Dr Rizwan Ahmed Shabbir Shaikh
Abstract
Vitiligo also known as Hypo-melanosis or Hypopigmentation. Vitiligo is a pigmentary disorder characterised by circumscribed loss of melanin pigment secondary to melanocyte attrition. It is an acquired, sometimes familial condition, an autoimmune disease in majority. Vitiligo is associated with other autoimmune diseases such as thyroid disease, diabetes mellitus, Addison’s disease and pernicious anemia
Classification
- Localized vitiligo: Focal vitiligo –
(a) A single macule or a few macules may be localized to skin or mucosa. (b) Segmental distribution of macules.
- Generalized –
(a) Vitiligo vulgaris – Common form of vitiligo with symmetrical distribution over trunk and limbs.
(b) Liptip vitiligo – Only tips of fingers or with mucosal surfaces like lips, nipples or palms or penis.
(c) Acrofacial vitiligo – Involvement of periorifacial and distal digits.
(d) Universal vitiligo – Involvement of most of the body with only a few areas spared
Treatment – Physical Regime
- Photochemotherapy –
(a) Topical application of ointment or lotion on alternate days (to avoid photosenSitivity) followed by PUVA exposure to gradually increasing doses (till mild erythema is seen) of sunlight or artificial source of UVA.
(b) Systemic PUVA solution 0.8 MOP, 0.6 mg/kg PO on alternate days followed by gradually increasing doses (till erythema) of sunlight or UVA lamps. Larger dose of UVA is needed here.
(c) After exposure to UVA protection of lesions from excessive exposure to sun by using sunscreen like zinc oxide and avoiding peak sunlight
Result: Slow re-pigmentation begins in perifollicular area and periphery of lesions and gradually becomes confluent especially on face, neck and hairy region.
Side effects: Phototoxicity results from excessive exposure to sun or UVA. Treatment is to stop and resort to topical or even systemic steroids
- Phototherapy – Narrow band UVA.
Indications – Extensive disease, children and in pregnancy, and contraindications to gradually increases doses are given from specialized chambers
Drug Therapy: various drugs including steroids in form of creams or oral are used in treatment
CASE SUMMARY
This is a case of 24 yead old male patient diagnosed with Vitiligo on left leg, the case presented is documented in Safa Clinic & Hijamah Center, Ahmednagar, Maharashtra.
The patient was treated with individualized homoeopathic medicine over period of 19 months during which he was given medicine in only 2 potencies for 3 days and stat respectively and was only kept on placebo. There were significant changes in the vitiligo with the individualized medicine and finally after 19 month of treatment his skin color become normal and hence, we stopped his treatment. The changes in skin color are shown in images which are date wise at the end of case
CASE RECORD
Mr. ABC male patient 24 years old came with the complaints of white patches on left leg especially shin bone area
H/o: taking treatment from various dermatologist for 4 years with slight improvement but when treatment stopped again there is same condition so he reported to Safa Clinic & Hijamah Center, Ahmednagar, Maharashtra on 5th March 2022.
While taking case I came across some important points, all relatives including parents use to taunt him as a deaf as he has problem with hearing since birth ( Neurological deafness). He thinks that family member use to take care of his older brother more than him as his brother is normal, friends use to bully him by telling him deaf. Later on, due to the surrounding (behavior or people around him) problems he became self-centered, also became indifferent i.e., he doesn’t care what people around are saying or telling him even if they are giving good advice to him. He used to get hurt more from the words of her mother she used to talk with him rudely, beat him a lot. Due to bullying, he used to get angry but doesn’t express the anger on any one, but these things use to continuously run in his mind that why these people are bullying me and he has fear for confrontation
Then 4-41/2 years back he observed white patch on his shin bone area of left leg for which he has taken treatment from various dermatologist with mild relief later on 19 months back i.e.05 March 2022 his father brought him for treatment in my clinic.
Father was also asked questioned; he said that his daughter younger to patient is also having same neurological deafness. Nothing extra information could be provided by father except that in recent time patient became very irritable on slightest things.
The following symptoms were considered for repertorization
- Complete – Mind – Forsaken Feeling
- Complete – Mind – Dwells, Events, On Past Disagreeable
- Complete – Mind –Selfishness, Egoism
- Complete – Mind –Indifference, Apathy, Surrounding to
- Complete – Skin- White, Spots, Vitiligo
- Complete- Extremities- Discoloration, Spots Lower Limb
- Complete- Extremities- Discoloration, Spots, Legs
Conclusion:
- After giving Calc-Carb 30 on basis of individualization; the patient started to feel better and subsequently there was significant improvement in the discoloration of skin which was visible from 2nd follow up (Images attached)
- There was increase and decrease in the discoloration of skin but the patient was mentally stable so no medicine was given during that period, time was given to body to react as vitiligo is autoimmune disease it take time to heal
- In May 2023 he came with new spots of discoloration with previous complaints for which Calc-carb 30 was given so again repertorization was done and Calc-Carb 200 was given in single water dose
- After 5 months of dose Calc-Carb 200 all discoloration is gone and skin turned normal in color and texture; hence the treatment is stopped now ( which he already stopped 3 months back), but just advised patient to turn-up whenever needed.
Dr. Rizwan Ahmed Shabbir Shaikh MD Paediatrics (Hom),
PGDCR & RA (London), Post graduate Diploma in Nutrition (U.K);
Assistant Professor Dept. of Surgery, Ahmednagar Homoeopathic, Medical College, Ahmednagar
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