Dr Greeshma Vikraman
Vitiligo denotes an acquired primary, usually progressive, melanocytopenia of unknown etiology, clinically manifested by circumscribed achromic macules often associated with leukotrichia and histologically by degeneration and disappearance of melanocytes in the involved skin and not infrequently in the pigment epithelium of eyes, leptomeninges and inner ear.
Besides a genetic predilection, diverse epigenetic factors also play a role in the etiopathogenesis. An alteration in the microenvironment of epidermal melanin units, related possibly to immunological and neurochemical factors , has also been presumed. Disruption of the process of physiological melanisation because of subcellular disorganisation of unknown mechanism within the melnocytes culminates in their death and disappearance. The following hypothesis have been proposed
Immune hypothesis: This theory states that primarily there may be some kind of biochemical trauma to melanocytes resulting in the release of some antigenic substance and subsequent autoimmunisation. Alternatively there may be certain immune cells directed against antigenetic components of autologous melanocytes.
Neural hypothesis: This hypothesis theorises that destruction of melanocytes occur because of liberation of some unusual neurochemical meditor or due to a gross alteration in the ratio of the normal neurotransmitter substances in the lesion.
Autotoxic self destructive or free radical hypothesis: This states that an intermediate metabolite of melanin synthesis causes destruction of melanocytes or that the normal process of melanosome destruction proceeds unbated to cause melanocyte death
Composite hypothesis:This states that vitiligo is a mixture of immune, neural and free radical hypothesis
Melanocyte growth factor reduction hypothesis: It has been proposed that depigmentation in vitiligo might be due to reduced local and circulation levels of growth factor, which is necessarily for the normal proliferation and maintenance of melanocytes
Antioxidant deficient theory: According to this there is a breakdown in the antioxidant defence of the epidermis leading to melanocyte toxicity.
Vitiligo is classified into focal, segmental, generalized and universal types, a conventional self-explanatory arrangement. However, Lerner classified vitiligo into 3groups namely:
a) segmental, localized, partial or focal vitiligo corresponding to adermatome / adjacent dermatomes b) vitiligo vulgaris generalized, involving thehands, face, axillae and limbs (ACROFACIAL) and
c) complete, total or universal vitiligo involving the entire or nearly entire body surface(UNIVERSALIS)
Vitiligo has been reported to be associated with alopecia areata, hypothyroidism, grave’s disease, addison’s disease, pernicious anaemia, insulin dependent diabetes mellitus,uveitis, chronic mucocutaneous candidiasis,polyglandular autoimmune syndromes and melanoma, caninitis, atopic eczema, psoriasis, scleroderma, lichen planus, lichen simplex, discoid lupus erythamatosis, halo nevus, ichtyosis
As the literature has given us sufficient reasons for vitiligo being an autoimmune problem, so it has to be dealt with CONSTITUTIONAL approach. Eventhough skin symptoms have to be considered we have to compare with the material medica whether the remedy is suited or not both in mental and physical plane. We cannot prescribe a medicine saying that it acts on skin and has a capacity to restore melanocytes. If it doesn’t cover the characteristic keynotes indicated of remedy it will not provide relief to the patient. Fundamental cause has to be identified and treated accordingly. Below are few remedies commonly used in treating vitiligio with its characteristic mental state, disposition and skin affections
1. ARSENICUM ALBUM
Suited to psoric constitutions, nervous temperaments with anxiety,exhaustion and restlessness.Anxiety about health, despair of recovery, fastidious,extreme nervous and anxious, full of worries about trifles, domineering and demanding.
Skin- oversensitivenss, intense itching after suppressed eruption. Brownish whitespots in skin. Dry, rough, scaly dirty, shrivelled. Burning pains, burning like fire, sudden great weakness.
2. CALCAREA CARBONICUM
Carbonicum personalities are susceptible to cold. goes out of breath very easily. Sweating is easily. Exhibits a jaded state, mental or physical, due to overwork.
Skin- cold like a snake, flaccid, unhealthy.Milk white spots.Glands swollen. Small wounds do not heal readily.
3. LACHESIS MUTA
Major characteristics of this constitution incudes: Great loquacity, one word often leads to another story, insane jealousy and suspiciousness. Quarrelsome from jealousy..fear of snakes, fear of being poisoned, malicious, wants to get revenge. Religious insanity.Alcoholism.
Skin – dilated capillaries, bluish purplish appearance. small wounds bleed much.
4. MAGNESIUM CARBONICUM
Suited to ailing, worn out, nervous, flatulent and flabby persons especially women, and children. Effects of shock, blows, mental distress; ailments from excess of care and worry with. Broken down.Mental exhaustion worse from mental exertion. Confusion of mind, as if intoxicated. Fear something bad will happen,
Skin – hair and nails unhealthy. Sore, dry skin, sensitive to cold.Violent itching and great dryness of skin.
5. MAGNESIUM MURIATICUM
Major mental characteristics whoch lead to this remedy include:.Confusion of mind aggravated by mental exertion. Aversion to conversation, prefers solitude. Peevishness and chagrin.Obstinate,headstrong.Grief.Forsakenfeeling.Nervous excitability with tendency to weeps easily.Feels on the verge of a nervous breakdown.Overwhelming anxiety.
Skin –formication all over the body,
6. NATRUM MURIATICUM
Suited to. Reserved and introverted. Acute and chronic grief.Severe depression and feelings of isolation.Cannot cry in front of others. Consolation aggravates. Ailments from grief, disappointed love. Sulking, sighing. Cries from music.Anxiety and fear. Fear of rejection. Fear of being ridiculed, embarrassed.Irritable, extremely forgetful.
Skin – dry and chapped skin. Greasy, oily skin especially on hairy parts.
