Vitiligo (Leucoderma) Written by Vidyalakshmi Negi

Vitiligo

The Hindustani is “ Phuleri” it . It is acquired idiopathic depigmentary condition which though world wide in distribution, is most common in India. Egypt and other tropical countries. It is a source of rsocial embarrassment to dark skinned people. It affect all age groups. With no predilection to either sex. Many cases start at age of five, 15 and at menopause. Its incidence is markedly on increase.

Incidence

Vitiligo has assumed epidemic proportions in several parts of India especially Gujarat and Rajasthan. Chemical are known to inhitet Melanogenesis, enzymatic actions and several chain biochemical reactions. They also cause interference with nutrition of the tissues. Role of food adultrants, industrial chemical and dyes, contaminating water and foods may be quess -work at this stage but may prove to be the ultimate causes.

Etiology

The exact etiology is not known and may vary from one pattern of disease of another.
A genetic factor is definitely important since about 20-30% of patients give a positive family history.

Autoimmune hypothesis

Evidence points to auto etiology because

1. Vitiligo is freguently associated with autoimmune disorders like alopecia areata and thyroid disorders.
2. Antibodies to melanocytes have also been demonstrated.
3. Histopathology of early lesion demonstrates presence of lymphocytes in the lesions.

Neurogenic hypothesis

Dermatomal distrinbution of seqmental vitiligo suggests that toxin, which distroys melanocytes, is relased at the Nerve ending.

Clinical features

It is characterized by comptelely depigmented macules and pathches of varying sizes and shapes. Dapigmented macules are the hallmark of vitigo. besides loss of colour, there is no other structural change

Early lesion may be pale white and ill defined. At this woods lamp helps to confirm the diagnosis. patches enlarge slowly and may affect the whole body but this involvement is very seldonn complete. Any part of body can be affected but the rates of predilection are the face, dorsa of feet and hands wrist and the legs. Involvement of mucous membranes especially the lips, is not uncommon, it can precede Cutaneous involvement by years. Hair may or may not become depigmented in vitiliginous areas. Patient’s skin is susceptible to even minor trauma it heals with depigmentation.

At times, lesions develop along the distribution of a peripheral nerve, zosteriform vitiligo. It is interesting sometimes to see a bunch of hair turning grey and then followed by loss of pigment in that area of skin. The hair in the lesions. May remain normally pigmented, though in the older lesion may remain normally pigmented, though in the older lesion the hairs may lose their pregment (Leucotrichia).

Occasionally vitiligo develops around pigmented moles Halo neevus.
The onset is slow and the course insidious but enigmatic. it may continue to increase slowly or come to halt and then increase again.

Haemoglobin content of blood is low and sometimes intestinal parrasites and infections can be detected. Patients complain of easy faliquability.

Classification

Vitiligo has been divided into three stages

• Active progressive stage V1
• Ouiescent stage V2
• Repigmenting stage V3

Clinical features

Active (V1)

• New lesions developing
• ]Lesion increasing in size
• Border ill defined.

Quiescent/stable (V2)

• No new lesion developing
• Lesion stationary in size
• Border defined and signs of spontaneous
• Repregmentation (follicular and  peripheral)

Improving (V3)

• Lesions decresing in size
• No new lesion developing
• Border defined and signs of spontaneous repigmentation (Follicular and peripheral

Zosteriformis/Segmental

Unilaleral distribution of lesion, preferably along the course of nerves.

Besides typing the stage disease, it is useful to decide the variety, severity and acutyt (insiduous or galloping or erratic).

Pathology

A defect in enzyme tyrosinase is held responsible for vitiligo according to some, melatonin, a substance secreted at nerve ending inhibits tyrosinase, thus interfering in pigment formation DOPA staining slow that nelanocytes are deficient.

In active cases, mononuclear hugging at the junction of the lesion and normal skin is a prominent features.

