Vitiligo

What is Vitiligo?

Vitiligo is a disease of skin pigments called melanin. It is a disease where there is a loss of skin pigment or color, which could be due to various reasons. Vitiligo affects about 2% of world population and close to 8% of the Indian and Mexican population. Vitiligo is not a serious disease, medically speaking. It has more social significance than medical importance, as it does not cause any major harm to the body. Cosmetically and personally, it can affect lives of the suffers especially in that society, where the color of skin is given importance; especially among brown and dark skin people.

 

Vitiligo is commonly misspelled as Vitilgo, Vitligo, Vitilligo, Leukoderma. Vitiligo is called as Safed daag in Hindi and Kod in Marathi.

 

In simple words, vitiligo is caused by one or two of the following processes:

  1. Melanin cell destruction, leading to loss of color on skin, leading to white patches of vitiligo.

  2. Defective process of melanin formation, hence, no skin color formation

 

The exact cause for above processes remains unknown. There are some theories which are considered responsible for the above processes in vitiligo. The probable causes of vitiligo explained elsewhere on this site. In brief, genetic and immunological factors in the background are considered responsible for vitiligo.

 

Due to the destruction of the melanin (pigment) cells due to lesser known processes (largely what is called as an auto-immune disorder) the normal skin starts losing pigments from various parts of the skin, in a varying speed and extent. Our clinical experience based on the treatment of over 5000 cases (as on Dec 2011), suggests that there is a strong genetic factor in the background of most cases, especially those who have extensive vitiligo or those who have vitiligo affecting the finger-tips, toes, lips or the genitals. The indication of a strong genetic factor is observed in the form of a family history of one or more of the auto-immune diseases such as vitiligo, alopecia areata, diabetes, underactive thyroid, cancer, rheumatoid arthritis or allergies.

 

The vitiligo sufferers are observed all over the world, including the white skin population. However, epidemiologically most cases are recorded in India (8.8 %) and Mexico. Estimated 1-2% of the Americans have vitiligo as per the survey made by the American Academy of Dermatology. Males and females are affected equally, including children of all age groups. It may begin at any age. Childhood vitiligo is not uncommon. We have registered cases as young as three months old, to late-onset vitiligo at the age of 80 years.

 

At Life Force, we have under our care practically most nationalities (from over 177 counties) with different skins (genetically speaking) presented to us with vitiligo; who has given us the opportunity to understand this disease much better than most other regular clinics.

 

In short, vitiligo is not as serious disease as it has been thought to be. However, it calls for attention as it requires to be treated and managed.

Causes of Vitiligo

 

 

Vitiligo is a disease of which the exact cause is not fully understood. However, there is increasing understanding of the processes involved in the development of Vitiligo. In most cases, there are multiple causes responsible for vitiligo. However, there are theories suggesting

 

a. Autoimmune links: The cells fighting among themselves leading to the destruction of the melanin, is one of the reasons. There are other immunological factors as well. One of the studies has suggested a role of some neuropeptide Y (NPY) which may damage melanin. Such neuropeptide may be released in response to skin injury or emotional stress; again suggesting a combination of causative factors.

 

b. Hormonal connections: Affection of certain hormones such as Thyroid hormones or Melanocyte Stimulating hormone may be responsible for vitiligo. Also, the simultaneous occurrence of vitiligo and other hormonal disorder suggest underlying genetic factor.

c. Genetic tendencies

 

d. Neural theory

 

e. Auto cytotoxic theory

 

As per this theory, there is self-destruction of melanocytes and hence the melanin. This could be a result of genetic, immunological, neural or stress factors.

 

There are factors, internal and external, which either predispose or trigger or maintain the process which leads to the development of vitiligo. In most cases, more there may be a mix of causes.

 

The familial incidence of 20 to 30% is observed in the family members. If one or more of the parents have vitiligo, there are more chances of one developing the same. However, it is not a rule. At the same time, numerous cases of vitiligo do not have a relevant family history of Vitiligo.

 

We have made an important observation through a study that most patients with vitiligo have one of the family members (father, mother, grandparents on either side, uncle, aunt or siblings) suffering from one or more of the following diseases:

a. Vitiligo
b. Hypothyroid or Underactive thyroid
c. Diabetes
d. Alopecia Areata (patchy hair loss)
d. Cancer
e. Other auto-immune diseases (such as psoriasis, rheumatoid arthritis, lichen planus, etc.)
f. vitiligo after injury

 

A study at our center also shows that the patients who have either extensive vitiligo or those developing vitiligo spots on both sides of the body (bilaterally symmetrical) have a strong genetic element. In other words, it is difficult for any patient to have extensive vitiligo without genetic links.

