Vitiligo

• Vitiligo is an acquire condition affecting 1% of the population worldwide.
• Focal loss of melanocytes results in the development of patches of hypopigmentation.
• A positive family history of vitiligo is relatively common in those with extensive disease, and this type is also associate with other autoimmune diseases.
• Trauma and sunburn may precipitate the appearance of vitiligo.
• The pathogenesis is unclear and, whilst melanocytes may be the target of a cell-mediated autoimmune attack, it is not known why only focal areas are affected. [1]
• The extent and rate of color loss from vitiligo is unpredictable.
• It can affect the skin on any part of your body & may also affect hair and the inside of the mouth.
• Normally, the color of hair and skin is determine by melanin.
• Vitiligo occurs when the cells that produce melanin die or stop functioning.
• Vitiligo affects people of all skin types, but it may more noticeable in people with darker skin.
• The condition is not life-threatening or contagious.
• It can stressful or make you feel bad about yourself.
• Treatment for vitiligo may restore color to the affected skin.
• But it does not prevent continued loss of skin color or a recurrence. [2]

Indian epidemiology then other

The exact causes of vitiligo are unclear. A number of factors may contribute.

These include:

• An autoimmune disorder, in which the immune system becomes overactive and destroys the melanocytes
• Genetic oxidative stress imbalance
• A stressful event
• Harm to the skin due to a critical sunburn or cut
• Exposure to some chemicals
• Heredity, as it may run in families
• Virus

Vitiligo is not contagious. One person cannot catch it from another.

It can appear at any age, but studies suggest that it is more likely to start around the age of 20 years. [4]

There are two types of vitiligo, non-segmental and segmental.

Non-segmental vitiligo:

If the first white patches are symmetrical, this suggests a type of vitiligo known as non-segmental vitiligo.

The development will be slower than if the patches are in only one area of the body.

Non-segmental vitiligo is the most common type, accounting for up to 90 percent of cases.

The patches often appear equally on both sides of the body, with some measure of symmetry.

They often appear on skin that is commonly exposed to the sun, such as the face, neck, and hands.

Common areas include i.e.:

• Backs of the hands
• Arms
• Eyes
• Knees
• Elbows
• Feet
• Mouth
• Armpit and groin
• Nose
• Navel
• Genitals and rectal area

Non-segmental vitiligo is further broken down into subcategories i.e.:

• Generalized: There is no specific area or size of patches. This is the most common type.
• Acrofacial: This occurs mostly on the fingers or toes.
• Mucosal: This appears mostly around the mucous membranes and lips.
• Universal: Depigmentation covers most of the body. This is very rare.
• Focal: One, or a few, scattered white patches develop in a discrete area. It most often occurs in young children.

Segmental vitiligo:

• Segmental vitiligo spreads more rapidly but is consider more constant and stable and less erratic than the non-segmental type.
• It is much less common and affects only about 10 percent of people with vitiligo.
• It is non-symmetrical.
• And more noticeable in early age groups, affecting about 30 percent of children diagnosed with vitiligo.
• Segmental vitiligo usually affects areas of skin attached to nerves arising in the dorsal roots of the spine.
• Responds well to topical treatments. [4]

Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

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The main sign of vitiligo is patchy loss of skin color.

Usually, the discoloration first shows on sun-exposed areas, such as the hands, feet, arms, face and lips.

Vitiligo

• Generalised vitiligo is often symmetrical and involves hands, wrists, knees also neck, as well as areas around body orifices.
• The hair of the scalp, beard, eyebrows and lashes may also depigment.
• Segmental vitiligo is restrict to one part of the body but not necessarily a dermatome.
• The patches of depigmentation are sharply define, and in Caucasians may surrounded by hyperpigmentation.
• Spotty perifollicular pigment may seen within the depigmentation and is often the first sign of repigmentation.
• Sensation in the depigmented patches is normal.
• Wood’s light examination enhances the contrast between pigmented and non-pigmented skin.
• The course is unpredictable but most patches remain static or enlarge; a few repigment spontaneously.

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Medical history and examination:

If your doctor suspects you have vitiligo, he will ask about your medical history, examine you and try to rule out other medical problems, such as dermatitis or psoriasis.

He may use a special lamp to shine ultraviolet light onto the skin to determine whether you have vitiligo.

Skin biopsy and blood draw:

In addition to gathering your personal and family medical history and examining your skin, your doctor may:

• Take a small sample (biopsy) of the affected skin.
• Draw blood for lab tests to look for underlying autoimmune conditions, such as anemia or diabetes. [2]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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Many treatments are available to help restore skin color or even out skin tone.

Results vary and are unpredictable.

Some treatments have serious side effects. So your doctor may suggest that you first try improving the appearance of your skin by applying self-tanning products or makeup.

Medications:

No drug can stop the process of vitiligo – the loss of pigment cells (melanocytes). But some drugs, used alone or with light therapy, can help restore some skin tone.

