Vitiligo: The White Spectre

Words: Dr Rajgopal NIDAMBOOR

Vitiligo [white patches, or leucoderma] is a chronic skin disorder. It causes depigmentation in patches of skin. The disorder occurs when melanocytes, the cells responsible for skin pigmentation, die, or are unable to function. While less than two per cent of the world’s population suffers from vitiligo, its impact is upsetting and demoralising.

Vitiligo is not dangerous in any way; it causes no bodily harm, yet it is unpleasant, owing to its awkward presence, which ‘offends’ the victim and the onlooker.

People who develop vitiligo first observe white patches [depigmentation] on their skin. These patches are more commonly found on sun-exposed areas of the body — hands, feet, arms, face and lips. Other equally common areas of ‘white incursion’ include the armpits and groins, around the mouth, eyes, nostrils, navel, genitals and rectum.

Vitiligo can wobble one’s life, besides triggering symptoms of low-confidence, insecurity, depression, aside from social withdrawal, rejection in matrimony, divorce, and to top it all suicidal tendencies.

Causes

The exact cause of vitiligo is not known. Some clinicians suggest that the disorder is caused by a combination of autoimmune, or genetic, and environmental factors. Psychological stress may also be one of the most likely triggers in certain individuals. In addition, the disorder is usually associated with low haemoglobin levels, diabetes and thyroid disorders.

Vitiligo generally appears in one of the three patterns:

  • Focal pattern, where depigmentation is restricted to one, or just a few areas
  • Segmental pattern, where depigmented patches develop on one side of the body
  • Generalised pattern, also the most common. Depigmentation occurs symmetrically on both sides of the body.

In addition to white patches on the skin, people with vitiligo may present with early greying of their scalp hair, eyelashes, eyebrows, and beard. People with dark skin, or complexion, may detect loss of colour inside their mouths.

Research suggests seven genes in people with vitiligo. The genes are associated with other autoimmune disorders such as type-1 diabetes, multiple sclerosis and rheumatoid arthritis.

A research group has developed a product that is a chemical derivative of a natural hormone that stimulates melanin [pigment] production in the skin. The product is administered as an implant, the size of a rice grain, beneath the skin. Will this help in resolving vitiligo from the ‘root’? Only time will tell.

  • Vitiligo affects approximately 1 in every 200 people worldwide
  • Around 40 per cent of vitiligo patients have an affected family member
  • Some vitiligo patients may, at times, have an increased risk of developing certain autoimmune diseases — e.g., kidney disease, hyperthyroidism, hypothyroidism, diabetes and alopecia areata [patchy hair loss].

Diagnosis

The precise cause of vitiligo is not known, although a host of factors are suggested to contribute to its development and progress. While genetic factors play a key role, research suggests that about one-third of individuals who develop vitiligo may have one, or more, relatives with the disorder. If vitiligo is suspected, your doctor will ask you about your medical and family history of vitiligo:

  • A rash, sunburn, or other skin trauma, perhaps, that occurred at the site of vitiligo, a few months before depigmentation began
  • Stress or physical illness, premature greying of hair, before age 30-35
  • Whether you, or anyone, in your family had any autoimmune diseases
  • Whether you are sensitive to sunlight.

To confirm the diagnosis, your doctor may ask for a small sample [biopsy] of the affected skin to be sent and examined in the laboratory. In vitiligo, the skin sample will usually show a complete lack of pigment-producing melanocytes. Alternatively, the presence of inflamed cells in the sample may suggest another condition — for example, anaemia — which may be responsible for loss of pigmentation.

Self-Help

  • Avoid going out in the sun between 10:00am and 4:00pm; use a sunscreen lotion [SPF 15, or 30] which guards against sunburn and long-term skin damage
  • Avoid any kind of trauma, or friction, as this can ‘trigger’ white patches
  • Don’t get a tattoo done
  • Wear full sleeve cotton shirts and trousers
  • Use a mild, preferably glycerine-based soap for bathing
  • Avoid direct contact with deodorants and perfumes
  • Practice stress-relieving exercises like yoga and meditation
  • Speak, consult, and follow-up with your physician on a regular basis.

Treatment

Ayurveda

Vitiligo, in Ayurveda, is referred to as shwetakushta, or switra, or kilasa. In other words, kushta roga [skin disease]. It is attributed to the imbalance of all the three doshas [vatapitta and kapha], which vitiate rakta, mamsa and medha dhatus.

