Vitiligo

What is Vitiligo?

Vitiligo is a disease where there is a loss of skin pigment or color called melanin. Medically speaking it is not a serious problem and does not cause any major harm to body.Cosmetically and personally, it can affect lives of the suffers especially in those society, where color of skin is given importance; specially among brown and dark skin people.

 
In simple words, it is caused by one or two of the following processes:
01 Melanin cell destruction, leading to loss of color on skin, leading to white patches of vitiligo.
02 Defective process of melanin formation, hence, no skin color formation
The exact cause for above processes remain unknown. There are some theories which are considered responsible for the above processes in vitiligo. The probable causes of vitiligo explained elsewhere on this site. In brief, genetic and immunological factors in the background are considered responsible for vitiligo.

Due to destruction of the melanin (pigment) cells due to lesser known processes (largely what is called as an auto-immune disorder) the normal skin starts loosing pigments from various parts of the skin, in a varying speed and extent. Our clinical experience based on the treatment of over 5000 cases (as on Dec 2011), suggests that there is a strong genetic factor in the background of most cases, especially those who have extensive vitiligo or those who have vitiligo affecting the finger-tips, toes, lips or the genitals. The indication of strong genetic factor is observed in the form of family history of one or more of the auto-immune diseases such as vitiligo, alopecia areata, diabetes, under active thyroid, cancer, rheumatoid arthritis or allergies.

The vitiligo sufferers are observed all over the world, including the white skin population. However, epidemiologically most cases are recorded in India (8.8 %) and Mexico. Estimated 1-2% of the Americans have vitiligo as per the survey made by the American Academy of Dermatology. Males and females are affected equally, including children of all age groups. It may begin at any age. Childhood vitiligo is not uncommon. We have registered cases as young as three months old, to late onset vitiligo at the age of 80 years.

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Causes

Vitiligo is a disease of which the exact cause is not fully understood. However, there is increasing understanding about the processes involved in the development of Vitiligo. In most cases there are multiple causes responsible for vitiligo. However, there are theories suggesting
a. Autoimmune links: The cells fighting among themselves leading to destruction of the melanin, is one of the reasons. There are other immunological factors as well. One of the studies has suggested role of some neuropeptide (NYP) which may damage melanin. Such neuropeptide may be released in response to skin injury or emotional stress; again suggesting a combination of causative factors.
b. Hormonal connections: Affection of certain hormones such as Thyroid hormones or Melanocyte Stimulating hormone may be responsible for vitiligo. Also, simultaneous occurrence of vitiligo and other hormonal disorder suggest underlying genetic factor.
c. Genetic tendencies
d. Neural theory
e. Autocytotoxic theory
As per this theory, there is self-destruction of melanocytes and hence the melanin. This could be a result of genetic, immunological, neural or stress factors.

There are factors, internal and external, which either predispose or trigger or maintain the process which leads to development of vitiligo. In most cases, more there may be a mix of causes.

The familial incidence of 20 to 30% is observed in the family members. If one or more of the parents have vitiligo, there are more chances of one developing the same. However, it is not a rule. At the same time, numerous cases of vitiligo do not have a relevant family history of Vitiligo.

We have made an important observation through a study that most patients with vitiligo have one of the family members (father, mother, grand parents on either side, uncle, aunt or siblings) suffering from one or more of the following diseases:
a. Vitiligo
b. Hypothyroid or under active thyroid
c. Diabetes
d. Alopecia Areata (patchy hair loss)
d. Cancer
e. Other auto-immune diseases (such as psoriasis, rheumatoid arthritis, lichen planus, etc.)
f. vitiligo after injury
A study at our center also shows that the patients who have either extensive vitiligo or those developing vitiligo spots on both sides of body (bilateral symmetrical) have a strong genetic element. In other words, it is difficult for any patient to have extensive vitiligo without genetic links.

Symptoms of Vitiligo

The typical symptom of Vitiligo is a milky white de-pigmented spot or spots. It may vary from a single white spot to multiple spots. The shape too is a variable; round or irregular in shape. In some cases generalized de-pigmentation observed all over the body. It has a tendency to start as a single spot and gradually grow in size and number. It may present with a single or several spots on limbs or abdomen or back and then spreading to other parts of the body. In some of the vitiligo patches the hair may turn grey suggesting of loss of melanin pigment at the roots.
 