Creams that control inflammation i.e.:

• Applying a corticosteroid cream to affected skin may help return color, particularly if you start using it early in the disease.
• You may not see a change in your skin’s color for several months.
• This type of cream is effective and easy to use.
• But it can cause side effects, such as skin thinning or the appearance of streaks or lines on your skin.
• Milder forms of the drug may prescribed for children and for people who have large areas of discolored skin.

Medications that affect the immune system i.e.:

• Ointments containing tacrolimus or pimecrolimus (calcineurin inhibitors) may effective for people with small areas of depigmentation, especially on the face and neck.
• This treatment may have fewer side effects than corticosteroids and can be used with ultraviolet B (UVB) light.
• However, the Food and Drug Administration has warned about a possible link between these drugs and lymphoma and skin cancer.

Therapies:

Combining psoralen and light therapy i.e.:

• This treatment combines a plant-derived substance called psoralen with light therapy (photochemotherapy) to return color to the light patches.
• After you take psoralen by mouth or apply it to the affected skin, you’re exposed to ultraviolet A (UVA), UVB light or excimer light.
• These approaches tend to have better results than just medication or just light.
• You may need to repeat treatments up to three times a week for six to 12 months.

Removing the remaining color (depigmentation) i.e.:

• This therapy may be an option if your vitiligo is widespread and other treatments haven’t worked.
• A depigmenting agent is applied to unaffected areas of skin.
• This gradually lightens it so that it blends with the discolored areas.
• The therapy is done once or twice a day for nine months or longer.
• Side effects can include redness, swelling, itching and dry skin.
• Depigmentation is permanent, and you’ll always be extremely sensitive to sunlight.

Surgery:

It may be an option for you if light therapy doesn’t work. Surgery can also be used with those therapies. The goal of the following techniques is to even out your skin tone by restoring color.

Skin grafting i.e.:

• In this procedure, your doctor removes very small sections of your normal, pigmented skin also attaches them to areas that have lost pigment.
• This procedure is sometimes used if you have small patches of vitiligo.
• Possible risks include infection, scarring, a cobblestone appearance, spotty color also failure of the area to recolor.

Blister grafting i.e.:

• In this procedure, your doctor creates blisters on your pigmented skin, usually with suction.
• They then removes the tops of the blisters and transplants them to an area of discolored skin.
• Possible risks include scarring, a cobblestone appearance and failure of the area to recolor. And the skin damage caused by suctioning may trigger another patch of vitiligo.

Tattooing (micropigmentation) i.e.:

• In this technique, your doctor uses a special surgical instrument to implant pigment into your skin.
• It’s most effective in and around the lips in people with darker complexions.
• Drawbacks include difficulty matching the skin color and potential for the tattooing to trigger another patch of vitiligo.

Potential future treatments:

A drug to stimulate color-producing cells (melanocytes) i.e.:

• In brief, Called afamelanotide, this potential treatment is implanted under the skin to promote the growth of melanocytes.

A drug that helps control melanocytes i.e.:

• Prostaglandin E2 is being tested as a way to restore skin color in people with localized vitiligo that isn’t spreading.
• Besides this, It’s applied to the skin as a gel.

drug that reverses loss of color i.e.:

• Tofacitinib, an oral drug typically used to treat rheumatoid arthritis, has shown some potential as a treatment for vitiligo. [2]

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Homeopathic treatment for Vitiligo is  natural, safe and without any side-effects, and one can enjoy immense relief from these frustrating symptoms.

It is a patient-oriented science and medicines are prescribed on the characteristics of the individual rather than just the symptoms of the disease.

Arsenicum Sulphuratum 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 to this drug.
• Its sphere of action also extends to catarrhal affections and asthmatic states.
• A deep acting drug which has been known to give good results in vitiligo.

Hydrocotyle Asiatica: 

• This is a remedy that is prepared from the tincture of plant called Indian Pennywort.
• After undergoing the process of Potentization, the curative powers of this remedy are brought forth.
• This is one of the very good remedies for vitiligo.
• It is supposed to stimulate the process of pigmentation.
• It is also beneficial for other skin problems such as psoriasis, lupus, leprosy, acne and other disorders of the skin in which there is much exfoliation of the skin.
• This medicine is often prescribed in combination with a constitutional medicine or other deeper acting medicine to get the best effect. [6]

Calcarea Carbonica – For Milky White Spots on the Skin:

• Calcarea Carb is a top grade constitutional medicine specifically for Vitiligo.
• Moreover, It is prescribed to patients of Vitiligo with milky white spots on skin.
• These white spots can appear anywhere on the body.
• The first among these is tendency to free perspiration over the head, neck also chest.
• Besides this, Next is intolerance to cold weather.
• Certain peculiar cravings may be present are eggs, lime, pencils.
• Person needing calcarea carb may show tendency to catch cold easily.
• Weakness of bone & easily fatigued especially by exertion.
•  The tendency to chronic constipation and obesity also guides the selection of calcarea carb in vitiligo.
• On the mental sphere, the person may show a number of fears.
• The prominent fears among them are fear of misfortune, of contagious disease, of losing reason and of insanity.

