Recently I came across some very well quoted lines ,”The skin is one of the main organs for human beings, especially because it is protective and allows interpersonal interactions, being characterized, then, as mediator between one and the world as well as one’s peers. Thus, the skin represents the main connecting channel between subject and world, if not the main one,certainly the first one .”
People are often judged and ostracised by their external appearance , their skin colour,
We often come across people having white blotches on their skin. Today we will talk about such patients with white blotches or Leucoderma also called as vitiligo .
Although it is not a condition that is contagious, people with vitiligo often face ostracism from those around them, including family and friends.
Recently, importance of emotional and psychological issues has been raised. Therefore, vitiligo could be considered as a psychosomatic disorder, which means physical and psychological factors concomitantly are involved in appearance, progression, relapse and remission of vitiligo .
Vitiligo imposes a large burden on patients’ lives, and many patients suffer from shame and embarrassment , low self-confidence, and social isolation.
Wrong social beliefs exacerbate the problems of vitiligo patients. As in women, vitiligo may end in divorce and some people believe it is God’s punishment for the sins.
In south Asia, and in India, in particular, vitiligo was once confused with the infectious disease leprosy, which is endemic in the region. Even today, India’s culture of arranged marriage still ostracizes those who have vitiligo; not only those with the disease but also their siblings can be eliminated as marriage prospects.
vitiligo, for being asymptomatic , is still considered by part of the medical community as something that brings no downside to the patients , disregarding several emotional factors that are intertwined with the process of falling ill ,as told by the patients .
Thus we reiterate the importance of psychodermatology as a field of knowledge and professional practice to better exploration ,aiming a therapeutic approach that takes into account the biological ,psychological and social aspects for the patient with vitiligo ,acknowledging them as whole individual .
Let’s talk about vitiligo in detail
Vitiligo
Vitiligo occurs when pigment producing cells which are the melanocytes die or stop producing melanin –(which is the pigment that gives your skin , hair and eyes colour)
Vitiligo is generally considered to be an autoimmune disorder. Autoimmune disorders occur when the immune system attacks the body’s own tissues and organs . In people with vitiligo the immune system appears to attack the pigment cells (melanocytes) in the skin About 15 to 25 percent of people with vitiligo are also affected by at least one other autoimmune disorder, particularly autoimmune thyroid disease (Hashimoto’s Thyroid disease) , Rheumatoid arthritis , Type 1 diabetes , psoriasis , pernicious anaemia ,Addison disease , or systemic lupus erythematosus.
Leucoderma is a photosensitive skin condition where the areas that are affected are more sensitive to sunlight.
In some people , physical trauma or stress to the skin like a sunburn or exposure to industrial chemicals seems to trigger vitiligo , or at least precedes it.
Vitiligo can appear exactly on the sites where there has been some kind of injury ,the reason for the same is not known .
There are mainly 2 types of vitiligo which are:
Non-Segmental Vitiligo
In this type of vitiligo you can observe that the white patches are symmetrical. The patches appear equally on all sides of the body which are exposed to sun. They generally appear on the hands, neck, face, mouth, elbows, knees, armpits, and eyes.
Non segmental vitiligo is the most common type , accounting for upto 90% of cases. The patches often appear equally on both sides of the body , with some measure of symmetry . They often appear on skin that is commonly exposed to the sun, such as the face, neck and hands.
Common areas include:-
• back of the hands
• arms
• eyes
• knees
• elbows
• feet
• Mouth
• armpit and groin
• nose
• navel
genitals and rectal area
Non segmental vitiligo is further broken down into sub categories:-
• Generalised – There is no specific area or size of patches . This is the most common type.
• Acrofacial– This occurs mostly on the fingers or toes.
• Mucosal – This appears mostly around the mucous membranes and lips.
•Universal: Depigmentation covers most of the body. This is very rare.
•Focal: One, or a few, scattered white patches develop in a discrete area. It most often occurs in young children.
Segmental Vitiligo
Segmental vitiligo spreads more rapidly but is considered more constant and stable and less erratic than the non-segmental type. It is much less common and affects only about 10 percent of people with vitiligo. It is non-symetrical.
