Vitiligo By Dr.Neena mehan

1. VITILIGO

2. ABSTRACT
 Individuals with vitiligo feel self conscious
about their appearance and have a poor self
image that stems from fear of public rejection
and psychosexual concerns.Most of the drugs
used in vitiligo provide only a temporary
relief,whereas they riddled with potential
toxicities and cost concerns. Hence,this study
explores the efficacy of homeopathic
treatment in achieving and maintaining the
remission of the disease with minimum side
effects and cost of treatment .

3. EVIDENCE BASED ANALYSIS OF HOMOEOPATHIC
TREATMENT IN VITILIGO
 Year of commencement- 2012
 Year of concluding - 2015 (31st march)
OBJECTIVE :-
 To highlight the efficacy of homoeopathic medicines in
achieving and maintaining the remission state in natural
course of vitiligo.
 The objective of the present study was to assess the
precipitating factors ,clinical features and concomitant
disease in vitiligo patients.

4. TARGET GROUP :-
 Patients of all age and sex suffering from vitiligo.
 Follow up cases of past years attending OPD
regularly.
TYPE OFTRIAL :
Interventional
TYPE OF STUDY :
Homoeopathy - An open clinical trial to ascertain the
role of homoeopathic therapy in vitiligo.

5. INTERVENTION OR COMPARATOR AGENT
 There was no pre- defined medicine in study.
 Any indicated homoeopathic medicine selected
on the basis of individualization was prescribed.
 Indicated medicated medicine was prescribed in
30 and subsequent higher potencies like 200, 1M
orally depending on presentation of symptoms
and signs of the patient.

6. OUTCOME :-
Primary Outcome- To ascertain the role of
homoeopathic therapy in the treatment of
vitiligo.
Secondary Outcome – To identify the
homoeopathic medicine in management in
vitiligo and to verfy the characteristic
symptoms.

7. PHASE OFTRIAL : PHASE III

8. METHODOLOGY :-
A) Materials and Methods – All the patients of vitiligo
attending the OPD of dr .B.R Sur homoeopathic
medical college were administered homoeopathic
simillimum and their response to the treatment was
noted.
B) Inclusion Criteria – all the patients of clinically
diagnosed vitiligo were included in the study.
 V1- active stage, lesion size increasing and borders ill
defined.
 V2- no new lesion ,lesion stationary in size,borders
well defined and hyperpigmented.
 V3- lesion decreasing in size, no new
lesion,repigmentation.

9. C) Exclusion criteria :-
-Albinism - pityriasis alba
-Nevus achromicus - lichen sclerosis
-Tinea versicolor - piebaldisim
-Leprosy
D) Assessment criteria :– there are two different
scales, which have been co- related together to
assess disease activity as well as degree of
improvement in the patient.VIDA score andVASI
score.

10. E) DATA COLLECTION :-
The demographic and clinical data of the patients were
collected using a data collection form and also from the
medical records of patients. The data collection form
Included articulars like the name, age and sex of the
patients, age of onset of
vitiligo, duration of disease since first visit, whether the
disease is stable or progressing, drug history, presence of
koebner phenomenon, distribution of
the vitiligo lesions, history of autoimmune diseases in asso
ciation with vitiligo (thyroid, diabetes, ), family history
of vitiligo. History of precipitating
factors especially physical trauma, emotional stress, contac
t with chemicals / synthetic footwear were also noted.
A record was made of the precise distribution of lesions,
and the clinical staging was done asV1,V2 andV3.

11. F) RESULT AND DISCUSSION :-
Of the 332 patients Females (52.5%) were
affected more than males (47.5%) giving a male
female ratio of 1.1:1. The incidence of 1.3%
obtained in the present study of vitiligo
corresponds to the observations made by
different authors. Though vitiligo affects both
sexes equally, most of the studies show a female
preponderance.

12. The cause of female preponderance in most
of the studies is probably because of a greater
cosmetic awareness among females.
Of the 332 patients, 32.5% of the study
population was within the age group of 21- 40
years while 31.3% were within the age group
of 2–20 yrs and 12.4% in 41-
60 years age group.
 The earliest onset was at 6 months, whereas
 The latest was at 60 years of age.

