Vitiligo

Clinic

• Vitiligo is a disorder that causes the skin to lose its color.
• Specific causes are unknown but studies suggest a link to immune system changes.
• Vitiligo results from the destruction of epidermal melanocytes by autoreactive cytotoxic T cells.
• It seems that vitiligo is a part of Autoimmune disease named APS
• Vitiligo usually associated with diseases like Thyroid abnormality, Pernicious anemia, SLE, diabetes mellitus,IBD, RA, etc.

Signs / Symptoms

• The only sign of vitiligo is the presence of pale patchy areas of depigmented skin
• Rarely itching in the absence of sunburn.
• Patches are initially small, but often grow and change shape.
• They are most prominent on the face, hands, wrists, around body orifices, such as the mouth, eyes, nostrils, genitalia and umbilicus.
• Some lesions have increased skin pigment around the edges.
• They may experience depression and similar mood disorders.
• Koebner phenomenon: Damage to the normal skin frequently results in an area of depigmentation.
• Inflammatory Vitiligo has an erythematous raised border similar to the one sometimes seen in pityriasis versicolour.

Related disease

• Hashimoto's thyroiditis
• Scleroderma
• Rheumatoid arthritis
• Type 1 diabetes mellitus
• Psoriasis
• Addison's disease
• Pernicious anemia
• Alopecia areata
• SLE
• Celiac disease
• Addison's disease
• Autoimmune Polyendocrine Syndrome

Causes

• 6.25-38% of patients have family history for vitiligo
• Vitiligo is considered as an autoimmune disease due to:
  • The presence of melanocytes auto-antibodies.
  • Associated with other autoimmune disorders.
  • Auto-antibodies in first degree relatives of patients
  • Associated with HLA – DR4, HLA-DR1.
  • Melanocytes Destruction

Rubrics

• Face- Discoloration, White Spot: Ars, Merc, Nat-c
• Genitalia- Spots- Scrotum, White: Merc, Thuj
• Extremities, Discoloration, Upper Limbs, White, in Spot: Apis
• Extremities, Discoloration, Thigh, White, in Spot: Calc
• Extremities, Discoloration, Thigh, White Spot: Calc.
• Extremities, Discloration, Ankle, White, in Spot: Calc.
• Extremities, Discloration, Foot, White In Spot: Apis
• Skin, Discoloration, White, Spot: alum, am-c, ars, aur, berb, calc, carb-an, coca,  merc, nat-c, nit-ac, phos, sep, sil, sulph.

Remedies

Banerji protocols
First line	Ars C200, BD for 3 months If fail: Mez C6, BD Sul C200 one dose every 10 days Ars C1000 one dose every 7 days
Second line	Ars-s-f 6X, BD for 3 month

Nat-m

• Greasy/ Oily esp on hairy parts.
• Dry eruptions esp on the margins of the hairy scalp and bends of points
• Skin-raw, red, inflamed,

Nit-ac

• Zig-zag, irregular edges, base look like raw flesh.
• Exuberant granulations,
• Forehead Papules: Large jagged, Bleeds on washing
• Sensitive splinter like pains
• Agg: Evening, night, cold climate also in hot weather.

Ars-s-f

• Leucoderma and squamous syphilitic diseases.
• Sciatica and pain around the knee.
• Associated with sense of needle pricks from within outwards in the chest and esp right side also on forehead

Ars

• Skin oversensitive, suppressed eruptions.
• Brownish white spots in skin.
• White patches; dry, rough skin.

Sep

• Delicate skin

Sil

• Skin is delicate, pale, and waxy; a tendency to excessive perspiration.

Thuj

• Unhealthy skin; brown or brownish white spots here and there

• AMMI VISNAGA – Relieves issues of Vitiligo and reduces associated anxiety. Associated with treatment of spasmodic bodily movements and in the treatment of angina pectoris.
• PSOROLIA COR – It helps in the treatment of Leukoderma, Leprosy and skin diseases. It is also helpful for treating the scorpion sting and snake bites as it has antibacterial and antioxidant properties.