Arsenic Album – For Vitiligo in Anxious Personalities:

• Arsenic Album is yet another useful remedy for vitiligo in persons prone to dry, rough skin.
• The skin shows whitish spots and skin is dry, dirty and rough.
• And skin complaint alternating with respiratory complaints like asthma is a strong pointer for using arsenic.
• In general sphere warmth is a relieving factor for persons needing Arsenic album.
• Warm applications over skin and warm drinks are highly desirable.
• Burning sensations in varying body parts may also be noticed.
• Extreme exhaustion may also be present.
• The most prominent out of these are fears and anxieties.
• This remedy is often indicated in persons who have fears including that of death,  disease,  germs and of catching infection.
• Patients requiring arsenic are highly anxious personalities.
• They may show anxieties about health, trifles and anxiety about others.
• Marked restlessness is often seen on both mental and physical planes in persons needing Arsenic Album.
• Next distinctive feature for selecting arsenic album in vitiligo is fastidiousness.
• Person demanding extreme neatness and order in everything are yet another suitable subjects requiring Arsenic Album.

Sepia – For Vitiligo in People with Indifferent Attitude:

• Sepia is another important remedy in the list that is selected constitutionally in vitiligo treatment.
• If the constitutional picture of Sepia matches with that of a person suffering with vitiligo, it possess a great ability to completely eradicate the disease.
• Constitutional symptoms that indicate the use of  sepia are; in detail having an indifferent approach towards life and family.
• They show aversion towards family members and friends who were once loved with great affection.
• They lack interest in doing any work.
• Tendency to avoid both physical or mental labor is present .
• They are constantly depressed with marked irritability, weeping tendency, desire to be alone also an aversion to consolation or sympathy.
• The use of sepia must also be thought in women with menstrual irregularities or those around menopausal age with tendency to hot flushes.

Silicea – Constitutional Medicine for Vitiligo:

• Silicea carries a good scope to treat vitiligo when selected as per the constitutional makeup of the person.
• The set of symptoms that indicate the use of  Silicea are; pale and waxy skin; additionally tendency to excessive perspiration on hands and feet; tendency to eruptions with pus formation in various body parts, and to catch cold on frequent basis; lean, thin physical makeup.
• The main mind symptom are timidity also an under-confident nature.
• Besides this, Silicea may be thought of in people who seem under-confident, fear public speaking, are timid and bashful.
• Obstinate behavior and stubbornness may also indicate its use .

Sulphur – One of the best Medicines for Vitiligo:

• Although Sulphur mention quite low down in the list for treating vitiligo but its worth equivalent to above narrated medicines.
• Furthermore, Sulphur is a deep acting medicine used frequently in treatment of varying skin diseases including vitiligo.
• Additionally, It goes deep inside the basic root cause to annihilate the disease in its complete extent.
• Besides this, The persons requiring Sulphur usually show a philosophical mindset.
• They popularly refer as ‘ragged philosophers’.
• Their mind constantly occupy with various theories also plans.
• As a result they suffer from mental fatigue and absent mindedness.
• They take little or no care for their physical appearance and even show aversion to bathing.
• Persons who have suffered a lot from skin troubles, itchy skin with long term use of ointments are also likely to be benefited from use of Sulphur.
• Apart from all above said symptoms burning sensations in various body parts may present along with white spots on skin.
• An extraordinary craving for sweets may also show as a constitutional symptom. [5]

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1. Davidson’s Principles and Practice of Medicine (22nd edition) Ch. 28
2. https://www.mayoclinic.org/diseases-conditions/vitiligo/diagnosis-treatment/drc-20355916
3. https://kidshealth.org/en/teens/vitiligo.html
4. https://www.medicalnewstoday.com/articles/245081.php
5. https://www.drhomeo.com/homeopathy-for-skin/vitiligo-its-homeopathic-treatment/
6. https://www.askdrshah.com/app/vitiligo/vitiligo-medicines.aspx

Frequently Asked Questions

What is Vitiligo?

Vitiligo is a loss of skin pigment (Melanocytes) that causes white spots or patches to appear on the skin.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Vitiligo?

• Arsenicum Sulphuratum Flavum
• Hydrocotyle Asiatica
• Calcarea Carbonica
• Arsenic Album
• Sepia
• Silicea
• Sulphur

What is the main cause of Vitiligo?

• Autoimmune disorder
• Genetic
• A stressful event
• critical sunburn or cut
• Exposure to some chemicals
• Heredity, as it may run in families
• Virus

What are the symptoms of Vitiligo?

• Patchy loss of skin color
• Discoloration on sun-exposed areas
• Hair of the scalp, beard, eyebrows and lashes may also depigment
• Segmental vitiligo is restrict to one part
• Spotty perifollicular pigment

Give the types of Vitiligo?

• Non-segmental vitiligo
• Segmental vitiligo