13.  Majority of the patients (45%) were in the
age group of 21-40 yrs followed by 2-20yrs (37%) at time of
onset vitiligo. Most cases (56.2%) were less than 5 years
duration, regardless of sex .
 Around 8.8% patients had family history of vitiligo.
Positive family history is considered to be a
poor prognostic factor for vitiligo. Negative family
history 91.2%.
 Major precipitating factor of vitiligo was found to be
physicaltrauma/ injury (18.8%) followed
by emotional trauma (16.2%),
chemicals / drugs (3.8%), footwear (1.3%), pregnancy (1.3
%) etc.

14.  Associated systemic(autoimmune) and cutaneous
diseases were observed in 38.8% of the patients.
 Thyroid disease being the most common(17.3%)
followed by diabetes mellitus (15.8%).Association of
foebner phenomenon was observed in 20% of the
patients which is a common feature of active stage
(progressive) .
 The associated cutaneous diseases noted in this
Study were Alopecia
areata (12.5%), leukotrichia (6.3%).

15.  The distribution pattern of lesions which denotes
the clinical types of vitiligo were.
 Vitiligo vulgaris / generalized vitiligo (53.7%)
the most common morphological pattern.
 Other patterns seen were focal vitiligo (18.8%),
acrofacial vitiligo (13.8%), segmental vitiligo
(8.8%), mucosal vitiligo (3.8%).

16. SEX BASED ANALYSIS ASSOCIATED AUTOIMMUNE
DISORDER

17. AGE BASED ANALYSIS DISTRIBUTION PATTERN OF
LESION

18. JUSTIFICATION BASED ON PICTURES

19. (before t/t ) (during t/t )
1) Priya sharma
11.10.13 13.3.14
Remedy given- natrum silicata 200
Points of justification-
1.Desire for rice and tomatto.
2.Menses before the proper age.
3.Sleeps on abdomen

20. 2) Shashi pandey
25.10.12 28.2.13
Remedy given- phos 200
Points of justification-
1.Patient is very sympathetic.
2.Sweets aggravate.

21. 3)Harish chand
Remedy given- sulphur 200
justification-
1.Voice is loud.
2.Patient is too much self centered.
3.thermals-hot.

22. 4)Kirti kumari
14.06.2013 8.01.2014
Remedy given- natrum mur-200
Points of justification-
1.Cannot tolerate sun exposure.
2.Add extra salt in the meal.
3.Timid
4.thermals-hot

23. 5)birender singh rawat
29.05.12 28.02.13
Remedy given- lachesis 200
Points of justification-
1.Depigmented patch on left hand .
2.Patient is very egoistic.
3.Flushes of heat on and off.
4.thermals-hot

24. 6) shainaz
12.03.14 6.01.15
Remedy given- natrum mur 200
Points of justification-
1.Shy and timid personality.
2.Do not like consolation.
3.Headache from sun exposure

25. 7) Pulkit sharma
14 .01.13 4.07.14
Remedy given- natrum mur 200
Points of justification-
1.Headache on exposure of sunlight.
2.Get irritated easily.
3.Thermally-hot.

26. 8) prachi
22.11.12 10.01.13
Remedy given- stram 1 M
Points of justification-
1.Antics play
2.Patient has fear from darkness.
3.Patient is talkative.

27. 9)rahul kumar
21.06.13 17.01.14
Remedy given- medo 200
Points of justification-
1.Sleeps more on abdomen.
2.Weakness of memory.
3.Cries easily
4.thermals-hot.

28. 10)salma
27.7.2013 24.12.2013
Remedy given- lycopodium 200
Points of justification-
1.Afraid to be alone.
2.Lack of self confidence.
3.Thermally-hot.

29. 11) Deepak
21.2.2013 21.10.2013
Remedy given- flouric acid-200
Points of justification-
1.Indifference to close one.
2.Do not want to take responsbility.
3.Thermals-hot.

