Treatment of vitiligo with individualized homoeopathic medicine- a case report

Dr Monica Moses Lobo

ABSTRACT

Vitiligo is an acquired condition affecting 1% of population worldwide. Focal loss of melanocytes results in the development of patches of hypo-pigmented patches. It is thought to be the result of cell mediated autoimmune destruction of melanocytes. The clinical presentation of vitiligo is depigmentation of the skin, scalp, hair, beard etc¹.  Vitiligo imposes a psychosocial burden and also has a profound impact on quality of life. It also exacerbates the feelings of distress and embarrassment².

A case report of a 3yr old suffering with vitiligo was successfully treated with individualized homoeopathic medicine- Calcarea phosphorica with a favorable outcome.

KEYWORDS: Vitiligo, Homoeopathy

INTRODUCTION
Vitiligo is an acquired skin disorder characterized by sharply demarcated depigmented lesions of variable size and shape and which have the tendency to increase in size during the patient’s lifetime³.

Epidemiology
Vitiligo occurs worldwide with an estimated overall prevalence of less than 0.5% in population-based studies. Some peaks of prevalence have been noted, especially in India, which may correspond to the still poor identification of environmental or genetic factors.

Almost half the patients present before the age of 20 years, and nearly 70–80% before the age of 30 years. Adults and children of both sexes are equally affected⁴.

Pathogenesis

Genetics
The observation that vitiligo was more prevalent in the immediate relatives of patients with vitiligo provided early evidence of its heritability. While vitiligo affects approximately 1% of the general population, the risk of a patient’s sibling developing the disease is 6%, and for an identical twin it is 23%. These early observations were later confirmed by genome-wide association (GWA) studies, which identified numerous common genetic variants in vitiligo.

Oxidative stress
Evidence suggests that melanocytes from vitiligo patients have intrinsic defects that reduce their capacity to manage cellular stress. Epidermal cells, including melanocytes, are constantly exposed to environmental stressors such as UV radiation and various chemicals, which can increase production of reactive oxygen species (ROS). While healthy melanocytes are capable of mitigating these stressors, melanocytes from vitiligo patients appear to be more vulnerable.

Environment
The earliest triggering events that lead to vitiligo are not fully understood. Multiple studies suggest that a combination of melanocyte intrinsic defects and exposure to specific environmental factors may play a central role in disease onset. Melanogenesis is a multi-step process through which the melanocyte produces melanin. Tyrosinase is a rate-limiting enzyme in this process that controls the production of melanin through oxidation of the amino acid tyrosine, a naturally occurring phenol. In vitro studies demonstrated that chemical phenols can act as tyrosine analogs within the melanocyte, precipitating high levels of cellular stress.

Innate immunity and adaptive immunity
GWA studies in vitiligo patients implicated multiple susceptibility loci related to the genes that control the innate immunity. Cytotoxic CD8+ T cells are responsible for the destruction of melanocytes. Cytokines secreted within the skin act as an early signal to help these autoreactive T cells locate stressed melanocytes. Chemokines are small, secreted proteins that act as chemoattractants to guide T cell migration. IFN-γ and IFN-γ-induced chemokines (CXCL9 and CXCL10) are highly expressed in the skin and blood of patients with vitiligo, as well as a mouse model. In addition, IFN-γ and CXCL10 are required for both disease progression and maintenance in a mouse model of the disease⁵.

Diagnosis
The diagnosis of vitiligo is usually made clinically and with the use of a Wood’s lamp, a handheld ultraviolet (UV) irradiation device emitting ultraviolet A (UVA) waves at a wavelength of approximately 365 nm.

Conventional Management
The conventional managements aim at regulation of the etio-pathologies. It involves the regulation of autoimmunity by topical immune-modulation, systemic immunosuppression, oral mini-pulse therapy, low dose therapy and high- dose therapy. Regulation of oxidative stress is done by topical antioxidants, systemic antioxidants. They promote the melanocyte regeneration and repigmentation by phototherapy, topical vitamin D3 analogues. And surgical treatment which involves transplantation of pigmented tissue or cells⁸.

Homoeopathic management
As the conventional mode of treatment proposes the extensive use of topical application for battling vitiligo, on the other hand our holistic system of medicine solely focuses on the administration of a single simple individualized homoeopathic medicine. Homoeopathic management shuns the use of local applications

Homoeopathic repertories (SYNTHESIS) give certain specific rubrics for vitiligo, such as

Skin, vitiligo- ant-tart, ars, ignatia, merc and others.