 


 

 

 

 

 

 

 

 

 

Vitiligo and Hypothyroidism (Underactive thyroid):

 

 

Research suggests that Vitiligo and Hypothyroidism (Underactive thyroid) often are predisposed to the same gene (NALP1 gene). All patients of Vitiligo are suggested to get Thyroid profile done every six months. Thyroid profile entails blood sample study for T3, T4, and TSH (Thyroid stimulating hormone) hormones at a small cost.

 

Vitiligo after injury: In some of the cases of vitiligo, patients are at risk of losing pigment or develop vitiligo after any bruise or injury. One such example can be seen in a case-photo on this page.

 

Other factors: The precipitating factors have been identified as due to the pressure of tight clothes (such as on the waist) or certain occupational hazards such as wearing certain rubber hand gloves. Long-term intake of certain drugs is found to produce this pigment disorder. In many cases, especially in children, we often have no clue why one develops vitiligo.

 

All said and done, there is definitely an abnormal process of melanocyte destruction and defective melanocyte formation, governed by known or unknown factors.

 

It may be noted that some of the above remarks are based on our study of over 6500 cases and they may not be found in the standard dermatological textbooks. We are still learning and exploring vitiligo, like many other diseases.

 

Like many disease conditions, the exact causation yet remains a mystery!

 

Lichen Planus, Psoriasis, and vitiligo: Some cases of Lichen Planus and Psoriasis may be observed to be associated with vitiligo, on the same location. In some cases Psoriasis or Lichen Planus may be a cause of loss of pigment, leading to vitiligo, which is relatively more difficult to treat, as per our experience at Life Force. Here you can see a couple of illustrative cases of concomitant existence of these disease conditions.

 

      

 

Symptoms of Vitiligo

The typical symptom of Vitiligo is a milky white de-pigmented spot or spots. It may vary from a single white spot to multiple spots. The shape too is a variable; round or irregular in shape. In some cases generalized de-pigmentation observed all over the body. It has a tendency to start as a single spot and gradually grow in size and number. It may present with a single or several spots on limbs or abdomen or back and then spread to other parts of the body. In some of the vitiligo patches, the hair may turn grey suggesting of loss of melanin pigment at the roots.

 

In some cases showing affection of the mucocutaneous junctions such as finger-tips, corners of the mouth, genital, around eyes. The spread of the disorder is usually slow and progressive. Symmetrical appearance on both the sides of the body (say, on the legs, hands, etc.) is common. In rare cases one finds vitiligo spreading all over the body. It is a common concern among the patients if the disease would spread to the entire body; which happens very rarely.

 

How Vitiligo Spreads?

 

The spread of vitiligo is governed by various factors such as 1. Genetic activity 2. Hormonal factors 3. Continued Stress factors 4. Exposure to chemicals, etc. Many patients may start with just a single spot and may not get more spots for many years or for throughout lifetime. Some patients may show rapid spread, as fast as from one spot to hundreds, in a few months time. It is not possible to predict the pace of spread. Also, some patients may show intermittent spread. It may be noted from experience that those who pace certain body areas affected such as the fingertips are at higher risk of having an aggressive spread; it is not a rule though. Some patients may present with grey hair, suggesting a loss of pigment in the hair.

 

Associated Systemic Disorders:

There are several systemic diseases symptoms (affecting the entire body system), which are at times associated with Vitiligo: 1. Underactive thyroid 2. Diabetes 3. Alopecia Areata (patchy hair loss) 4.SLE (Systemic Lupus Erythematosus) 5.  Pernicious Anemia 6. Addison's Disease 7. Collagen Diseases 8. Grave's Disease 

 

It may be noted that the sufferers of Vitiligo need not be unduly scared of the above disease conditions, as they should not be regarded as the complications of Vitiligo in every case. The most common condition found along with vitiligo include Underactive thyroid (hypothyroidism) and Alopecia areata (patchy hair loss).

 

Vitiligo with Eczema, Psoriasis and Lichen Planus

 

In some cases, Vitiligo may co-exist or follow after one of the conditions such as psoriasis, lichen planus or eczema. Here is a photo of a patient who has loss of pigment after having eczema on foot.