In some cases showing affection of the muco-cutaneous junctions such as finger-tips, corners of the mouth, genital, around eyes. The spread of the disorder is usually slow and progressive. Symmetrical appearance on both the sides of the body (say, on the legs, hands, etc.) is common. In rare cases one finds vitiligo spreading all over the body. It is a common concern among the patients if the disease would spread to entire body; which happens very rarely.

How Vitiligo Spreads?

The spread of vitiligo is governed by various factors such as 1. Genetic activity 2. Hormonal factors 3. Continued Stress factors 4. Exposure to chemicals, etc. Many patients may start with just a single spot and may not get more spots for many years or for throughout life time. Some patients may show rapid spread, as fast as from one spot to hundreds, in a few months time. It is not possible to predict the pace of spread. Also, some patients may show intermittent spread. It may be noted form experience that those who pace certain body areas affected such a finger tips, are at higher risk of having an aggressive spread; it is not a rule though. Some patients may present with grey hair, suggesting loss of pigment in the hair.

Associated Systemic Disorders:

There are several systemic diseases symptoms (affecting the entire body system), which are at times associated with Vitiligo: 1. Under active thyroid 2. Diabetes 3. Alopecia Areata (patchy hair loss) 4.SLE (Systemic Lupus Erythematosus) 5. Pernicious Anemia 6. Addison’s Disease 7. Collagen Diseases 8. Grave’s Disease
 
It may be noted that the sufferers of Vitiligo need not be unduly scared of the above disease conditions, as they should not be regarded as the complications of Vitiligo in every case. The most common condition found along with vitiligo include Under active thyroid (hypothyroidism) and Alopecia areata (patchy hair loss).

Vitiligo with Eczema, Psoriasis and Lichen Planus

In some cases Vitiligo may co-exist or follow after one of the conditions such as psoriasis, lichen planus or eczema. Here is a photo of a patient who has loss of pigment after having eczema on foot.

Treatment for Vitiligo

There are various modalities of treatment available for vitiligo under different systems of medicine.

  • Conventional treatment
  • Ayurvedic (herbal) treatment
  • Surgical treatment
  • Homeopathic treatment

Conventional Treatment for Vitiligo

The main goal of treating vitiligo is to improve and enhance melanin formation on white patches. Each patient responds differently to treatment, and a particular treatment may not work for everyone. There is no ideal treatment in the absence of a clear understanding of the cause of vitiligo. The conventional treatment can be divided into the following:

  • General Aspects
  • Medical Treatment
General Aspects

Vitiligo has an unpredictable course and that its prognosis may not always be encouraging. Patients need to maintain good general health and a balanced nutritious diet enriched with adequate proteins, vitamins B-complex and E, and minerals such as copper, zinc, and iron.
One must avoid physical, chemical, and emotional trauma as far as possible. One must also avoid use of soaps and detergents containing phenolic compounds, rubber goods, and contact exposure to other chemical agents known to affect melanogenesis.

Medical Treatment

The type of treatment selected depends on the type of vitiligo, its severity, as well as the patient’s preference, health, and age. Medical treatment of vitiligo comprises the following:

Psoralen Compounds and UVA Therapy

Psoralen is one of the most effective of all drugs. It contains chemicals (furocoumarin compounds) that reacts with ultraviolet light (photosensitizing chemicals) to cause darkening of the skin. However, it is time-consuming, and care must be taken to avoid side effects, which can sometimes be severe.

Topical PUVA Therapy

Topical psoralen photochemotherapy is often used for individuals with a small number of depigmented patches affecting a limited part of the body and for children aged 2 years and older, who have localized patches of vitiligo.

Oral PUVA Therapy

Oral PUVA therapy is used for individuals with extensive vitiligo (leucoderma) (affecting more than 20% of the body) or for those who do not respond to topical PUVA therapy. Oral psoralen is not recommended for children under 10 years of age because it increases the risk of damage to the eyes caused by conditions such as cataracts.

