Vitiligo is an idiopathic depigmentary disorder which is wide spread in our country , the percentage of people suffering from this disease in India is higher than in western countries , because of its disfiguring presentation it gives rise to severe psychological strain ( also social stigma by many ) , it is characterized by progressive well circumscribed cutaneous white macules and patches of varying sizes and shapes . They are whitish almost milky in appearance and uniform in color with well demarcated edges because of peripheral hyperchromia . It is common to find over the patch depigmented , graying of hair is noticed before the appearance of the vitiligo patch . A single white stand of hair could be the first sign of vitiligo of the scalp . the lesions are found mainly on the face , neck , forearms , the dorsum of the hands or soles of the feet besides loss of pigmentation no other structural change is seen but other disorders like diabetes , hyper thyrodism pernicious anaemia , carcinoma of stomach etc, may be associated , the peak incidence of the disease is between 10-30 years .
Etiology of vitiligo is obscure , various hypothesis have been suggested for its genesis , among them important ones are :
- immune hypothesis : suggests an aberration of immune surveillance which results in melanocyte destruction and dysfunction or both
- Neutral hypothesis : suggests that neuro chemicals inhibitor is released at nerve endings that destroy melanocytes .
- melanocytes self destruction hypothesis : proposes that an intermediate in melanin synthesis causes melanocyte destruction .
- composite hypothesis : none of the theories alone is entirely satisfactory , actual mechanism of inhibition or destruction of melanocytes is much more complex than any of these mechanisms suggests .
precipitating factors :
immediate precipitating cause for most of the cases is inapparent but few are :
- emotional crisis – death in family , loss of job etc,
- g.i.tract disorder
- prolonged use of antibiotics oral anovulating agents
- local causes like physical injury , trauma burn , etc, wearing rubber goods .
clinical classification :
from the clinical and treatment point of view vitiligo has been divided into 3 types .
Active progressive stage :
- new lesion developing
- lesions increasing in size
- border ill defined .
Quiescent stage :
- no new lesion developing
- lesions stationary in size
- border hyperpigmented and well defined .
Improving stage :
- lesions decreasing in size
- no new lesions developing
- border defined and signs of spontaneous repigmentation .
HOMOEOPATHIC APPROACH :
It has been mentioned that vitiligo is a progressive systemic disease of unknown etiology that destroys pigment cells in epidermis , there patches of varying sizes and shapes with no other structural changes .
Depigmentation of skin is the sole complaint , hence it can be named under the class of local diseases . we can consider vitiligo a local malady with causa-infernal but according to the studies conducted , this disease usually superficially appears as one sided due to lack of observation on the part of the physician and the patient . a thorough case taking and deep evaluation of the case uncovers many concealed dis equilibrium in mental , emotional and physical plane in addition to the depigmentation of the skin and all these together constitutes the totality of the case which have been given maximum weightage in our practical approach .
Miasmatic Analysis Of Vitiligo :
The study of patho-physiology of vitiligenous lesions shows that it involves destruction of melenocytes which indicate syphilitic miasm underlying , in addition
The absence of itching in these lesions further enhances our view about the syphilitic miasm . In chronic local maladies that are obviously veneral the internal antipsoric treatment is alone requisite suggests that it is psoric in nature , sycosis disturbs the pigment metabolism and produces hyperpigmentation and depigmentation in patches or diffuse in different parts .
Basis Of Prescription :
Efforts have been made to prescribe on the principle of totality of symptoms – which includes symptoms expressed by the patients and their attendants (with modalities)the exciting cause ; the fundamental (miasmatic) causes and the accessory circumstances of the case in hand following spheres have been approached to the similimum .
- constitutional sphere
- temper mental sphere
- cravings and aversions sphere
- specific sphere
this was done in cases where a relevant history as regarding the drug selection could not be obtained .
“ arsenicum sulpha flav-3X” was given but it had only placebo effect , probably study on larger groups of patients would be more justified .
Selection of Potency and Repetition :
All medicines were given in 30, 200, 1M’s higher potency . “Nosodes “were given in 200’s higher , “ars sulph flav “ was given in 3X potency , the indicated medicine was given in 3 fractional dose for one day which was followed by placebo for 2 weeks , repetition of the same potency was done till it continued to act , potency was increased to next higher stage when scar in repigmentation process was observed or new fresh lesions developed . When patient was not responding to the medicine given , the case was reviewed and a true similimum was selected . Vitiligo is not a one sided disease , proper case taking evaluation is a must in the selection of true similimum , common polycrests selected are most effective .
