APPROCH TO VITILIGO

AUTOIMMUNE DISORDER – APPROCH TO VITILIGO
Dr. S. Sabarirajan., M.D. (Hom)
An autoimmune disorder is any of a number of conditions in which a person's immune system reacts against the body's own organs or tissues, and the person's immune system produces antibodies to them. An autoimmune disorder is NOT an "immune deficiency". Vitiligo is a condition that causes depigmentation of sections of skin. It occurs when melanocytes, the cells responsible for skin pigmentation, die or are unable to function. In the case of vitiligo, we believe that the immune system probably sees the person's own pigment cells as foreign bodies, and attacks them, destroying them or weakening them. There is increasing evidence to support the view that vitiligo is an autoimmune disease and that it shows a familial trait in about 18% of cases. Vitiligo is a benign skin disorder due to loss of pigment. Estimated 1.2% of American and world population, about 8% of Indian and Mexican population suffer with this disorder.
Association Of Vitiligo With Autoimmune Disease:
Vitiligo is more common in people with certain autoimmune diseases (diseases in which a person's immune system reacts against the body's own organs or tissues). Autoimmune diseases that are associated with vitiligo include: hyperthyroidism (overactivity of the thyroid gland), adrenocortical insufficiency (the adrenal gland does not produce enough of the hormone corticosteroid), alopecia areata (patches of baldness), and pernicious anemia (a low level of red blood cells caused by the failure of the body to absorb vitamin B12).
The basis for the association between vitiligo and these autoimmune diseases is not well understood. Moreover, the connection between them seems optional. Most people with vitiligo, fortunately, have no autoimmune disease such as hyperthyroidism, adrenocortical insufficiency, alopecia areata or pernicious anemia.
Vitiligo & Hereditary
The cause of vitiligo is not fully known, but there are several theories. One theory of some substance is that people with vitiligo develop antibodies that, instead of protecting them, turn upon them and destroy their own melanocytes, the special cells that produce the pigment melanin that colors their skin.
Another theory is that the melanocytes somehow attack and destroy themselves. Finally, some people with vitiligo have reported that a single event such as a severe sunburn or an episode of emotional distress seem to have triggered their vitiligo. Events of this nature, however, have not been scientifically proven to cause vitiligo and may simply be coincidences.
Vitiligo may be hereditary and run in families. Children whose parents have the disorder are more likely to develop vitiligo. However, most children will not get vitiligo even if a parent has it, and most people with vitiligo do not have a family history of the disorder.
Psychological Effect
An important aspect of vitiligo is the psychological effect of the disease. Vitiligo is often immediately visible to others and those with the condition may suffer social and emotional consequences including low self-esteem, social anxiety, depression, stigmatization and, in extreme cases, rejection by those around them. In people with a pale white skin colour, vitiligo may cause little concern.
Aetiology
The cause of vitiligo is unknown, but research suggests that it may arise from autoimmune, genetic, oxidative stress, neural, or viral causes. various hypothesis are suggestive of its genesis. Among these the important ones are: -
• Immune Hypothesis - Melanocyte destruction and dysfunction or both may result into Hypopigmentation of vitiligo.
• Neural Hypothesis - Neurochemical inhibitors are released at nerve endings that destroy the melanocytes or inhibit their functioning.
• Melanocyte Self-Destruction Hypothesis - Proposes that an intermediate in melanin synthesis causes melanocyte destruction.
• Dietary deficiency of Proteins and Cupro minerals is a major factor for causing vitiligo. Serum skin and cerebro-spinal fluid copper levels are low in theses cases.
• A gastro-intestinal disorder like chronic amoebiasis, chronic Dyspepsia and Intestinal Worms may be additional factors.
• Use of Broad spectrum Antibiotics, especially Chloramphenicol and Streptomycin leads to appearance of vitiligo.
• Trauma or Local irritation caused by wearing the sari or Trousers too tightly do produce vitiligo in individuals predisposed to it.
• Acute Stress may be followed by fast spreading type of vitiligo proving the theory of Troponeurosis. Emotional crisis may be an additional factor.
• An Endocrinal disorder may be operative, Diabetes, Pernicious anaemia, Thyrotoxicosis, Myxoedema, and Addison's disease may be associated with vitiligo.
• 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 suggested.
Precipitating Factors: -
• Emotional Crisis - Death in family, Loss of job, Sudden shock etc.
• Gastro intestinal tract disorders like Worms, Jaundice, amoebiasis etc.
• Prolonged use of Drugs, antibiotics, Oral an ovulating agents etc.