 

      

Homeopathic Treatment for Vitiligo

Homeopathy offers proven treatment for the cases of vitiligo which do not have extensive spread. Early and milder cases may be treated with excellent success, moderate and spreading cases can expect partial color formation with good control, while rapidly spreading cases may be controlled significantly. It may be noted that good control over the spread is also considered a success in extensive cases.

 

Homeopathic treatment works in the following manner:

Controlling the spread of Vitiligo by attempting to correct the immune system

Enhancing the natural melanocyte formation (melanogenesis)

 

What does the Homeopathy treatment do?

The scientific and documented study shows that the homeopathic treatment helps achieve:

  • Enhances melanocyte formation by stimulating the natural process called melanogenesis
  • Controls genetic disposition by using miasmatic medicines
  • Treats after effects of environmental factors such as exposure to chemicals
  • Treats aftereffects of emotional stress which may have triggered the disease process of vitiligo (Leucoderma)
  • Corrects the hormonal imbalance such as Underactive thyroid (hypothyroid)
  • Helps body cope up with stress and emotional pressures
  • Individualistic approach whereby every patient is treated based on one's case

 

Dr Rajesh Shah, M.D. Vitiligo Specialist:

Dr Rajesh Shah, M.D. has been working on Vitiligo (and other diseases) since 1984. His research-based molecules have granted patents. His unique treatment protocol is made available to patients of Vitiligo world over. Dr Shah is also involved in extensive scientific clinical trials for vitiligo and other diseases. At this point, there are patients from 177 countries (as on December 2011) under Dr Shah's care, which has been a world record.

 

What is the duration of treatment for Vitiligo:

Vitiligo is an obstinate, difficult disease, largely considered incurable. As the disease is chronic and long-standing in nature, it takes time to obtain results. Exact time cannot be predicted. Nevertheless, homeopathy offers an excellent treatment and a hope to most cases of vitiligo. Most of our patients begin improving within 4 to 8 weeks. The length of treatment should be considered as over 6 months to two years or more.

Extent: Single or a few patches (2 to 9) respond better than a large number of patches.

Size of patches: Smaller patches respond better than larger ones; very large patches (more than 5 inches in size) may not respond.

Unilateral patches involving only one side of the body respond better than those distributed bilaterally and symmetrically.

Spots on the fingertips, lips, corner of the mouth, etc. do not respond. This can be controlled if treatment is taken for a long time.

Response to treatment is better in case of children and young individuals. Most patients show improvement within initial four months, in form of re-pigmentation or slowing down of spread of Leucoderma (vitiligo).

 

Vitiligo: Chances of Recovery

Every vitiligo patient or child's parent will have this question. You have to understand that the chances of recovery or regimentation in case of Vitiligo depend on several factors. Based on our extensive study and research, we would like to share some of our observations with you. It may be noted that the standard medical textbooks do not clearly suggest what we have described on this page, based on our clinical experience. It has to be also noted that we are simply sharing our viewpoint based on a study of over 6500 cases of vitiligo at Life Force. Following notes are simply suggestive and not conclusive as there may be exceptions.

1. Cases which can find excellent results:

a. Cases of recent origin (less than two years)

b. Children

c. A few, scattered and sporadic spots (segmental vitiligo)

d. No history of oral or local use of cortisone

e. No strong family history of Vitiligo or other autoimmune diseases

 

2. Cases which can find very good results:

a. Cases of recent origin (Vitiligo of two to five years)

b. Fewer spots

c. No affection of fingertips, lips, and genitals

d. No history of use of cortisone, oral or local

e. No strong family history of Vitiligo

 

3. Cases which can find good results and better control:

a. Cases of recent origin (Vitiligo of two to five years)

b. Moderate spread of vitiligo spots

c. No affection of fingertips, lips, and genitals

d. No history of use of cortisone, oral or local

e. Family history of Vitiligo

f. Associated Hypothyroid (Underactive Thyroid), Diabetes, Alopecia Areata or other auto-immune disease makes the recovery of vitiligo difficult

 

4. Cases which can find poor results but fair control:

a. More than ten years old cases of Vitiligo

b. Extensive spread. Bilateral affections (vitiligo spots on both sides of the body, such as elbows, legs, around eyes, fingertips, etc.)