Reasons of Failure :
- steroid treated cases have lower reactivity and poor characteristics
- emotional and psychological factors
- misconceptions that homoeopathy is slow and patients dropout in apprehension even before a fair trial .
- use of antibiotics for intercurrent illnesses
- age above 45 years and low vitality.
The origin of the term vitiligo is obscure like the disease itself , some believe it is derived from the latin word “vitelius “ meaning veal , which is the pale pink flesh of calf , because the lesions resemble the white patches of a spotted calf . Interestingly , the rigveda named leucoderma as “kilas” meaning a white spotted deer .
Down the ages many homoeopathic medicines have been used for treating vitiligo and leucoderma . If homoeopathic practitioners used an oily extract of psoralia corlifolia seeds , commonly called bavachee , bouchi or vasunchike . The Egyptians relied on a dried poder made from the fruits of a herb named amni majus . These preparations were capable of produsing pigmentation in many cases , even today dry powder from bouchi seeds of Gaya-Bihar , is popular and is mailed all over the country to any one who needs it . those who recommend it advise the patients to mix it with rose water , distilled water and even cow’s urine and apply on the white patches . After a fixed time the patch should be exposed to sunlight .
Basically modern medicine also applies the same theory of applying a drug on the patches and exposing them to ultraviolet light , but the exact composition of the drug used is known , which is not the case with the bouchi seeds .
Since there is no definite known cause for vitiligo a number of myths persist . The most common are related to food “ people are told to avoid combinations like curd and chutney , in fact any white food item some doctors advise the patients to avoid anything that contains vitamin C including citrus fruits but there is no truth in any of these “ . Though vitiligo affects all human races , the highest incidence has been recorded in India ( three to four percent ) and Mexico . Many patients have a family history of vitiligo which possibly indicates genetic factors . the familial incidence is 20 to 30 % in India and between 7.5 to 41 % abroad . leucoderma ( literally white skin ) is different from vitiligo . The former has a known cause ; it is usually caused by prolonged contact with chemicals that destroy the skin’s color , unlike vitiligo , leucoderma is not progressive and does not spread other parts of the body .
Many people develop leucoderma after continuous contact with articles that contain chemicals like phenols . The most common cause is plastic slippers that have these chemicals . A definite pattern of de pigmentation can be seen along the points of maximum contact , women who wear low quality bindis are also prone to developing leucoderma . The effect can be seen as a white patch on the fore head in the exact shape of bindi . some times , leather objects , watch straps , elastic bands etc ., also cause loss of colour , severe damage to skin burns too can have the same effect , some people who have extensive leucoderma use creams to remove the patches of brown skin that remain in the white area , these creams (benoquin is a common one) are usually purchased over the counter without prescription , these drugs are harmful and can cause irreversible de pigmentation , it is impossible to treat such cases . Vitiligo patients who have received homoeopathic treatment have shown steady improvement . The stigma attached to vitiligo is unbearable to the victims and their relatives , medically it is one of the most harmless afflictions and does not spread to others , even by the most intimate contact , yet vitiligo victims are considered untouchables and if the patient is a woman of marriageable age , god only help her . Some help can come from the doctors too now homoeopathic treatment , vitiligo , leucoderma , and psoriasis .
The most popular allopathic form of treatment for vitiligo involves the application of the psoralen cream on the affected part and its exposure to sun light after about an hour . Psoralen helps in making the area sensitive to light , enabling it to absorb the ultraviolet rays , when this therapy makes use of long wave ultraviolet (A rays) from an artificial source . The therapy involving exposure to sun light has obvious disadvantages , one may not get enough light in the right intensity all the time and it is impossible particularly for women to expose every part of the body affected by vitiligo . the whole body homoeopathic treatment is convenient , faster and more effective .
Leucoderma Cured By “ Sepia “
Sepia is useful particularly in females , besides the usual white discolouration ,these patients have regular menses , late, scanty ,painful menses in young girls , leucorrhoea , pruritis , dysmenorrhoea and frigidity . Most patients give H/O morning sickness , vomiting , nausea , travelers head ache , swings merry-go-round etc., also affect her , the remedy removes the above symptoms and the white spots become pink in color but do not disappear completely . “sepia “ requires to be complemented with “ Natrum Muriaticum “ to complete the cure .