Skin, discoloration white spots – Arsenicum, Mica, Sepia, Silicea are the well marked remedies⁹.

CASE
A case of a 3year old girl reported to the outpatient department of government homoeopathic medical hospital, Bangalore. She presented with complaints of hypo-pigmented patches over the skin (below the left eye) since 1year.

Case history
Patient was apparently well before the complaints started. In September 2018, the family members started noticing a small hypo-pigmented patch below the left eye. The onset and progress was gradual. The size of the patch gradually increased. There was no itching, no eruptions, no discharges or any history of trauma. The patient was given allopathic treatment without any marked relief

Family history: Maternal grandmother has vitiligo

General symptoms: The patient has a craving for egg2+, and has an aversion to sweets2+. Perspiration is profuse of the scalp while as sleep, and thermally Ambithermal.

The patient has a timid disposition as observed during case taking. According to her mother she is very restless- cannot sit in one place have to keep moving from one place to another even while eating. She wants continuous attention and compliments from her mother- about her handwriting, her dress. She is very inquisitive- wants to know about everything she sees, keeps of questioning the mother. She loves travelling- as her mother is a working lady and gets holiday on Sunday only- the patient waits for Sundays as she can get to travel to different places.

Mental general	Physical general	Characteristic particulars
Inquisitive2+ Restlessness2+ Timid2+ Loves travelling3+	Craving: egg2+ Aversion: sweets2+ Perspiration: scalp while sleeping Ambithermal	Hypo-pigmented patch over the skin under left eye

Reportorial totality (synthesis repertory)

1. Mind, curious
2. Mind, restlessness, children in
3. Mind, timidity, children in
4. Mind, travelling, desire for
5. Generals, food and drinks, egg desire
6. Generals, food and drinks, sweets aversion
7. Head, perspiration of scalp, sleep during
8. Skin, discoloration, white spots

Reportorial result

1. Calcarea carbonicum 12/7
2. Phosphorus 10/7
3. Calc phos. 9/6
4. Carcinosin 8/6
5. Lycopodium 8/6
6. Sulphur 8/6

Prescription (8/09/2019) : Calcarea phosphorica 200 , 1 dose  (EMES)

Placebo 200/ BD for 15 days

The remedy covered the maximum rubrics and was at the 3^rd position in the reportorial totality. Considering the physical constitution- thin, emaciated and her constant marked love for travelling and attention from her mother, Calcarea phosphorica was selected as the similimum

DISCUSSION AND CONCLUSION
The founder of homoeopathy – Dr Samuel Hahnemann in the Organon aphorisms 185-195 clearly and specifically points out the disadvantage of using a local application in the local maladies. The old school of medicine considers these local maladies to be merely local. But, as Hahnemann says no local external malady can arise, persist and even grow worse without any internal cause. As the cause of the disease is internal- the patient should be exclusively treated with internal remedy only¹⁰.

There is only one condition where local application of the indicated potentized remedy may be used to advantage, and that is in case where it is impossible to administer it by mouth. The external surface of the body covered with the cuticle is capable of receiving the action of the liquid medicines¹¹.

Here, the case was treated with individualized homoeopathic medicine by considering the patient as a whole. No external applications were given whatsoever. Which clearly shows the scope of homoeopathy is diseases which the conventional mode of treatment can do but little.

PATIENTS CONSENT
Patient’s consent was obtained from her mother. All the details were informed to her in her own vernacular language

CONFLICT OF INTEREST
None declared

REFERENCES

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2. Casey, C. and Weis, S., 2017. Insight into Natural History of Congenital Vitiligo: A Case Report of a 23-Year-Old with Stable Congenital Vitiligo. Case Reports in Dermatological Medicine, [online] 2017, pp.1-3. Available at: https://www.hindawi.com/journals/cridm/2017/5172140/
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8. Bleuel, R. and Eberlein, B., 2018. Therapeutic management of vitiligo. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, [online] 16(11), pp.1309-1313. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/ddg.13680
9. Schroyens F, Synthesis. Version 9.1. New Delhi: B Jain Publishers.2004
10. Hahnemann Samuel. Translated by Boericke William. Organon of medicine.6/e,Kuldeep Jain; B. Jain publishers; Aug.2008;
11. Roberts H. The Principles and Art of Cure by Homoeopathy. New Delhi: B Jain Publishers; 2002. Pp: 176-177

Dr. Monica Moses Lobo
PG scholar (MD PART 2)
Organon of Medicine with Homoeopathic philosophy
GHMC & H, Bengaluru

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