Treatment

Though treatment of vitiligo is not very satisfactory reasonable improvement can be expected to several patients

Treatment depend on

• Age of Patient
• Extent of diseases
• Pattern

Reasons for Poor response to treatment

1. Poor nutrition and general health
2. Emotional stress and strain.
3. Recurrent/Intercurrent infection
4. Prolonged/repeated antibiotic courses.
5. bad disgestion, diarrhoea and dysentery.
6. Leucotrichia/mucosal involvement.
7. Endemic areas
8. Age above 60

Svitra (leucoderma) is more dreadful than even Khustha (leprosy) and very soon become incurable. Hence urgent efforts should be done for it s Cure just as house which is on fire.

Samsodhana (Purifactory therapies) for entire body should be administered in begining (of treatment) itself. Sramsana (mild Purgative therapy) is best for leucoderma the juice of malapu added with guda (Jaggery) is ideal. After drinking it The entire body should be anointed with oil and the patients asked to expose himself to the warmth of rays of the sun. As much as his strength (permits) then he should undergo purgation therapy once in 3 days and when 30, should drink peya (thin gruel) for 3 days.

Vesicles that get formed on part of affected by leucoderma should be pricked with thorns (needle) when vesicle are drained out every morning the patient should drink either the decoction of Malapu Asana, Pryangu, and satapuspa or Ksara (ash/alkali) of palasa mixed with phanita (half Goked saggry (molaises) for 3 day depending on his strength.

Decoction phalgu, bark of aska (vibhitaka) mixed with paste of (bakuchi) should be consumed and the body enposed to sun lead to appearance of vesicle, he should take meal along with takra and c salt.

Preparation

Avulgugebeejchurna
Powder of Bakuci seed 10 gm is taken with warm water using profuse ghee in diet. It destroy all type of Khusth.

Putikadi lap
Leave of putike, arka, snuhi, Aragvadha & gali are pounded with urine and pasted on part. It destroy the vitiligo.

Dhatryadi Kwath
Decoction of Dhatrya and Khadira added with bakuci destroy the vitiligo in no time.

Gujpurisharpakvavulgujpralap
Elephants faeces are burnt and ash is deconted several time with elephants urine. This liquid 10.24 lt. should added with bakuci seed in 1/10 quality and cooked till it become smooth and glistening. Then it is made into pills by rubbing the pills. The paste is applied to affected part. This alleviated vitiligo and Normalises the colour of skin.

Shvetajayantimulak Kulka
Root of white jayanti pounded and takes with cow’s milk on Sunday, destroy vitiligo.


Vayasadi lap
Vayasi (kakamaci) Cakramarda Kustha ,Pippali are pounded with goats urine and made into pills. Pills is rubbed and paste is applied to affected part, it destrory vitiligo.

• Punchnimb Churna
• Panchnimb (flower, bark, fruit, leaves, root of Azardirchta Indica) with trikatu Triphala, Bakul are powdered

Powder should be impregnated in 7 times with Conc. Decoction of Khadira, Murva and also with Bhringraja juice. This Panchnimba ( Churna ) should be taken often proper unction and evacution of body with honey, trivet, Tickt Ghrita (ghee procced with bitter). Decoction of Khadira with Bijaka or worm water in dose of 5mg increased upto 40gm. Diet during regimen should consist of unctuous, light,and wholesome item

1. Markava tried in oil in an iron vessel should be consumed next, milk boiled with bijaka should be consumed ater meals. This cures leucoderma
2. Sphota hetu (bhallataka/crushed well is kept immersed in cow urine at night and dried in shade during day, after doing so for 3 days it should be made into a nice paste along with milky sap of snuhi and applied on skin for destroying leucoderma.
3. Ash of black serpant mixed with aksat taila (oil of vibhitaka) likewise, the sikhi pitta (bile of peacock) mixed with it. Or ash of hribera (Mixed with aksat taila) applied on skin cures leucoderma.
4. Bhallataka, roots of dripi ( Chitraka) sudha and arka, seeds of Gunja, Tryusana, powder of sankha, tutha kustha panca lavana, the two ksara and langalika are cooked along with milky sap of shuhi and arka and preserved in a thick iron vessel. Taken and with an iron rod and applied this paste to Cure leprosy, leucoderma warts etc.
5. By purifactory therapies blood- letting, use of dry (Moisture free and fat free) corn flour as food, leucoderma gets cured of the person whose sins have decreased.