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

	Skin	Peculiar Constitutional Sign / Symptoms
Calc	Top grade constitutional medicine for Vitiligo esp in milky white spots on skin. These white spots can appear anywhere on the body.	Free perspiration over the head, neck and chest. Intolerance to cold weather. Certain peculiar cravings for eggs, lime, pencils Tendency to catch cold easily. Weakness of bone may also be found. Easily fatigued by exertion Chronic constipation and obesity A number of fears esp fear of misfortune, of contagious disease, of losing reason and of insanity.
Ars	Dry, rough skin Skin is dry, dirty and rough. Skin complaint alternating with respiratory complaints like asthma is a strong pointer for using Ars 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. Fears and anxieties including fear of death,  disease,  germs and of catching infection. They are highly anxious personalities esp  about health,  trifles and about others. Marked restlessness is often seen on both mental and physical Fastidiousness. Person demanding extreme neatness and order in everything are yet another suitable subjects requiring Arsenic Album.
Sep	Sep is also selected constitutionally in vitiligo	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 and an aversion to consolation or sympathy. Women with menstrual irregularities or those around menopausal age with tendency to hot flushes.
Sil	Sil is also selected constitutionally in vitiligo Skin is pale and waxy Tendency to excessive perspiration on hands and feet; Tendency to eruptions with pus formation in various body parts;	Tendency to catch cold on frequent basis; lean, thin physical makeup . The main mind symptom are timidity and an under-confident nature. Under-confident, fear public speaking, are timid and bashful. Obstinate behavior and stubbornness may also indicate its use .
Sul	Although Sulphur is mentioned quite low down in the list for treating vitiligo but its worth is equivalent to above narrated medicines. . Sulphur is a deep acting medicine used frequently in treatment of varying skin diseases including vitiligo. It goes deep inside the basic root cause to annihilate the disease in its complete extent. The persons requiring Sulphur usually show a philosophical mindset. They are popularly referred as ‘ragged philosophers’.	Their mind is constantly occupied with various theories and 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 be present along with white spots on skin.  An extra ordinary craving for sweets may also be shown as a constitutional symptom.

5. Sulphur – One of the best Medicines for Vitiligo

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.