Clinical Management of Hyperkeratotic Lichen Planus Associated with Grahani through Virechana Karma: A Case Report

Background: Lichen planus is a chronic inflammatory disorder of the skin and mucous membranes. Hyperkeratotic lichen planus is characterised by thickened, persistent skin lesions. In Ayurveda, these manifestations may correlate with Kitibha Kushta. This case report describes the clinical management of hyperkeratotic lichen planus associated with gastrointestinal symptoms interpreted as Grahani, using an individualised Ayurvedic treatment approach. Case Presentation: A 38-year-old female patient presented with multiple intensely hyperkeratotic, dark brown-to-black lesions over both upper limbs for approximately 18 months. Associated symptoms included loose stools after meals, colicky pain during defecation, reduced appetite, disturbed sleep, and psychological distress. The clinical diagnosis was hyperkeratotic lichen planus, correlated with Kitibha Kushta in Ayurveda. Intervention: The patient received individualised Shamana Chikitsa, followed by Snehapana with Panchatikta Ghrita and Virechana Karma using Manibhadra Avaleha. Outcome: The reported clinical assessment showed improvement in cutaneous manifestations and gastrointestinal symptoms. The presentation documented approximately 72% overall clinical recovery. The reported Lichen Planus Severity Index decreased from 80 to 22.4; however, the scoring calculations require verification. Conclusion: This case describes an integrated Ayurvedic approach to hyperkeratotic lichen planus associated with Grahani. The patient reported clinical improvement after individualised treatment, including Virechana Karma. As this is a single case report, further systematic investigation is required to evaluate the efficacy and safety of this therapeutic approach.