INTRODUCTION

VITILIGO - A HOMEOPATHIC PERSPECTIVE

BACKGROUNDBased  on dermatological  outpatient records, the incidence of vitiligo is found to be 0.25-2.5% in India.Vitiligo occurs worldwide  with  an  overall  prevalence  of  1% The highest  incidence  of  the  condition  has  been  recorded in Indians from the Indian subcontinent, followed by Mexicans and Japanese.There is a stigma attached to vitiligo and  affected  persons  and family.This  disorder does  not  result  in restriction   of  capacity  to  work   or   expectancy of  life,  but   it   causes cosmetic   disfigurement  leading  to psychological  trauma  to the patients.The spread of the disease can be arrested and substantial amount of repigmentation can be achieved in majority of patients who undergo appropriate treatment. 

This paper unearthes homeopathic treatment as a most viable treatment modality in vitiligo .

Vitiligo is an acquired autoimmune depigmentary condition characterized by appearance of chalky or milky white macules with well defined margins of varying sizes and shapes.It has familial predisposition. It is the only skin disease which does not itch, pain or give any kind of physical discomfort.

AIMS AND OBJECTIVE

Study design and settings80 self reporting vitiligo patients attending out patient department of a  hospital were selected for the study.It  was  a  observational, descriptive  study  done  in  OPD of SHMC.for a period of three yrs (April 2010 to march 2013.)

INCLUSIVE CRITERIAWell diagnosed cases of vitiligo were taken for study. The patients reported in three different stages:V1 – Active stage, lesion size increasing and borders ill-defined          and hypo pigmented.V2 - No new lesion, lesions stationary in size. Static stage.V3- Lesions decreasing in size, no new lesion, re-pigmentation of margins which become well defined. It is a recovery stage.EXCLUSIVE CRITERIA AlbinismNevus achromicusTenia versicolorLeprosyPityriasis albaLichen scelerosis PiebaldismData collection The demographic and clinical data of the patients were collected using a data collection form and alsofrom  the  medical  records  of  patients.

MATERIALS AND METHODS

1) To highlight the efficacy of homeopathic medicines in achieving and maintaining the remission state in natural course of vitiligo.

2)      The objective of the present study was to assess the          prevalence, precipitating factors clinical features             and concomitant disease in vitiligo patients.

 

CASES

Sulphur 200

Natrum mur 200

Lachesis 200

Natrum mur 200

The earliest onset was at 2 years of age, whereas the latest was at 60 years of age. Majority of the patients (45%) were in the age  group of  21-40yrs  followed by 2-20yrs (37%)  at time of onset of vitiligo.Duration   of  the   disease  at  the  time  of presentation  varied  from  2 months to15 years. 

Most  cases  (56.2%)  were  less  than    5 years  duration, regardless  of  sex.Around8.8%  patients  had  family  history  of vitiligo

First  degree  relatives  (parents/  brother/ sister/  children) were  affected  in  6%  of the  study  population  and  second  degree relatives (grand parents/ maternal and / or paternal uncle/aunt) in 2.8% of  patients. Positive  family  history  is considered to be a poor prognostic factor for vitiligo  Negative family history  91.2%. Major  precipitating  factor  of  vitiligo  was found to be  physicaltrauma/ injury  (18.8%).followedby   emotional  trauma (16.2%),chemicals  /  drugs  (3.8%),  footwear  (1.3%),  pregnancy  (1.3%)  etc.

 A record  was  made   of  the precise distribution of lesions, and the clinical staging was done as V1,V2 and V3.Study approvalThe  study  protocol was  approved by Delhi Homeopathic Anusandhan paris 

RESULTS & DISCUSSION

Of  the 80 patients   Females  (52.5%)were affected more than males (47.5%) giving a male female ratio of 1.1:1.  The incidence of 1.3% obtained in the present study of vitiligo corresponds to the observations made by different authors 

Though vitiligo affects both sexes equally,] most of the studies. show a female preponderance. The cause of female preponderance in most of the studies is probably because of a greater cosmetic awareness among females.

Of the 80 patients, 32.5% of the studypopulation was within the age group  of 21-40   years  while 31.3%  were  within     the age  group   of   2  – 20yrs and 12.4% in 41- 60  years  age  group  .

The youngest patient  was   4  years      old  and  the oldest  was  65  years.  .

MATERIALS AND METHODS

Lycopodium 30

Lachesis 200

Tuberculinum

CASES

VITILIGO - A HOMEOPATHIC PERSPECTIVE

Flouric acid 30Lyco 200

Associated systemic(autoimmune) and cutaneous diseases were observed in 38.8% of the patients.Thyroid disease being the most common(17.3%) followed by diabetes mellitus (15.8%). Association of Koebner phenomenon was observed in 20% of the patients which is a common feature of active stage (progressive) .

The associated cutaneous diseases noted in this study were Alopeciaareata (12.5%), leukotrichia (6.3%). Leukotrichia is considered to be a poor prognostic,factor.,atopic dermatitis (3.8%),pruritis in (2.3%).The distribution pattern of lesions which denotes the clinical types of vitiligo were.Vitiligo vulgaris / generalized vitiligo(53.7%) the most common morphological pattern. Other patterns seen were focal vitiligo (18.8%) acrofacial vitiligo (13.8%), segmental   vitiligo  (8.8%),  mucosal  vitiligo  (3.8%)The most common site of onset of vitiligo lesion was lower limbs (42.5%), followed by face (27.5%), upper limbs (13.8%), finger tips (7.5%), trunk (3.8%), scalp (2.5%), and genital mucosa (2.5%) in the descending order of frequency Drug analysis:Medicines found to be most effectiveNat Mur=42% cases Pulsatilla=28%Lycopodium=8 % arsenic album=6%Sulphur=17% Tuberculinum-6%Sepia=4 Medorrhinum=4%Lachesis=3% Natrum silicate=2%Nux Vom=2% Baryta sulph=2%

23%of patients shifted fromV1 to V2, 42%from V2 to V3 and 12% remained static in V2stage.92%patients completed the study.52%of patients went into remission and there was no appearance of new lesion and spread of old lesion for a minimum period of 6 months.8% of patients had remission of as long as period of 2 yrs.

CONCLUSION

This study shows the efficacy of Homoeopathic medicines in achieving remission, preventing recurrence and checking its further progression.Prospectus for future: To study the role of homeopathic medicines as immunomodulators in the natural course of vitiligo.Key words: depigmentation, autoimmunity, leucotrichia, koebners phenomenon, constitutional treatment, repigmentation, remission,concomitant disease

ACKNOWLEDGEMENT

I express my gratitute to Dr V.K Chauhan,principal,SHMC for his constant support and encouragement throughout the project.

I am thankful to Dr S.N.Jana,(co guide) ,Drs pavneet,arushi ,kalpna,meenakshi parvez,neha richa,himanshuand manu interns who have helped me in the OPD.

Dr Neena MehanAsst.professorDepartment of medicine,SHMCProject guide

Sepia 200

Natrum mur 200

Calcarea silicata

Staph 200