UVB Phototherapy

Narrow band UVB therapy is more effective in re-pigmentation than PUVA therapy. It targets specific small lesions. Selective narrow-band UV-B (311 nm) is used with a fiber optic system to direct radiation to specific areas of skin.

Excimer Laser

The 308-nm xenon chloride excimer laser is an efficacious, safe, and well-tolerated treatment for chronic stable vitiligo (leucoderma) limited to less than 30% of the body surface. It acts through immunomodulation by affecting T cells. Treatment periods of more than 12 weeks may be necessary to obtain satisfactory results.

Topical Therapy

Topical therapy is used in vitiligo treatment, topical agents like methoxsalen, trioxsalen, corticosteroids and calcineurin inhibitors are used in this therapy. Though its used prominently for treating vitiligo it has few side effects.

Surgical treatment for vitiligo

All surgical therapies must be considered only after proper medical therapy has been attempted. These treatment regimens are often indicated in segmental or localized and stable vitiligo. Areas such as dorsal fingers, ankles, forehead, and hairline tend to not re-pigment well. Carefully selected patients who have small areas of vitiligo with stable activity are candidates suitable for surgical transplants. Surgical techniques are time-consuming and expensive and usually not paid for by insurance carriers.
Surgical modalities include:

Autologous skin grafts:

In this procedure, the skin from one area of the patient’s body is removed and attached to another area. This type of skin grafting is sometimes used for patients with small patches of vitiligo. Treatment with grafting takes time and is costly, and many people find it neither acceptable nor affordable.

Skin grafts using blisters:

In this procedure, the blisters are created on the patient’s pigmented skin by using heat, suction, or freezing cold. The tops of the blisters are then cut out and transplanted to a depigmented skin area. The risks of blister grafting include scarring and lack of re-pigmentation. However, there is less risk of scarring with this procedure than with other types of grafting.

Punch mini-grafting:

In this procedure, small donor grafts are inserted into the incision of recipient sites and held in place by a pressure dressing. The graft heals readily and begins to show re pigmentation within 4-6 weeks. Some pebbling persists but is minimal, and the cosmetic result is excellent.

Micro-pigmentation (Tattooing):

This procedure involves implanting pigment into the skin with a special surgical instrument. It works best for the lip area, particularly in people with dark skin.
Ayurvedic (herbal) Treatment for Vitiligo
Ayurveda is a Sanskrit term meaning ‘science of life’. Ayurveda perceives life as the union of body, mind, senses, and soul. ‘Charaka Samhita’, a two thousand-year-old Indian Ayurvedic text, describes vitiligo as ‘Svitra’ or ‘Kilasa’, with recommendations for treatment.

Some Ayurvedic physicians recommend raktamoksha (therapeutic bloodletting), either by topical application of leeches to affected areas, or by using a syringe or surgical knife, from the affected skin patches, as part of the therapy. This method is used to remove excess pitta dosha in the rakta dhatu.

Ayurvedic Medicines for vitiligo:

Arogya Vardhini, Trivanga Bhasma, Mahamanjishthadi Qadha (decoction) & Khadirarishta are most commonly used traditional ayurvedic medicines for Vitiligo.

Herbal medicines useful for vitiligo:

Manjishtha (Rubia cordifolia), Saariva (Hemidesmus indicus), Triphala (Three fruits), Haridra (Curcuma longa), Daruharidra (Berberis aristata), Khadir (Acacia catechu), Vidanga (Embilia ribes), and Bavachi (Psoralia corylifolia).

Homeopathic Treatment for Vitiligo

Homeopathic approach to treating any disease is based on the philosophy of augmenting body’s own healing processes. This is achieved by administering a medicine, which has the capacity to correct the altered immunity that led to the development of disease.

How to cope up with vitiligo

1) Coping up with vitiligo as a patient:

First of all, you need to get convinced for yourself that vitiligo is a not a serious illness. Vitiligo is much less serious than allergy, colds or asthma with which over 20% of the world population suffers! Apart from making a change in your appearance it does not harm you in any way. Vitiligo is not a serious disease at all. Vitiligo is more of a social disease than medical disease.

