Archive for December, 2007

Leucoderma

Vitiligo, also known as leucoderma (leuco=white, derma=skin), is a disorder manifesting on the skin which can cause extreme distress to sufferers because of its unusual appearance. There is loss of skin pigmentation in patches due to destruction of the pigment manufacturing cells, the melanocytes. It is usually progressive and over time the white patches may spread to other areas of the body.

In India, it is often called ‘safed kor/kod’. It affects at least one in every hundred people in countries throughout the world. It affects people of both sexes equally, and it affects all races. It can begin at any age, though about fifty percent of people with vitiligo develop it before the age of twenty.

Vitiligo is usually not harmful medically, but it often takes a toll on the psychological well-being and self esteem of the individual. People have to be aware that it is NOT infectious or contagious and cannot be spread to other people by contact. The social stigma attached with this condition needs to be removed.

SIGNS & SYMPTOMS — Small areas of different skin colour or patches with the following characteristics:
· They are flat, white and can’t be felt with fingers.
· They spread to form very large, irregularly-shaped areas without pigmentation.
· They are usually on both sides of the body in approximately the same place.
· Their size varies from 2mm or 3mm to several centimeters in diameter.
· They don’t hurt or itch.
· The hair growing on skin affected by vitiligo sometimes turns white.

CAUSES —
The exact cause is not yet well understood. It is believed to be the result of autoimmune, genetic and environmental factors. An autoimmune origin implies that the body’s own defence mechanism does not recognize the pigment cells as the body’s own; considers them to be ‘foreign’, and destroys them. As we know, stress often play a major role in adversely affecting the immune system and creating an autoimmune condition. Family history of the condition is found in about 10-30% of the affected patients. Some studies suggest that people with vitiligo inherit a group of three genes that make them susceptible to developing it. Vitiligo may be precipitated by injury or sunburn.

RISK INCREASES WITH –
· Family history of vitiligo.
· Thyroid or adrenal disease.
· Diabetes mellitus.
· Injury.
· It may be associated with some other auto-immune diseases.

PROBABLE OUTCOME AND TREATMENT — It is important to realise that inheriting a vitiligo trait from your parents does not necessarily mean that you will develop the condition. If the body’s immune system remains healthy, functioning to its best capacity, latent predispositions do not become active. To keep your immune defences high, it is important to have a healthy, well-balanced nutritious diet, with plenty of fresh fruits and vegetables; avoid junk food and processed food as far as possible. Get adequate sleep and exercise in fresh air. Learn to handle stress effectively.

Treatment is prolonged but there can be no guarantees for complete and permanent re-pigmentation. It is impossible to predict how much improvement will occur with treatment. Younger individuals (under 30) and those who obtain treatment early usually respond best. Allow one year to evaluate results. Spontaneous re-pigmentation is noted in about 10-20% of patients. Factors indicating good prognosis for regimentation are: recent onset within the past 6 months, in a young individual on the facial area. Conversely, factors which indicate an unfavorable prognosis are: late onset in life, long-standing persistent lesions, located on the extremities and on the lips.

HOMOEOPATHY has a holistic approach and treats a patient with vitiligo as an individual, mind and body together. The physician will inquire into all aspects of the patient’s life; mental, emotional and physical characteristics of the patient, personal and family history. The aim is to set right the immune functioning of the patient and remove the tendencies to illness. Once the body’s immune system is functioning well, there are good chances that re-pigmentation will set in. In this way, homoeopathy offers a safe and gentle approach in the treatment of vitiligo.

This was a case of a 14 year old boy who had received a back injury 6 months previously. He had then developed pain in the lumbar region, on either side of the spinal column. X-Ray had showed oedema of the disc. He had been advised bed rest and pain relieving drugs which had apparently cured him.

When I saw him in early 2006, he had a recurrence of the pain for the last 15 days.
There was back pain with tightness all over the back. It was worse by standing long (about 1/2 an hour), worse on lying down initially for 5-10 minutes. He was better on walking, sitting, lying on his sides and by pressure.
Since about 2 weeks, he had pricking and aching pains in both his heels which was worse on rising after sitting for some time.
He had a tendency to dry lips. His lips chapped all the year round and bled in winter. He also complained of headaches on returning from school. It was located in the forehead and over the eyes and was better by lying down and by pressure. He also had visual blackouts on playing in the sun.

He loved sweets, ice cream, sour foods like lemons and tamarind which he ate with sugar and salt. He was very fond of cheese and loved cold milk. He drank about 10 glasses of water daily and was fresh after 8 hours of deep sleep; he slept mainly on his left side.

He was born during the 7th month of pregnancy and was in an incubator for about 2 weeks. His mother was 17 years old at the time and she went into labour following the exertion of travel on a bumpy road. He had pneumonia at 1 year, typhoid at 4 years and jaundice at 9 years.

He was an obedient boy but enjoyed teasing his younger brother who was 10 years old. He was friendly by nature, mixed easily with others and enjoyed entertaining people with magic tricks. He enjoyed movies and music and was scared of dogs. He enjoyed physical activities like cricket, football, volleyball and wanted to join the National Defence Academy when older.

Considering the old injury, my initial prescription was of Arnica 1M. After a week, he was much better and was asked to see me again after a fortnight. When he came to the clinic again, he still had a backache though his heel pain was much better. Based on his general characteristics, he was given a dose of Phosphorus 200 along with the biochemic Calcarea Phos 6x, three times daily.

His backache cleared up along with his other constitutional symptoms and he didn’t show up again for 6 months after which he returned since the dryness of his lips was recurring. One more dose of Phosphorus 200 was repeated. I presume he has been fine since he hasn’t visited the clinic again.