2. Dr Zakia Farheen
3. Dr Manab Sagar Mardi
[Abstract: The following paper describes the positive outcome of homoeopathic treatment in the case of focal lesion vitiligo. On the basis of totality of (especially focusing on the constitution of the patient) Pulsatilla was prescribed on repeated ever-increasing potency which ultimately cured the vitiligo of the patient.]
Keywords: Homoeopathy, vitiligo, Pulsatilla.
Vitiligo is a common form of localized depigmentation. It is an acquired condition resulting from the progressive loss of melanocyte. It is characterised by milky white sharply demarcated macules1.
Vitiligo is a common pigmentary disorder of the skin with a worldwide incidence of 1%. Some dermatological outpatient records show the incidence of vitiligo to be 3%-4% in India although an incidence as high as 8.8% has also been reported. In the Indian states of Gujrat & Rajasthan the prevalence of vitiligo is very high2.
CLASSIFICATION1: According to “A Recent Vitiligo Global Issue Consensus Conference”. It can be classified into 4 types:
- Segmental vitiligo: It has 3 types:
- Non-segmental vitiligo:
e) Rare variant of vitiligo
f) Focal lesion: Small isolated depigmented lesion that are not segmentally distributed & have not evolved into non-segmental vitiligo after 1-2 yrs.
g) Isolated mucosal lesions on one site are considered as undetermined/Unclassified vitiligo.
Vitiligo is an autoimmune condition in which multiple immune response genes are believed to be involved. Studies have shown that vitiligo may be caused by a response to oxidative stress, mediated by T cells and involving mediators such as tumour necrosis factor alpha(TNFα), heat shock protein 70( Hsp70), and interleukin 1 alpha (IL-1α).Melanocyte destruction is initiated by an imbalance in the production of reactive oxygen species (ROS) that causes free radical damage to cell endoplasmic reticulum. The severity of Vitiligo may be assessed by measuring superoxide dismutase, a by-product of oxidative stress that increases when vitiligo is active but regresses when lesion become stable. Cytokines and chemokines such as C-C chemokine ligand 5 (CCL5), CXC chemokine ligand 12 (CXCL 12), interleukin 1 alpha (IL-1α) and tumour necrosis factor alpha (TNFα) have been shown to have a major role in autoantigen presenting cells(APCs) and activated T-cells and to have a role in destruction od skin melanocytes, supporting the autoimmune etiology of vitiligo.3
Pulsatilla nigricans is a polychrest medicine which is suited to persons of indecisive, slow, phlegmatic temperament; affectionate mild, gentle timid, yielding disposition is very useful in all disease condition when prescribed on the basis of totality especially focusing on its mental symptoms and physical constitution of the patient4.
Dr Hahnemannn gives a fair idea on the importance of constitution in aphorism 5 of the Organon of Medicine, wherein he states “ Useful to the Physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to chronic miasm. In these investigations, the ascertainable physical constitution of the patient( especially when the disease is chronic) his moral & intellectual character, his occupation, mode of living & habits, his social & domestic relations his age, sexual function, etc. is taken into consideration5.
Vitiligo can be a frustrating condition to treat. Spontaneous repigmentation occurs in no more than 15-25% of cases. Response is typically slow.6
Surgical treatment can be applied to limited lesion if medical treatment does not prove beneficial. Surgery is recommended primarily in patients with treatment resistant vitiligo, specifically segmental vitiligo which does not reactivate with injury.6
CASE STUDY: A 30 yrs old Hindu patient with moderate built constitution, presented with hypo-pigmentation of wrist. The complaint of hypopigmentation on left side of wrist present since 5 months. The causation was unknown. While taking history of presenting complaints, it was found that initially it was started as a white dot spot & gradually spreading. Patient had a history of Chicken Pox- 2 yrs ago also had a whitish eruption in groin since 2 yrs had applied cream but no significant result.
In family history, it was found that his mother suffered from generalized vitiligo grandmother – Ca of the throat.
Generalities included easy catches cold easily appetite good, patient thirstless. Tongue was moist white-coated stool urine was clear. There was a pain in arm after sitting for a long time.
Mental generals: The patient was very mild & gentle.
Clinical finding: On physical examination & systematic examination no abnormality was found.
Homoeopathic medicine was given & advised not to take citrus fruits, curds, etc
The homoeopathic medicine prescribed after a case analysis was Puls 200/ 1 dose.
|[Kent][Extremities]Discolouration:Upper Limbs:White:In Spots:(1)||1|
Criteria for selection of remedy was the analysis of the case:
Patient had a history of skin disease treated by allopathic medicine, mother suffered from generalized vitiligo, grandmother- CA of throat.
Patient had an easy tendency to catch cold easily, desire for sour. Patient is thirstless. After repertorization Pulsatilla, Arsenicum album, Apis, Veratrum album came out to be the best-indicated drug for prescription. After considering the constitution & mental makeup of the patient the best remedy ruled out was pulsatilla.
Follow-up assessment of outcome:
|Date of visit||Symptoms||Vitiligo noticeability scale||Remedy||Improvement|
|02.12.2017||Hypopigmentation slightly decrease.||3||Placebo is given for 15 days||Better|
|03.1.2018||Hypopigmentation is same as before||1||Placebo is given||Same|
|10.2.2018||Hypopigmentation is same as before||1||Pulsatilla 1M/1 dose is given.|
|24.2.20018||Hypopigmentation decrease more than before. Snoring at night.||3||Placebo is given for 15 days.||Better|
|10.03.2018||Hypopigmentation is better than before. Dyspnoea< at night > sitting.||3||Pulsatilla 10M/ 1 Dose is given||Better.|
|09.06.2018||Vitiligo still persist. No dyspnoea. Thirstless||3||Pulsatilla 50M/ 1 dose is given||Better.|
|28.08.2018||No vitiligo present||5||Placebo is given||Better|
Assessment outcome: On 28 August, there was no white spot present.
In Vitiligo noticeability scale, the score was 5 (success score).
Discussion and Conclusion
Vitiligo is an autoimmune disease that can be very frustrating condition to treat. This is a focal lesion vitiligo where patient presented with hypopigmentation & by individualized homoeopathic treatment repigmentation occur. Homoeopathic medicine includes a holistic approach to the understanding of the patient & integrate this approach to provide individualized patient treatment. The range of action of homoeopathic medicine aims to strengthen the action of immune system through the primary understanding that symptoms are an attempt by the immune system to achieve balance. The fundamental principle of homoeopathy is “let like be treated by like”.
Therefore, by individualised homoeopathic treatment given according to homoeopathic principles, the improvement may last longer.
- Christopher EM, Barker J, Bleiker T, Chalmer R, Rook’s Textbook of Deramtology#9th ed: Blackwell, Wiley; 2016.
- Mohamed GF. Coma HA, Highlights in the pathogenesis of.Oct 28,2014
- Manga P. Elbuluk N, Jorlow S. Recent advances in Understanding Vitiligo 2016 Sep 6.
- Hering C. The Guiding Symptoms of Our Materia Medica, Vol 4. New Delhi ; B.Jain(p) Ltd
- Dudgeon R.E, Organon of Medicine New Delhi; B.Jain Publishers 1810.
- James WD. Berger GT. Andrews Diseases of The skin Clinical dermatology.# 12th edn: Elsevier, 2015 May 19.
- Kent JT. Repertory of the Materia Medica.6th ed. New Delhi : B.Jain Publishers (p) Ltd.
About the authors:
2. Dr Zakia Farheen
3. Dr Manab Sagar Mardi