• Local causes like trauma, burns exposure to chemicals etc.
• Pathologically: - A defect in enzyme Tyrosinase is held responsible for vitiligo. According to some Dermatologists, it is a Trophoneurosis and Melatonin, a substance secreted at nerve endings inhibits Tyrisinase, thus interfering in pigment formation.
Clinical Features
People with Vitiligo develop white patches on their skin of irregular shapes and sizes. Vitiligo is more common on the exposed areas for example hands face, neck and arms. It also occurs on covered areas too: – like genitals, breast and legs. In some patients the hair may also turn grey early and in the inside of the mouth, white discoloration may also occur.
The spread of Vitiligo cannot be determined. It may stop completely after the first patch but often these patches do spread. For some patients further development may takes years and for others the large areas can be covered in months. In some patients mental stress has been seen to increase the growth of these white patches.
The three main diseases that can be mistaken for vitiligo are tinea (pityriasis) versicolor, piebaldism and guttate hypomelanosis. Tinea versicolor is a superficial yeast infection that can cause loss of pigment in darker skinned individuals. It presents as pale macules typically on the upper trunk and chest, with a fine dry surface scale. Piebaldism is an autosomal dominant disease in which there is absence of melanocytes from the affected areas of the skin. It usually presents at birth with depigmented areas that are usually near the mid-line on the front, including a forelock of white hair. In idiopathic guttate hypomelanosis, multiple small, white macules are noted, mostly on the trunk or on sun-exposed parts of the limbs. When vitiligo affects only the genital areas, it can be difficult to exclude lichen sclerosus, which sometimes can coexist with vitiligo.
Vitiligo & leucoderma
Vitiligo is also known as leucoderma in India, which is technically not correct. Leucoderma simply means white (leuco) skin (derma), i.e. a disorder where the skin loses its normal color. Leukoderma is a cutaneous condition, an acquired condition with localized loss of pigmentation of the skin that may occur after any number of inflammatory skin conditions, burns, intralesional steroid injections, postdermabrasion, etc In case of leucoderma, there is partial and superficial pigment loss; while in case of vitiligo there is deep and complete pigment loss.
General Measures
Diet & Regimen: Foods that are excessively sour should be avoided. The ascorbic acid in sour foods tends to reduce melanin pigmentation. So the patients should restrict their intake of citrus foods. Non vegetarian foods are also to be avoided as they act as a foreign body to pigment cells. Flavoured drinks are to be avoided. Artificial colours used in various food preparations should also be avoided. There may not be enough scientific evidence to prove how these foods worsen vitiligo.
Healthnotes Newswire (August 21, 2003)—Supplementation with a standardized extract of ginkgo (Ginkgo biloba) may help slow the progression of skin depigmentation and actually increase pigmentation in adults suffering from vitiligo, according to a study in Clinical and Experimental Dematology . Other nutrients that may be useful in treating vitiligo include picrorhiza (Picrorhiza kurroa), a traditional Indian herb, may also stimulate repigmentation of skin in people with vitiligo.
Supplementation - A small study at the Department of Dermatology of the University of Alabama Birmingham Medical Center found that supplementation with folic acid, vitamin B12, and vitamin C resulted in noticeable repigmentation of the subjects' skin. Taking a vitamin-B complex containing 100 milligrams of each of the major B vitamins and at least 400 micrograms of folic acid daily; 1,000 micrograms of vitamin B12 daily, and 2,000 milligrams of vitamin C twice daily.
Ayurveda, Natural Treatment - Local application of Babchi Oil over the depigmented areas, Use of Copper utensils.
Homoeopathic Management
Homoeopathy treats the person as a whole. It means that homoeopathic treatment focuses on the patient as a person, as well as his pathological condition. Homoeopathy is able to give wonderful and miraculous cures in many cases of Vitiligo. This is due to the fact that homoeopathic treatment enhances the natural production of pigments. According to homoeopathic philosophy Vitiligo not a disease in itself but an expression of an inner disturbed state of the body. Thus, the cure should occur at a level where things have gone wrong.
Boericke- skin- leucoderma. - Ars.alb., Ars.sulph.flavum., Bacillinum., Graphites., Merc sol., Nat.mur., Nit.acid., Nux vom., Phos., Sep., Sil., Sulph., Thuja.
• Arsenicum Sulfuratum Flavum - This is one of the specific remedies used for the treatment of vitiligo in homeopathy. It has discoloration of the skin in blotches that are pale or white in color. It is also a good remedy for eczematous lesions which are moist and have intense itching with corrosive discharge. Pyoderma and urticaria also find a solution through this drug.
