Skin is made up of many layers. Skin is the largest organ of the body. It protects, maintains the temperature balance, releases out the toxins out of the body in the form of sweat and maintains the equilibrium. It reflects the internal and general health of the person. Unhealthy, Patchy, Dry, Discolored and Pigmented skin depicts indication for certain medical diseases. Though People crave for fair skin.
Skin cell contains Melanin, a dark pigment that gives the Colour to the Skin and protects it from the strong rays of the Sun that are particularly harmful. If the Melanin is destroyed at certain part of the body or not produced then the skin looses its colour and turns leave white spots known as Leucoderma or Phulveri in laymen’s language. Leucoderma means Leuco – White and Derma – Skin also known as Vitiligo in medical terminology. It is also true that all white spots are not of leucoderma.
Children born with congenital absence of Melanin have complete white skin of the whole body called Albinism that is a congenital and incurable condition.
Though the exact cause of Leucoderma is not known to the medical world still Stress, and General Low Immunity level are considered certain precipitating factors for this ailment. Vitiligo the depigmentry disorder is wide spread in India and has higher percentage than in Western countries. Because of its disfiguring presentation, it gives rise to severe Psychological Strain and Social Stigma. The Occurrence of leucoderma is Stress related is about 42 %; Hereditary 28% and Worms infested 30%.
Leucoderma patch may start as a small white colored almost milky patch that keeps on increasing in varying size and shapes. Patches are usually uniform in colour with well-demarcated edges because of peripheral hyperchromia. It may occur anywhere on the body or all over the body but still the commonest sites are around lips, on cheeks, bilaterally distributed on legs, hands, fingers, chest or back around the eyes and even on the head. A single white strand of hair could be the first sign of vitiligo on the scalp. Few patients have these patches around or over the joints like elbow, knee etc. Most of the times people get scared of any white patch on the body and fear it to be leucoderma, but any and every white patch is not of leucoderma they can be because of Liver disorders, Worms, Taenia infection, Calcium deficiency Injury or burns spots or even Leprosy. As such patient of leucoderma does not have any problem or symptoms like Itching, Pain, Discharge etc. whatsoever but still the patient seek treatment for cosmetic reasons.
Though the aetiology of vitiligo is obscure, 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 Proeins 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 Presentation of Vitiligo
Localised Type: –
Focal – One or more macules in two single areas but not segmented.
Segmental – One or more macules in a dermatomal pattern.
Mucosal – Involvement of mucous membrane alone.
Generalised Type: –
Acrofacial – Involvement of face and distal extremities.
Vulgaris – Scattered macules in symmetrical or asymmetrical distribution.
Universalis- Total or nearly whole body involvement.
There are certain precautions, which can delay or stop the onset of the disease.
Maintain good general health and immunity.
It is a non-communicable disease.
Any patch should be thoroughly examined first.
Application of any unconfirmed tropical medication on skin should be avoided.
Use of synthetic clothes should be restricted.
Avoid excess intake of Sour things.
It is a myth that leucoderma occurs by drinking milk over the fish. There is no relevance in avoiding anything to eat or drink which is white in colour as assumed by some people similarly in cases of Jaundice for Yellow coloured things.
Allopathy – Commonest drug used is Psoralen, Melanocyl etc to be use locally followed by sun exposure. In few cases oral Antioxidants are also being used. The latest application of Placentex is also used. Ultraviolet Rays exposure or PUVA.
Ayurveda- Local application of Babchi Oil over the depigmented areas, Use of Copper utensils.
Others- Applying Coloured Dyes, Silver Nitrate etc. Latest being permanent Colouring.
Surgical measures- Grafting etc.
Homoeopathy – Offers a comprehensive treatment as it goes to the root of the problem by helping build up immunity and eventually restores the pigmented patches back to the normal skin colour. I have observed in my clinic that there are some definite connection in the patients who are being treated for Hypothyroidism then getting Hyperthyroidism show patches of leucoderma as drugs induced leucoderma.