It is more noticeable in early age groups, affecting about 30 percent of children diagnosed with vitiligo.
Segmental vitiligo usually affects areas of skin attached to nerves arising in the dorsal roots of the spine. It responds well to topical treatments.
Myths VS Facts
There are some common myths associated with vitiligo .
Myth 1: Vitiligo is an outcome of the wrong combination of foods, for instance, milk consumption shortly after eating fish can bring on the disorder.
Fact: Factually, vitiligo has no link with the diet. It is irrational to deprive patients of the sour foods like lemon, curd, tomatoes, and pickles in the hope of declining the possibility of the disease.
Myth 2: People with vitiligo disorder are lesser in their mental or physical proficiencies.
Fact: Vitiligo is limited entirely to the skin. It has no relationship with or does not influence or affect any other organs.
Myth 3: Vitiligo is a kind of leprosy and is communicable.
Fact: Vitiligo is in no way linked to leprosy. It is not infectious or contagious and, hence, cannot pass on from one person to another.
Myth 4: Vitiligo is connected to serious skin diseases, such as skin cancer and albinism.
Fact: There are transparent dissimilarities among each of these syndromes, not any of them are linked to Vitiligo
Myth 5: Vitiligo is untreatable
Fact: Medications like steroids, Ultraviolet A, immunomodulator drugs and the newer narrowband Ultraviolet B are accessible, along with several surgical options and alternative treatments.
Diagnosis
If your dermatologist suspects that you have vitiligo, your dermatologist will:
• Review your medical history, and may ask specific questions, such as whether anyone in your family has vitiligo also the doctor will inquire about medical history and try to rule out other medical skin-related conditions like psoriasis and dermetitis
. The doctor will use ultraviolet light on the affected areas to determine if its vitiligo.
• Perform a physical exam, looking carefully at the affected skin
You also may need a small biopsy of the affected area and blood samples are taken to look for autoimmune disorders. People who have vitiligo often have thyroid disease.
Blood test to check the homocysteine levels .Elevated homocysteine in vitiligo patients may be a precipitating factor in the development of vitiligo. One study showed that patients with active vitiligo had significantly higher homocysteine levels than those with stable vitiligo, which would also indicate a B12, B6, and folate deficiency.Homocysteine metabolism depends on folic acid and vitamin B12, both of which are lowered in patients with vitiligo. Elevated serum homocysteine levels are found in extensive vitiligo and may represent a severity marker.
symptoms
Usually pale and white spots, patchy areas of depigmented skin appear. This is generally found in those body parts that face sun exposure. It usually occurs on hands, wrist and facial areas. If a white pigmentation already exists on your skin & you get hurt all of a sudden thereby developing similar white patches on the skin, then you should immediately visit a doctor.
Remember that the patches are painless and it does not even cause any sensation of itching. But, with the sun’s exposure, it may cause irritation and even sometimes a burning sensation.
Lifestyle related restrictions:
• A tight fitting dress or undergarment which leaves marks on skin, elastic must not be used as it can disturb the blood circulation over that particular area.
• Itching, scratching over skin should also be avoided. Vitiligo patients should refrain themselves from any accident or injury as much as possible ,as injury may develop into a new white spot.
• Rubber and plastic wear should be avoided in regular use.
• Synthetic or plastic artificial ornaments, Bindi or any stickers which sticks with an adhesive over skin should be completely avoided.
• Playing in direct sun in afternoon (between 11 a.m. to 4 p.m) should be restricted.
Swimming in pools should not be done in Vitiligo & Leucoderma.
Some Food Restriction Tips for Vitiligo patients:
1-It has been seen that Turmeric slows down pigmentation rate & responsible for depigmentation and is good for fairness. So, turmeric application & raw intake has to be avoided in Vitiligo. Moreover it’s a great antiseptic.
2- Beetroot & Carrots actually helps in pigmentation. These can be helpful in faster pigmentation.
3-Almost 70% of Vitiligo patients suffer from Vitamin D3 and Vit B12 deficiency. Taking Vitamin D3 and B12 supplement helps in control of spots.