• Bacillinum - The patient is suffer from chronic cold, cough & occasional history of haemoptysis. He has loss in weight, loss of appetite, flat chested young boys & girls, prominent ribs & prominent clavicles. We get history of asthma, pneumonia, bronchitis & even T.B. in patients. A Maceration of a Typical Tuberculous Lung Mind. Taciturn, sulky, snappish, fretty, irritable, morose, depressed and melancholic even to insanity. Fretful ailing, whines and complaints; mind given to be frightened particularly by dogs.
• Graphites - Obese patient with a history of suppressed itch. Suited to – Excessive cautiousness; timid, hesitates; unable to decide about anything. Fidgety while sitting at work. Sad, despondent; music makes her weep; thinks of nothing but death.
• Merc sol. - There is history of dysentery with mucus & blood. Jaundice with liver enlargement. These patients are worst at night with salivation & have a syphilitic miasm. They perspire in bed & do not tolerate too hot or too cold climate. Nervous affections after suppressed discharges especially in psoric patients. Glandular and scrofulous affections of children.
• Nit. Acid - White spots are found at the muco-cutaneus junction. More at the angle of the mouth, eyes, nose, nipples, glans penis, vulva, etc. Along with it, there may be fissure at the same spot. In some of the patients along with this there is a desire for eating chalk, pencils, etc., particularly in children.
• Sepia - Best acted in females. Beside the usual white discolouration, these patients have irregular menses either early or late, scanty & painful menses in young girls. Leucorrhoea, prurites, dysparunia, & frigidity is noted. Most of the patients complain of morning sickness along with motion sickness, nausea, vomiting or headache travelling in a car or bus. These patients are not social, they prefer to be alone. Adapted to persons of dark hair, rigid fibre, but mild and easy decomposition.
• Sulphur - There is a history of suppression of skin diseases or any other suppression like suppressed diarrhoea, dysentery, jaundice, typhoid & in tropics many other fevers. There is heat in the palms, soles, eyes, anus, vulva, vagina & on the top of the head. Generally hot patient but could be chilly. Irritability & obstinacy is also noted. Adapted to persons of a scrofulous diathesis, subject to venous congestion; especially of portal system. Persons of nervous temperament, quick motioned, quick tempered, plethoric, skin excessively sensitive to atmospheric changes. For lean, stoop-shouldered persons who walk and sit stooping like old men. Standing is the worst position for sulphur patients; they cannot stand; every standing position is uncomfortable. Dirty, filthy people, prone to skin affections. Aversion to being washed; always <. after a bath.
• Thuja - There is history of vaccination. There is dreams of falling, startling in sleep, have warts on face or on the body, with loss of appetite after vaccination. There is history of tuberculosis or respiratory diseases. Adapted to hydrogenoid constitution of Grauvogl. Acts well in lymphatic temperament, in very fleshy persons, dark complexion, black hair unhealthy skin. Ailments from bad effects of vaccination; from suppressed or maltreated gonorrhoea. Fixed ideas: as if a strange person were at his side; as if soul and body were separated; as if a living animal were in abdomen; of being under the influence of a superior power.

In order to archive this, the patient is analyzed on various aspects of mental and physical and familial attributes and also a complete study is done on the psychological-environment that the patient has gone through in his life. The exact remedy is best chosen by a qualified homoeopath.
References
1. Harrison's Principles of Internal Medicine
2. http://en.wikipedia.org/wiki/vitiligo
3. Homeopathic Materia Medica by Boericke
4. http://viticlear.com/vitiligo.asp
5. http://en.wikipedia.org/wiki/Leukoderma
6. Vitiligo: Current Knowledge & Nutritional Therapy by MD, MS and FRCPC Leopoldo F. Montes
7. http://www.njhonline.com/forums/viewtopic.
8. http://hpathy.com/cause-symptoms-treatment/vitiligo-leucoderma-2/
9. Lilienthal S., Homoeopathic Therapeutics
10. http://www.drhomeo.com/about/
11. http://www.homeorizon.com/homeopathic-articles/dermatology/vitiligo-cure
12. Wanakee' s Nutritional Approach to Vitiligo & Other Autoimmune Diseases by Wanakee Hill N.D. and Michael D Hill
13. http://www.askdrshah.com/remedies.htm
14. http://hpathy.com/cause-symptoms-treatment/vitiligo-leucoderma/
15. Dewey W. A., Practical Homeopathic Therapeutics


Dr. S. SABARIRAJAN., M.D. (Hom) (Prac. of Med), Professor, Dept. of Practice of Medicine