Syphilitic. (destruction of melanocytes) predominance
Psoric – Though in Aphorism 195, Dr. Hahnemann states that “In chronic local maladies that are not obviously venereal, the internal antipsoric treatment alone requisite’ suggests that it is Psoric in nature.
Sycotic- As sycosis is the miasm which disturbs the pigment metabolism and produces hyperpigmentation and depigmentation in patches or diffuse in different parts.
Case. Ms. C. G. 24 Yrs. presented on 13.5.2000 with Hypopigmented patches on the body since 3 yrs. Patches were wide spread on Face, Neck, Forehead, Chest and both Breasts around nipples of the sizes 6x 3 cms to 8x 4 cms dimensions.
Complaints started in 1998 with small white spots appearing on the body. Took allopathic treatment in the form of Internal medicines and local applications. Took Homoeopathic Tt. With some relief. PUVA Tt. was also taken by Skin Specialists which gave much relief but spots reappeared after some time. No itching or burning. Slight redness over the patches. H/O Hair falling with Dandruff
Had tendency for Sore throat infections, Epistaxis and Palpitations. H/O Acute Mental shock and depression prior to the appearance of the spots.
F/H 1st Cousin’s daughter has same white spots. Father suffers with Hypercholestremia. G.M had Cancer Breast.
Gen. Nothing very significant except gets hot flushes on Ears when gets embarrassed, Perspiration Offensive. Menstrual history -NAD except oc. leucorrhoea which is thick, sticky, whitish creamy. Tendency to get mouth ulcers.
Mentals: – Sensitive++, Sympathetic+++ , Sentimental ++ , Fastidious++ , Strong Headed ++ , Likes Company, Likes Sympathy, Fault Finding + , Suppresses her Emotions++.
O/E – Patches on face white spots with regular margins. Patches around the Lips are with irregular margins. One big patch on the chest with mild pigmented spots. Bilaterally symmetrical spots on both the breasts. Nipple with red discoloration surrounded by an area of pink discoloration with regular margins, No itching anywhere except the area on breasts.
ECG – Deep S in V6 – Sinus Arrhythmia.
Stool -Cysts of E. Histolytica .BCs -2-3/hpf.
Urine- Bacteria +ve.
S.Calcium -10.9 mg%
ESR- 31mm /1st Hr.
Tt, started on 13.5.2000 with Sil1M/1 dose followed by Ars.Sulf Flav 30.
24.6.2k – boils appeared on lower abdomen with suppurative mouth.
Rx . Sil 1M/1 dose followed by A.S.F 30 and Emetin Hydrochloride 30 and Hydrocotyle Q.
15.7.2k – On further probing she revealed the actual incident which led her to the Acute mental shock and depression altwr on followed by these spots.
Rx. Phos 200/3 doses followed by S/L
22.7.2K. Remarkable change in the colour of spots. White spots turned Reddish, barring one spot on the left side of the cheek and one over the lips. Developed acute cold and coryza .Rx. Allium Cepa 200.
7.10.2k.All over much better. Now difficult to identify that where the white spots were. Few spots diffused in shape and mingled with the normal skin colour. Developed Stye in Left Eyelid.Rx.Staph200/3 doses. followed by A.S.F and Hydrocotyle Q.
Repertporial Analysis on the following symptoms:
1. Sentimental+ ,
3. Company Desire for++
7 .Fault Finding+
8 . Tendency for mouth ulcers
9 . Rec. Sore Throat
10 . Tendency for eruptions Pustular
11. Desire Sweets++
12. Discoloration Chest spots
13 . Discoloration face
14. Discoloration Mammae spots.
Remedies on repertorisation.
N.V. – 15/8
Nit. Acid- 15/6
Nat.Mur – 13/7
The Pt. Has shown remarkable improvement since the beginning of treatment. Many a pathes have completely disappeared and has gained he re-pigmentation. Change of color is notice in all the patches the minimum effect has been seen in the patches of the breasts.
Discussion ; I selected Phos as her main remedy despite Ars Alb coming on the top on reportorial analysis. As she has the essence of Phos remedy. Progress is evident with the slides.