A case of vitiligo treated with Homoeopathic Remedy Natrum mur

Dr Riswana S

Vitiligo is defined as an acquired condition characterized by circumscribed depigmented patches resulting from the loss of melanocytes. It affects approximately 1% of the global population

AETIOLOGY

• Autoimmune Mechanisms: Autoimmunity plays a significant role in vitiligo. Patients with vitiligo often have other autoimmune disorders such as thyroiditis, diabetes mellitus, and alopecia areata. The presence of autoantibodies and autoreactive T lymphocytes suggests that the immune system may mistakenly attack melanocytes, leading to depigmentation
• Genetic Predisposition: Vitiligo tends to run in families, indicating a genetic component.Studies have identified several susceptibility loci associated with vitiligo, including genes related to immune system regulation and melanocyte function
• Environmental Triggers: Certain environmental factors can trigger or exacerbate vitiligo in susceptible individuals.These include trauma (Koebner phenomenon), sunburn, chemical exposure, and infections.
• Oxidative Stress: An imbalance between reactive oxygen species and antioxidants can lead to oxidative stress, which may damage melanocytes and contribute to the development of vitiligo.
• Neural Factors: Neurogenic factors, including the release of neuropeptides, may influence melanocyte function and contribute to the pathogenesis of vitiligo.
• Nutritional Deficiencies: Deficiencies in certain nutrients, such as vitamin B12, have been associated with vitiligo.Supplementation with these nutrients may improve repigmentation in some patients.
• Hormonal Factors: Hormonal changes, particularly during puberty, may influence the onset and progression of vitiligo

TYPES

• Vitiligo vulgaris: The most common form, characterized by bilateral, symmetrical patches on sun-exposed areas such as the face, hands, and wrists.
• Focal vitiligo: Limited to a single area of the body.
• Segmental vitiligo: Affects a specific segment or dermatome, often with a rapid onset and unilateral distribution.
• Acrofacial vitiligo: Involves the face, hands, and feet.
• Universal vitiligo: Extensive involvement covering most of the body surface area

CLINICAL FEATURES

• Appearance: Vitiligo presents as well-demarcated, ivory or chalky-white macules or patches.These lesions may be surrounded by a ring of tan or intermediate color, creating a trichrome pattern.In some cases, the lesions may be zosteriform, following a dermatome distribution.
• Distribution: Common sites of involvement include the face, hands, wrists, knees, and areas around body orifices. The lesions are often bilateral but not necessarily symmetrical.
• Associated Features: In some cases, vitiligo may be associated with other conditions such as halo nevi, alopecia areata, and autoimmune disorders like thyroiditis and diabetes mellitus.

 DIFFERENTIAL DIAGNOSIS

• Pityriasis alba
• Vitiligo
• Nevus depigmentosus
• Piebaldism
• Post inflammatory hypopigmentation
• Linear scleroderma
• Pityriasis versicolor
• Chemical or drug induced leukoderma

HOMEOPATHIC MANAGEMENT

• Arsenicum Sulphuratum Flavum: Indicated for early-stage vitiligo with small, milky-white spots.
• Sulphur: Useful for chronic cases with itching, burning sensations, and dry, scaly skin
• Calcarea Carbonica: Recommended for individuals prone to obesity or excessive sweating, presenting with white patches on the skin.
• Natrum Muriaticum: Indicated when vitiligo is triggered by emotional distress or sun exposure, with dry skin and pale spots.
• Psorinum: Suitable for persistent cases with a family history of skin disorders, characterized by extreme dryness and aggravation in winter.
• Silicea: Beneficial for slow-progressing vitiligo in individuals with weak immunity, presenting with depigmented patches and recurring infections.
• Phosphorus: Indicated for rapidly spreading white spots, especially on the face, accompanied by anxiety and restlessness.
• Sepia: Useful for hormonal imbalance-related vitiligo, common in women, with white spots on the face and neck.
• Tuberculinum: Recommended for vitiligo in individuals with a family history of tuberculosis, presenting with milky white spots and weakness.
• Bacillinum: Indicated for resistant vitiligo with a history of skin infections, characterized by depigmentation and recurring fungal infections

CASE REPORT
18 year old boy came to the  outpatient department of government homoeopathic medical college and hospital Bangalore with a C/O  Hypopigmented patches over B/L legs and chest region since 7 years.

Details of presenting complaints
Patient was apparently well 7 years back after which he noticed hypo pigmented patches over chest region and B/L legs. It first started over the chest region and after 2 Months he noticed it over his B/L legs.

According to the patient, his dad is an alcoholic person due to which he used to hit his mom and himself. Because of this , he started feeling abandoned by his family members as there was nobody to understand him during his difficult times, he always felt – want of love from his family.

Whenever he feels upset he keeps his emotions within himself and never shares it to anyone. Very little things annoy him due to his dads lifestyle and also if friends talk anything against his ideas(studies) ,he gets offended very easily. but he never express his anger but once he gets emotionally hurt, he stops talking to those who hurt him inspite of  approaching them to compromise things.

Presently he’s completely dissatisfied with his education course as he wanted to pursue something which is very challenging like ( to be a police officer)  but his family is not supporting him to achieve his dream as they want him to join something related to business.

Mentals

• Forsaken feeling
• Suppressed emotions
• Offended easily

Totality of symptoms

• Forsaken feeling
• Suppressed emotions
• Offended easily
• Desire for Sour food
• Aversion to fatty foods
• Hypopigmented patches over legs and chest region

 Reportorial totality

• MIND- Forsaken feeling , beloved , by his parents
• MIND- Emotions -suppressed
• MIND – Offended easily
• GENERALS – Food and drinks – Sour food -desire
• SKIN – Vitiligo

Prescription : Natrum mur 200

Conclusion
This case report  speaks about the success of  constitutional homoeopathic medicine in the treatment of vitiligo  .The importance of repertorization in selection of  individualized remedy has a crucial role for the successful treatment.

Declaration of patient consent
Patient consent and assent was taken for images and clinical information to be reported for this article.

Conflict of intrest:Nil

REFERENCE

1. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Harrison’s principles of internal medicine. 18th ed. New York: McGraw-Hill; 2012.
2. Gupta P. Textbook of pediatrics. 3rd ed. New Delhi: CBS Publishers & Distributors; 2016
3. B William,pocket manual of homoeopathic material medica and repertory
4. Kent J T,lectures of homeopathic material medica
5. Gopi KS. Diseases of skin with homoeopathic management. 3rd ed. Kozhikode: AIY Publications; 2022.
6. Kliegman RM, St. Geme JW III, editors. Nelson textbook of pediatrics. 22nd ed. Philadelphia: Elsevier; 2024
7. Allen JH. Diseases & homeopathy therapeutics of skin. 1st ed. New Delhi: B. Jain Publishers; 2001.

Dr Riswana S
MD part 1 paediatrics
Under the guidance of Dr.Muddassir M Mulla
Associate Professor Department of Paediatrics
Government  Homoeopathic Medical College and Hospital,Bangalore

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