Suited to tall, slender persons of sanguine temperaments, sensitive nature. Young people who grow too rapidly and are inclined to stoop, chlorotic, anaemic. Tall, slender, narrow chested, delicate eyelashes. Nervous weak people, who like to be magnetized. Great sensitivity to external impressions to light, sound, odor, touch, electric changes, thunderstorms.Human barometer.Insidious onset, gradually increasing debility, ending in severe or rapid disease. Sudden symptoms, sudden prostration, faints ,sweats etc.
Skin – burning in skin with restlessness, Wounds bleed very much, even if small. Persons of waxy, transcluent skin.
8. PULSATILLA NIGRICANS
Suited for females of mild, gentle, plethoric, yielding dispositions, who cry readily and weep when talking. The disposition and mental state are the chief guiding symptoms. Sad, crying readily, weeps when talking. Moody, contradictory. Changing, shifting symptoms, known as weather cock remedy. Changeable nature. The patient seeks the open air, always feels better there. Thirstless, shortness of breath.Craves sympathy and affection.Forsakenfeeling.History of abandonment or grief. Better being held or hugged. Consolation improves all complaints.
Skin- skin itches on being heated. Moles or freckles
9. SEPIA SUCCUS
Suited to nervous and delicate constitution who are disposed to sexual excitement or worn out by sexual excess. yellow saddle across nose, irritable, faint from least exertion, leuco-phlegmatic constitution. Pre-eminently a woman’s remedy. Cries when telling her symptoms.Weeping worse from consolation.Self pity.
Skin-chloasma.Blotched, raw, rough, hard or cracked. Delicate skin, least injury tends to ulcerate.
10. SILICEA TERRA
Demineralised constitution.Constitutions that suffer from deficient nutrition due to lack of assimilating power, oversensitive physically and mentally.Nervous, irritable with dry skin. Want of grit, moral or physical. Tendency to easy exhaustion and abnormal sweats. Want of vital heat even when exercising. Loss of self confidence. Faint hearted, anxious. Performance anxiety, timidity about appearing in public.Bashful.Conscience about trifles.Yielding disposition. Fear of needles, pins and sharp objects.
Skin – delicate, pale, waxy skin. Unhealthy skin, every injury suppurates. Palms and soles of feet sweat profusely.
Ailments from shame, punishment, vexation and suppressed anger.Humiliation.Ailments from sex, sexual excesses, masturbation. Surgery, cutting wounds, injury, falls. Tobacco, mercury, dentition. Guilt and depression with headaches.Insomnia due to sexual fantasies. Great indignation about the things done by others or by himself, grieves about consequences. Violent outbursts of passions. Morbidly sensitive to the least word said. Irritable, nervous, excitable and violent.Overly nice, timid.Passive, pathological desire to please.Feels guilty, reproach themselves.Very poor confidence, low self esteem.Deep feelings of worthlessness, severe depression.Easily offended.Acute anger.Speechless when angry.
Skin-unhealthy, doesn’t heal. Biting pain and itching. Profuse cold sweat.Scratching changes location of itching.
Suited to lean, stooped shouldered persons, who walk and sit stooped shouldered, standing is the most uncomfortable position. Persons of psoric temperament, nervous, quick tempered. People with hot, sweaty hands.Dirty looking persons who are always speculating on religious or philosophical subjects. Sulphur is a major anti psoric. Complaints that relapse.
Skin- affinity to skin where it produces burning with itching, made worse by heat of bed. Dry unhealthy hair and skin.Skin disorders after local application. , skin excessively sensitive to atmospheric changes. Dirty filthy people with greasy skin, and long straight matted hair, prone to skin disorders.
The syphilis nosode is mainly used on the general symptomatology with family and personal history of the patient. In night aggravation of complaints, with extreme mental and physical restlessness, together with its intense irritability, are striking indications for its use. It’s frequently used to great advantage as an intercurrent remedy in the course of treatment in chronic disease, prior to or following the apparently indicated remedy when the patient’s response to that remedy is feebly or nil. Syphilitic disorders. Utter prostration and debility in the morning. Anxiety ofhealth.Feeling as if going insane.
Skin – symmetrical appearance of depigmented patches, reddish brown eruption with disagreeable odour. Distorted nails.
14. TUBERCILINUM BOVINUM
Tubercular constitutions.Very susceptible to weather changes. Desire to travel, deep feeling of being unfulfilled, wants to do something different or to find a new doctor. Restlessness, impulse to run.Desire to break things. Precocious children, sensitive to music, fear of animals. Maliciousness behaviour and destructiveness. Abusive, fits of violent temper. Wants to throw anything at anyone without a cause.
Skin – dry, harsh, sensitive. Acne in tuberculous children.(33,34,35,36,37,38,39,40)
- Valia RG, Valia AR. IADVL Textbook Of Dermatology. 3rd ed. Vol 1. India:Bhalani Publishing House. Ch- 25, p749-760.
- . HabifT.Clinical Dermatology.5th ed.UK: Elsevier.2010.Vol 1.Ch-19,Pg 766
- . Murphy R. Lotus MateriaMedica. 3rded.India: B.Jain Publishers (P) Ltd;Pg 226,231,408-412,1112-1117,1208-1211,1213-1215,1356-1362,1502-1508,1596,1601,1765-1770,1778-1784,1833-1836,1865-1869,1889-1891,1978-1980.
- Boericke W. Pocket Manual of Homoeopathic MateriaMedica,2010 Reprint Ed.New Delhi:B.Jain Publishers (P) Ltd; 2010.p 72-75,129-130,408-410,518,520,521-524.
Dr Greeshma Vikraman
PGT Department of organon of medicine
Father Muller Homoeopathic Medical College