Vitiligo, in modern medical parlance, is a progressive, idiopathic pigmentation disorder of the skin, characterised by hypopigmented white lesions.

While switra, or kilasa, is used to describe hypopigmentation disorders of the skin, as already cited, the former is caused by various dietetic and behavioural factors which aggravate the tridoshas, especially the kapha dosha which, in turn, vitiates the medha dhatu.

Many Ayurvedic drugs are well-known for the regeneration of melanocytes, among which bakuchi is one.

A study was conducted to analyse Ayurveda’s efficacy in the regeneration of melanocytes. The outcome of treatment in 50 cases of shvitra vis-à-vis vitiligo receiving shvitrahara kashaya and shvitrahara lepa was analysed and compared. Group I [n=25] patients were treated with shvitrahara kashaya and shvitrahara lepa; Group II [n=15] patients received shvitrahara lepa only; and, the remaining ten patients of Group III used both [Western medicine] oral psoralens and UV-A therapy.

Assessment was done after 6 months with bi-monthly follow-ups. Out of 25 cases in Group I, 17 showed 80 per cent improvement [t=7.65; P<0.01] in the surface area, number of lesions, pigmentation and associated symptoms, like itching; out of 15 patients in Group II, ten showed partial repigmentation, i.e., 50 per cent [t=5.72; P<0.01] response. In Group III, 90 per cent response [t=6.14; P<0.001] in repigmentation and number of lesions was noted, but eight patients developed adverse effects like sunburn, severe itching and gastric upset on taking oral psoralen. On the basis of the results and observations, it may be concluded that the Ayurvedic formulation containing bakuchi is efficacious and has no untoward effects when compared to oral psoralens and UV-A therapy.

  • Ajay Dhanik, et al, “Clinical Evaluation of the Efficacy of Shvitrahara Kashaya and Lepa in Vitiligo,” Ayurveda, 2011, Jan-Mar; 32[1]: 66–69.

Homeopathy

Homeopathy views skin disorders as the outer expression of an underlying, latent problem in the body’s built-in regulatory mechanism, or defence system. The early, pioneering homeopaths called this the ‘vital force.’ Today, this is called immunity. It is for this reason that professional homeopaths have always advocated a practical plan of treatment — the basis on which homeopathic remedies work.

Homeopathy uses medicines made from natural substances that actually cause symptoms of the health problem, or illness, in large doses, but in micro-doses stimulate the body’s own defences, or our immune forces, to throw, or ward, off the disorder, from the inside-out.

Put simply, homeopathy treats the external problem — in this case, white patches — with an internal medicine, or remedy. This is quite unlike conventional medicine, where an external problem is treated merely as a surface problem.

Homeopathic medicines not only help to control the spread of white patches; they also facilitate repigmentation by enhancing the natural formation of melanocytes — without side-effects.

Homeopathy also helps control certain underlying imbalances that may exist deep within; in so doing, it helps the body to cope better at the emotional and physical levels, albeit it cannot cure all forms of vitiligo. While homeopathy may reduce the chances of recurrence — the possibility of white patches reappearing again — this may, perforce, be limited to certain cases, not all, again.

Nutrition 

Vitiligo is an acquired skin pigmentation disease with a global burden of 0.5-2 per cent of the population. Vitiligo therapy frequently poses a difficulty, which has sparked interest in alternative treatment modalities, including multivitamins and herbal supplementation. It has previously been established that nutrition plays a crucial role in developing, amplifying, or rehabilitating an array of human disorders. However, the correlation between diet diversity and immune-mediated skin diseases is still up to interpretation. Several supplements have been studied, including vitamins, minerals, and herbal supplements. Most studies agree that combining vitamin B12, folic acid, and sun exposure is good for inducing repigmentation. Supplementation of zinc and phenylalanine when used in conjunction with topical steroids, or UV-B [ultraviolet B] treatment shows therapeutic effects on vitiligo due to their role in the melanin synthesis pathway. Investigations conducted on herbal supplements [gingko, for example] have revealed that most of them contain antioxidants, which aid in repigmentation.

  • Dutta R R, Kumar T, Ingole N [August 28, 2022], “Diet and Vitiligo: The Story So Far.” Cureus 14[8]: e28516. doi:10.7759/cureus.28516.
Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360.

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