30. 12) vishal
30.11.13 03.04.14
Remedy given- bacillus proteus 30
Points of justification-
1.Headache on exposure of sunlight.
2.Desire for sweets.
3.thermals-hot

31. DISCUSSION
 In our study, predominance of females was observed and this
was in accordance with the study of BHU ,Varanasi( 2009- 2011)
on” epidemiological profile of vitiligo in northern India” Kovacs,
1998; Al-Mutairi & Sharma, 2006; Shajil et al, 2006; Martis et
al., 2002 and Nunes& Esser, 2011.
 This may be attributed to the fact that parents are probably
more concerned when confronted with a daughter instead of a
son with vitiligo and therefore more likely to consult a doctor
(Jaishankar, 1992).
 In our study the more common age group for onset of disease
is 10-30 years and this is consistent with other reports (Rajpal,
2008; Arycan, 2008). This shows that disease starts at a younger
age in the Indian population. Contrary to this Howtiz et al
(Howits, 1977) showed age of onset of vitiligo to be in between
40-60 years.

32.  In our study the duration of disease varied from six months to
20 years but 34.3% cases were less than 5 years in duration and
65.7.5% were from active vitiligo category. Similar studies had
been performed by BHU,Varanasi 2011,Hann & Lee, 1996; Shah
et al, 2008 & Dave et al., 2002.
 A positive family was reported in 17 % cases in our study.
Hann et al, 1997 reported 13% family history; Handa & Kaur,
1999 reported 11.5% while Al Mutairi & Sharma, 2006 reported
18.9%. This is attributed to the role of genetic factors in the
pathogenesis of vitiligo.
 Generalized Vitligo vulgaris (55.5%) is the most prevalent
subtype followed by localized type(49.8%) in our study.
Similarly Kovacs, 1998; Handa & Kaur, 2003 & Hann et al, 1997
also reported vulgaris to be most commonsubtype.

33.  Association of vitiligo with other diseases or abnormalities has
also been a subject of great interest.In our study autoimmune
diseases were seen in 16.5% cases.
 The association with thyroid disease was 7.6%, followed by
diabetes mellitus in 4% patients. Gopal et al, 2007 & Arycan et al,
2008 reported 12% & 4.4% thyroid disease respectively, Huggins
et al, 2006 reported 1-7% diabetes mellitus, Reghu et al, 2011 &
Handa & Dogra, 2003 reported 6.3% & 11.5% leukotrichosis
respectively.
 Clinically apparent deafness or any other ocular abnormality
was not observed in any of the patients in our study.
 Majority of our patients were from urban areas thus
environmental pollutant may acts as triggering factor in these
cases. Slominski et al, 1989 reported several environmental
factors such as stress; extreme exposure to sunlight or pesticides
plays a role in the etiology of vitiligo.

34. Medicines most effective
Medicines used maximum: The prescriptions were
made on basis of totality of symptoms and the patients
showed marked improvement by the constitutional
medicine (natrum mur followed by pulsatilla , sulphur,
sepia, lycopodium , tuberculinum , phosphorous etc)
during treatment.
•Nat mur 200 was given to 30 patients out of which 22
went into remission & 8 were static.
•pulsatella 200 was given to 25 patients out of which 15
went into remission & 10 were static.
•sulphur 200 was given to 18 patients out of which 10
went into remission & 8 were static.

35. •Similarly sepia 200, lyco 200, tuberculinum 200,
natrum silicate 200, lachesis 200, and other
constitutionally selected medicines were given
according to symptom similarity.
23%of patients shifted fromV1 to V2, 42% from V2
to V3 and 12% remained static in V2 stage.
92%patients completed the study.52%of patients
went into remission and there was no appearance
of new lesion and spread of old lesion for a
minimum period of 6 months.
8% of patients had remission of as long as period
of 2 yrs

36. CONCLUSION
This study shows the efficacy of Homoeopathic medicines
in achieving remission, preventing recurrence and checking
its further progression.
It may further define the reliable indications of medicines
found effective in vitiligo. This shall be a valuable data for
indexing in the repertory and the same may immensely
benefit the profession and patients at large. The result of
study may also help in verification of various clinical or
additional symptoms of medicines used during study.
These medicines will provide a gentle, safe and cost
effective treatment of vitiligo