4-Omega 3 capsules and diet should be completely restricted in Vitiligo as Omega 3 triggers Vitiligo spots.
5-Soda bi carbonate found in aerated drinks are found to be triggering Vitiligo and should not be taken.
6-Copper glassful water helps in pigment deposition over skin. It is helpful and should be taken daily at least one glassful.
7- Figs & Dates are copper rich and are helpful in pigmentation so these are recommended in Vitiligo.
Treatment
Many treatments are available to help restore skin color or even out skin tone. Results vary and are unpredictable. Some treatments have serious side effects. So your doctor may suggest that you first try improving the appearance of your skin by applying self-tanning products or makeup.
If you and your doctor decide to treat your condition with a drug, surgery or therapy, the process may take many months to judge its effectiveness. And you may have to try more than one approach or a combination of approaches before you find the treatment that works best for you.
Medications
Topical applications
Creams that control inflammation-• Applying a corticosteroid cream to affected skin may help return color, particularly if you start using it early in the disease. You may not see a change in your skin’s color for several months.
This type of cream is effective and easy to use. But it can cause side effects, such as skin thinning or the appearance of streaks or lines on your skin.
Milder forms of the drug may be prescribed for children and for people who have large areas of discolored skin.
Medications that affect the immune system
Ointments containing tacrolimus or pimecrolimus (calcineurin inhibitors) may be effective for people with small areas of depigmentation, especially on the face and neck.
This treatment may have fewer side effects than corticosteroids and can be used with ultraviolet B (UVB) light. However, the Food and Drug Administration has warned about a possible link between these drugs and lymphoma and skin cancer.
Therapies
Combining psoralen and light therapy. This treatment combines a plant-derived substance called psoralen with light therapy (photochemotherapy) to return color to the light patches. After you take psoralen by mouth or apply it to the affected skin, you’re exposed to ultraviolet A (UVA), UVB light or excimer light. These approaches tend to have better results than just medication or just light. You may need to repeat treatments up to three times a week for six to 12 months.
Removing the remaining color (depigmentation)
This therapy may be an option if your vitiligo is widespread and other treatments haven’t worked. A depigmenting agent is applied to unaffected areas of skin. This gradually lightens it so that it blends with the discolored areas. The therapy is done once or twice a day for nine months or longer.
Side effects can include redness, swelling, itching and dry skin. Depigmentation is permanent, and you’ll always be extremely sensitive to sunlight.
Surgery
Surgery may be an option for you if light therapy doesn’t work. Surgery can also be used with those therapies. The goal of the following techniques is to even out your skin tone by restoring color.
Skin grafting , blister grafting, are other options
Potential future treatments
Treatments being studied include:
A drug to stimulate color-producing cells (melanocytes). Called afamelanotide, this potential treatment is implanted under the skin to promote the growth of melanocytes.
A drug that helps control melanoctyes. Prostaglandin E2 is being tested as a way to restore skin color in people with localized vitiligo that isn’t spreading. It’s applied to the skin as a gel.
A drug that reverses loss of color. Tofacitinib, an oral drug typically used to treat rheumatoid arthritis, has shown some potential as a treatment for vitiligo.
Lifestyle and home remedies
The following self-care tactics may help you care for your skin and improve its appearance:
Protect your skin from the sun and artificial sources of UV light –use a broad-spectrum, water-resistant sunscreen with an SPF of at least 30. Don’t use tanning beds and sunlamps.
Conceal affected skin–
Concealing products may improve the appearance of the skin and help you feel better about yourself, especially if your vitiligo patches are on exposed skin.
Don’t get a tattoo– It is seen that some vitiligo patients opt for totooing .
Avoid tattooing that’s not related to treating your vitiligo. Damage to your skin, such as that caused by a tattoo, may cause a new patch of vitiligo to appear within two weeks.
