An Ayurvedic Clinical Approach To NSAID-Induced Lichen Planus Pigmentosus: A Case Study

Abstract

Lichen Planus Pigmentosus (LPP) is an immune-mediated pigmentary disorder characterized by diffuse, greyish-black macules, predominantly affecting sun-exposed and flexural areas. NSAID-induced LPP represents a drug-triggered variant resulting from type IV management, including topical corticosteroids and tacrolimus, often yields limited results. Ayurveda correlates LPP with Kitibha Kushtha, a Ksudra Kushta, presenting with Shyava Varna, Parushata, Kandu and Kina-Khara Sparsha. Management is focused on Nidana Parivarjana, Shodhana, and Shamana Chikitsa. Case Presentation: A patient with NSAID-induced LPP presented with diffuse greyish-black pigmentation and mild pruritus over the neck. Based on Ayurvedic evaluation, the condition was diagnosed as Kitibha Kushta with predominant Vata-Kaphaja involvement. Intervention: Treatment commenced with Deepana-Pachana using Trikatu Churna, followed by Shodhananga Snehapana with Indukantham Ghrita. Sequential Vamana and Virechana therapies were administered 3 months apart. After Shodhana, Shamana Chikitsa included Aragvadhadi Kasaya, Khadirarista, Manibhadra Gula, and Gandhaka Rasayana, with Manjishtadi Taila for Sarvanga Abhyanga. Pathya Ahara-Vihara (Dietary and lifestyle modifications) were strictly followed. Outcome: Significant reduction in pigmentation, pruritus, and burning sensation was observed, along with overall improvement in skin tone and texture. No adverse effects were reported during the therapy or follow-up. Conclusion: This case demonstrates the efficacy of a structured Ayurvedic protocol combining Shodhana and Shamana Chikitsa in managing NSAID-induced LPP. The integrative approach effectively alleviated symptoms, enhanced skin health.