treated with Ignatia noted that there was a statistically significant reduction of pain and size of lesions compared to the control group (placebo). These authors also report that, after the treatment, the patient had an improvement of quality of life and was able to eat better and perform oral hygiene without discomfort. Ignatia amara is suited for nervous temperaments, women in a sensitive and excitable nature and of great contradictions8. In the case described in this paper, the initial prescription was also Ignatia Amara, given the emotional elements presented in the first instance. However, a new homeopathic interview revealed other features that culminated in the replacement of the medication by Natrum muriaticum. Among the mental characteristics of Natrum muriaticum, according to Materia Medica8, are: "Psychic causes of disease; ill effects of grief, fright, anger, depressed, particularly in chronic diseases. Consolation aggravates. Irritable; gets into a passion about trifles. Awkward, hasty, Wants to be alone to cry".

LP is a T-cell-mediated autoimmune disease. Inflammatory cells involved in this process consist of T helper and T cytotoxic lymphocytes, natural killer (NK) cells, and dendritic cells. T-cell activation is central to the pathogenesis of the pathology. Cytotoxic T-cell infiltration into the epithelium results in apoptotic basal keratinocytes9. LP is a complex disease and hus can be caused or triggered by genetic malfunction and/or environmental factors. The existence of familial cases of LP may suggest a possible genetic predisposition10. Associated factors and disease conditions seen in LP include but are not limited to stress/anxiety, hepatitis C virus (HCV), autoimmune diseases, internal malignancies, dyslipidemia, and viral infections11.

The use of homeopathy for the treatment of OLP is based primarily in its correlation with stress, as previously described in the literature. It has been documented that if the adrenal medullary sympathetic system is activated excessively, persistently and too often, illness and disease may occur12. Chronic stress may cause a reduction in mitogenesis, alterations in lymphocytes, reductions in the ratio of T-helper cells and T-suppressor cells and an elevation in the number of natural killer cells13.

Nanoy et al14, in a study with 148 patients with OLP reported that 51% of them revealed having experienced stressful life events prior to the appearance of the lesions. Furthermore, over 37% of patients believed that the pathology was caused by stress. The main categories of causes of stress were death and illness of beloved ones, work and interpersonal and family relationships. At this point, one can understand that the main purpose of the homeopathic remedy is help the patient to make the effort of facing his conflict, adjusting himself to reality and of integrating himself as a healthier person15. This process is what happened to the patient described in this paper who, during the years, learned how to co-exist with her condition and make internal adjustments that made her able to overpass the difficulties that all social relations brings along to people involved.


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