Homeopathic Treatment
The conventional mode of treatment believes that the treatment for vitiligo may improve the appearance of the affected skin but does not cure the disease. Nevertheless, Homeopathy offers an excellent treatment in most of the cases of vitiligo; if not all. As the disease is chronic and long-standing in nature, it takes time to obtain results. Exact time cannot be predicted.With the homeopathic mode of treatment early and milder cases of vitiligo can be treated with excellent success, moderate and spreading cases can expect partial color formation with good control, while rapidly spreading cases may be controlled significantly. It may be noted that good control over the spread is also considered a success in extensive cases.
The homeopathic treatment for vitiligo is addressed to enhance the melanocyte formation by stimulating the natural process called melanogenesis. It also controls the spread of Vitiligo by attempting to correct the immune system.
There are many remedies in homeopathy indicated in the treatment of vitiligo but exact medicines are selected on the basis of an individual case history and symptoms. Few of the best remedies indicated in the treatment of Vitiligo are:
Silicea
It is a popular remedy for those vitiligo patients who are sensitive to cold wind (breeze, air-conditioners, winter); who tend to sweat on palms and soles; have typically offensive foot-sweat; have lean-thin physical body structure, and may additionally have a tendency to have easy pus formation after injury.
It is useful in treating nutritional deficiencies, it regulates the immune system and treats skin and bone diseases. Silicea helps in the correction of nutritional and immunological imbalance and hence useful in the treatment of vitiligo. It helps in absorption and retention essential nutrients in the body. Silicea can prevent further depigmentation of the skin by arresting the progressive destruction of melanocytes.
Kali carbonicum
Kali carb is used for treating autoimmune disorders such as vitiligo, hypothyroidism and hair loss .kali carbonicum is effective for treating diseases in people whose constitutional states include mental anxiety and stress hence it is used for the treatment of the effects of stress on the body.
Syphillinum
Syphilinum belongs to a group of homeopathic remedies called nosodes. Nosodes are obtained from diseased tissues. In the case of Syphilinum, the tissue used is afflicted with the syphilitic virus. However, in the homeopathic remedy, the virus has been removed and its toxins diluted to non-virulent levels by the process of potentization.
It’s a useful drug to combat diseases that are destructive in nature and are deep-seated. Its effects can be seen in many organs and it is a common remedy for diseases such as vitiligo, osteomyelitis, and rheumatism.
Nitric Acid
In vitiligo white spots are found at the muco-cutaneus junction. More at the angle of the mouth, eyes, nose, nipples, glans penis, vulva, etc. Along with it, there may be fissure at the same spot. In some of the patients along with this, there is a desire for eating chalk, pencils, etc., particularly in children.
Arsenicum Sulfuratum Flavum
This is one of the most commonly used, over the counter remedies used for the treatment of vitiligo in homeopathy .A deep acting drug which has been known to give good results in the treatment of vitiligo.
It is indicated in vitiligo cases where discoloration of the skin in patches that are pale or white in color. It is also a good remedy for moist eczema with intense itching with corrosive discharge.Tremendous anxiety comes on during evening .
Carcinosin
Homeopathy believes that the genetic predisposition or inherent susceptibility is usually the root cause of a wide range of diseases and Carcinosin in one such remedy which is used to combat these genetic tendencies effectively. Carcinosin works wonderfully in patients with family history of genetic disorders or cancer.
Other remedies are
Thuja , Kali brom , Drosera
Along with these medicines patient can use Bouchi oil (U can get this oil in a Homeopathic pharmacy) for local application .
pls note :-The treatments and medicines mentioned above should be taken only after consulting registered medical practitioners or health care provider .Self medications may aggravate or worsen the condition .
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General signs and symptoms of Hypothyroidism are
Hyperthyroidism can mimic other health problems, which can make it difficult for your doctor to diagnose. Increased secretions of thyroid harmones can produce myraid of symptoms that vary from patient to patient and with the age of the patient.
Blood tests that measure thyroxine and thyroid-stimulating hormone (TSH) can confirm the diagnosis. High levels of thyroxine and low or nonexistent amounts of TSH indicate an overactive thyroid. The amount of TSH is important because it’s the hormone that signals your thyroid gland to produce more thyroxine.