What is more important in managing vitiligo is a positive attitude and correct approach towards leucoderma (vitiligo).

One has to learn not to feel embarrassed, ashamed, depressed, or worried about how others will react to vitiligo.

It is better not to avoid social situations, networking and parties. Let people around you know once and for all that you have some color problem with your skin. Once they will know it, they will also learn to accept it.

There are many products out there to provide excellent camouflage of vitiligo spots.

Consult a doctor who specializes in dealing with vitiligo cases.

2) Coping up with vitiligo as a parent:

Children usually cope best with vitiligo better when their parents themselves are not over anxious about it. Your own over consciousness may create more problems for your child than the actual vitiligo. Learn to overcome that.

Let your child know that vitiligo is a benign skin problem and it is not serious.

Educate your child on how to answer his friends, teachers and relatives if they enquire about vitiligo. S/he should be taught to answer firmly and carelessly about the insignificant nature of vitiligo.

Communicate with some of the close relatives (grand parents, aunts, uncles, neighbors and teachers) informing them about vitiligo, requesting them not to discuss it with your child.

Avoid discussing your child’s vitiligo repeatedly. Moreover, avoid negative discussion about leucoderma (vitiligo) during the child’s presence. Examination of the spots is better done when the child is asleep.

When your child questions you whether anything can be done for this or not, explain your child that this condition can be treated to certain extent like any other skin ailment.

Support your child, and encourage him/her to get involved with activities and hobbies.

Do not allow vitiligo to interfere with your child’s joy of living and his self esteem. Do not restrict your child from wearing clothing which may expose some white spots on the skin. Do encourage your child to continue attending social events, other activities like swimming, hiking, sports, parties, etc.

Help your child to boost self confidence and let vitiligo not come on his/her way of growing as a person. Many parents unknowingly end up making their children more conscious about vitiligo by feeling panic about it.

3) Coping up with vitiligo as as a citizen (who does not suffer from vitiligo):

Vitiligo is a benign, non-infectious condition of the skin. Those who suffer from it do also suffer from some emotional trauma associated with vitiligo. As a civilized person it is our duty to have healthy outlook towards those who suffer from Vitiligo.

Do not stare at a person with vitiligo. It is considered bad manners to embarrass any one suffering from vitiligo!

Do not discuss with the sufferer as to what is this, how did it happen, etc which might make him feel more embarrassed.

Patients with vitiligo do not need pity or sympathy. They simply need understanding.

Cortisone is no more effective as a long term treatment for Vitiligo*

Cortisone or corticosteroid or steroid is used by conventional doctors for vitiligo as a primary therapy, in the form of topical (local) application, oral tablets or injections. Cortisone does help initially. However, the common experience is that on stopping its use, not only does vitiligo return, but it may even increase and it is made more difficult to treat. This opinion is based on our extensive study of cases of vitiligo who have consumed cortisone in the past. Some points must be noted by every patent or parent, before opting for cortisone in any form: · Cortisone may help initially for a short time

  • Cortisone lead to relapse of Vitiligo
  • Cortisone treated relapse is more severe, more complex
  • Cortisone treated vitiligo is more difficult to treat
  • It is wise to avoid steroid during any stage of Vitiligo
  • Cortisone puts you to the vicious cycle of dependency
  • Cortisone dependents have to come out of the vicious cycle

(*Observations based on a statistical study of over 1200 cases of Vitiligo at our center, who were earlier treated with Cortisone.)

This article has been written on the basis of our extensive experience in treating a large number of cases of vitiligo and other diseases which are otherwise treated conventionally using cortisone. This is also supported by practice and experience of numerous reputed homeopathic professionals.

Also, as per the medical philosophy of homeopathy, cortisone in any form (oral, systemic or local) is not a wise option for treating Vitiligo. Cortisone is an immuno-suppressive measure which helps but it also leads to an inevitable relapse in most cases after stopping its the use.

It has been observed in daily practice, that, use of cortisone produces dramatic result initially. However, its influence is quite superficial, as the vitiligo spots (or psoriasis or Lichen Planus eruptions) tend to relapse (more aggressively) at times.

The routine use of cortisone is not recommended due to the following observations:
01 It helps only superficially and temporality
02 Stopping of the steroids eventually leads to the reappearance of vitiligo spots or eruptions
03 The eruption, which relapses after the use of steroids, are more resistant than before
04 The relapse of disease (vitiligo or Lichen planus or Psoriasis or Eczema) following stopping cortisone is often difficult to manage with milder medicines.
05 The extent of eruptions increase after stopping the steroids in most cases
06 Cortisone produce side effects by hampering the immunity, lowering resistance, disturbing hormonal cycle, etc.
07 Cortisone leads to dependency

Vitiligo on Hands (Fingers, Finger Tips, Palms)

Vitiligo on hands (including back of palms, palms, fingers and finger-tips)

Vitiligo can appear on any part of the body where there is skin. The patients having vitiligo on hands are more conscious as it draws attention of people, especially in social and professional interaction. Some people having vitiligo on hands find it a bit uncomfortable shaking hands. Those involved in public appearance including teachers and speakers might feel awkward while talking in public especially holding a microphone in hand.
Is vitiligo on hands different than elsewhere on the body?
Well, vitiligo anywhere on the body results from loss of melanin pigments on skin. It is the same phenomenon if one has vitiligo on palms.

Vitiligo on finger-tips:
Vitiligo on the finger tips falls under the category of what is called as Muco-cutaneous junctions, the area where skin meets with mucus- membranes.

Any difference in the chances of recovery?
Yes, when it comes to the treatment of vitiligo which affects the finger-tips, the chances of recovery are less or none.

Vitiligo on back of the palm is not that difficult to treat, but a bit more difficult than the spots on some softer parts like abdomen. Vitiligo on the fingers (not on the tips) can see improvement with certain treatment.

Vitiligo on Face, Around Eyes and Lips

Vitiligo is nothing but loss of skin melanin, that is skin color pigment. Due to the internal immunological process, skin may lose color anywhere including any part of the face.

For cosmetic and social reasons, patients with vitiligo always have a concern of spreading vitiligo on the face, the most visible area, as it can affect the self-esteem of the person.

Medically speaking, a random, single spot of vitiligo on one side of the face is not very difficult to treat, unless it affects lips or corner of the lip or the corner of the eyes; what is typically called as muco-cutaneous junctions; which makes the treatment difficult.

If one has vitiligo around both the eyes, again, that brings one in the ‘difficult to treat’ category, as ‘bilaterally symmetrical vitiligo’ is more difficult to show results.

If one has lips affected with vitiligo, it is better to accept this situation and the treatment should be targeted at controlling further spread rather than curing it; as this variety is very difficult to treat. Camouflage or tattooing is a suggested treatment for it.

Vitiligo around both eyes is difficult to cure completely.

There is no specific treatment or medicine to prevent vitiligo on any specific part of the body such as the face. The treatment can try to control the underlying disease process whereby controlling the spread of vitiligo in general.

What are my chances of recovery?

Every vitiligo patient or child’s parent will have this question. You have to understand that the chances of recovery or regimentation in case of Vitiligo depend on several factors. Based on our extensive study and research, we would like to share some of our observations with you. It may be noted that the standard medical text books do not clearly suggest what we have described on this page, based on our clinical experience. Following notes are simply suggestive and not conclusive as there may be exceptions.

01 Cases which can find excellent results:

a Cases of recent origin (less than two years)
b Children
c A few, scattered and sporadic spots (segmental vitiligo)
d No history of oral or local use of cortisone
e No strong family history of Vitiligo or other autoimmune diseases

02 Cases which can find very good results:

a Cases of recent origin (Vitiligo of two to five years)
b Fewer spots
c No affection of finger tips, lips, and genitals
d No history of use of cortisone, oral or local
e No strong family history of Vitiligo

03 Cases which can find good results and better control:

a Cases of recent origin (Vitiligo of two to five years)
b Moderate spread of vitiligo spots
c No affection of finger tips, lips, and genitals
d No history of use of cortisone, oral or local
e Family history of Vitiligo
f Associated Hypothyroid (Under active Thyroid), Diabetes, Alopecia Areata or other auto-immune disease makes the recovery of vitiligo difficult

04 Cases which can find poor results but fair control:

a More than ten years old cases of Vitiligo
b Extensive spread. Bilateral affections (vitiligo spots on both sides of body, such as elbows, legs, around eyes, finger tips, etc. )
c Affection of finger tips, lips, and genitals
d History of use of cortisone, oral or local
e History of family history of Vitiligo or other diseases such as diabetes, hypothyroid, alopecia Areata, cancer, etc.
f Associated Hypothyroid (under active Thyroid), Diabetes, Alopecia Areata or other auto-immune disease makes the recovery of vitiligo difficult

05 Cases which find very poor results and no treatment is suggested:

a More than ten years old cases of Vitiligo
b Extensive spread. Bilateral affections. Large patches of vitiligo.
c Affection of finger tips, lips, and genitals
d History of use of cortisone, oral or local
e History of family history of extensive Vitiligo or other diseases such as diabetes, hypothyroid, Alopecia Areata, cancer, etc.
f Associated Hypothyroid (Under active thyroid), Diabetes, Alopecia Areata or other auto-immune disease makes the recovery of vitiligo difficult
It may be noted that above information is based on clinical observation. There are many factors which influence the course and treatment of Vitiligo, which is out of the scope of this article. The above remarks give broad idea to the patients about the prognosis of Vitiligo.
It is not possible to give visuals of all sorts of cases which are either treatable or not treatable; however, just to give you glimpses of the extent + curability, please examine three cases, showing mild, moderate and severer extent of Vitiligo. Mild cases are curable, moderate cases are partly curable and controllable; while severe cases are incurable and controllable, using homeopathy.

Vitiligo on Abdomen (Stomach) and Back

Vitiligo spots could appear randomly on any part of the body. There is no predictable pattern. They could be in any size, shape or number.

Vitiligo spots on abdomen (stomach) or on the back are often considered, as ‘safe zone’ by patients are they are not easily visible to outsiders.

Vitiligo the abdomen, neck or back are usually on the soft skin areas except those on the skin over spine, which are bony areas. We have observed that vitiligo over bony regions are relatively more difficult to treat.

Vitiligo spots on abdomen, if not too large, respond well the treatments. They also respond to the phototherapy. Challenge comes if the vitiligo spots in these areas are very large.

Vitiligo on Forearms, Elbows and Shoulders

Vitiligo spots could appear randomly on any part of the body. There is no predictable pattern. They could be in any size, shape or number.

Vitiligo affecting only one side of the body or affecting both sides at the same place (symmetrical); are two different varieties.

Vitiligo on forearms, if only scattered and small spots can be treated with success. If vitiligo patches are large and or on both sides of the body, such as both wrists or both elbows, it is difficult to cure completely. Elbows are bony surfaces, which pose difficulty in achieving complete pigmentation.

Vitiligo on upper arms and shoulders, if not large, can be treated with good results.

Vitiligo on Thighs, Knees, Legs, Feet and Toes

Skin is the largest organ in the body. Vitiligo is one of the most common skin diseases affecting over 2% world populations and 8% of the Indians.

Vitiligo affection on the skin of legs, thighs, legs, knees, feet and toes is common.

Scattered and small patches on these parts are relatively easy to treat. Large patches of vitiligo are always difficult to treat. Those affecting bony areas such as knees, ankles are difficult to repigment.

If one has vitiligo on both sides of legs, knees, ankles, feet or toes; it is difficult to cure them. Vitiligo on toes on both sides is better controlled than cured.

If one has vitiligo on shins on both sides, it is difficult to bring color. Especially, if you find gray hair on those vitiligo spots, it may not be possible to bring color and retain it.

If one has vitiligo on tips of the toes (and finger tips), in the early stage, one should work on keeping this variety under control.

Best Homeopathic Doctor & Treatment for Vitiligo in India. Just Call at +91 7087462000 and make an appointment with Dr. Singhal Homeo, and get Homeopathic Treatment.