c. Affection of fingertips, lips, and genitals

d. History of use of cortisone, oral or local

e. History of family history of Vitiligo or other diseases such as diabetes, hypothyroid, Alopecia Areata, cancer, etc.

f. Associated Hypothyroid (Underactive Thyroid), Diabetes, Alopecia Areata or other auto-immune disease makes the recovery of vitiligo difficult

 

5. Cases which find very poor results and no treatment is suggested:

a. More than ten years old cases of Vitiligo

b. Extensive spread. Bilateral affections. Large patches of vitiligo.

c. Affection of fingertips, lips, and genitals

d. History of use of cortisone, oral or local

e. History of family history of extensive Vitiligo or other diseases such as diabeteshypothyroidAlopecia Areata, cancer, etc.

f. Associated Hypothyroid (Underactive thyroid), Diabetes, Alopecia Areata or other auto-immune disease makes the recovery of vitiligo difficult

It may be noted that above information is based on clinical observation. There are many factors which influence the course and treatment of Vitiligo, which is out of the scope of this article. The above remarks give a broad idea to the patients about the prognosis of Vitiligo.

 

It is not possible to give visuals of all sorts of cases which are either treatable or not treatable; however, just to give you glimpses of the extent + curability, please examine three cases, showing mild, moderate and severer extent of Vitiligo. Mild cases are curable, moderate cases are partly curable and controllable; while severe cases are incurable and controllable, using homeopathy. These images and information are more empirical. There can be many variants and variations.

    

 

Dietary Instructions For Vitiligo patients: 

There are a few instructions for patients regarding their diet to follow when suffering from vitiligo, especially about what they should avoid. Following are some of our observations based on our clinical experience of treating a large number of patients (clinical observations):

 

Avoid Sour Foods:

Foods that are excessively sour should be avoided. Vitamin C (ascorbic acid) is known to inhibit the production of the melanin, the color pigment. Patients with vitiligo are suggested to refrain from eating citrus fruits, sour yogurt, sour pickles, and other sour foods.

 

The author of this write up is of the opinion is that the since the process of melanin formation calls for physiological pH, in the process where tyrosinase converts tyrosine to dihydroxyphenylalanine (DOPA) and then to dopaquinone, intake of sour foods may work adversely, hence hampering the process of melanogenesis.

 

Do Not Eat Non-Vegetarian Foods:

Non-vegetarian foods should be better avoided, as much as possible, as they act as a foreign body to the pigment cells. At Life Force, we have observed that certain fish leading to sudden aggravation of vitiligo in some patients. Also, it has been observed that industrial chemicals (such as mercury) could enter our body through seafood, especially fish; so it should better be avoided in your vitiligo diet.

 

Stay Away From Artificial Food Colors:

Artificial colors used in various food preparations may better be reduced or avoided as far as possible.

There may not be enough scientific evidence to prove how these foods worsen leucoderma (vitiligo), but our clinical experience has shown that many patients report worsening of their vitiligo after consuming these items and hence they are better avoided.

 

Keep Fruits Containing Hydroquinone At Bay:

It is very important to take care that foods comprising hydroquinone, which is a prominent depigmenting agent present in various skin bleaching creams, should be avoided when you are combating vitiligo. Certain fruits, such as blueberries and pears, contain hydroquinone which minimizes melanin production. So, make sure you do not add fruits, such as blueberries and pears, in your vitiligo diet as they may make your white skin patches whiter and aggravate the condition.

 

Have Foods High In Zinc:

Increase your intake of foods, which are rich in zinc, when you are suffering from vitiligo. Increase in the levels of zinc in your body can help cure vitiligo to a great extent. So, make sure you include oysters, which is abundant in zinc, in your diet for vitiligo. Also, you can add nuts, beans, and dairy foods in your regular diet to boost the levels of zinc in your body.

 

Add Vitamin B-12 Rich Foods In Diet:

The consumption of vitamin B-12 rich foods is highly effective in reversing vitiligo. Various medical studies and researchers reveal that deficiency of vitamin B-12 tends to cause a boost in homocysteine, which is a compound responsible for the destruction of skin pigmentation in various parts of your body. So, you need to include vitamin B-12 rich foods in your regular diet for vitiligo. Make sure you eat fortified breakfast cereals, yogurt, and other vitamins B-12 abundant foods.

 

Eat Folate Rich Foods:

Low folate levels in your body are known to be one of the prominent causes of vitiligo. By modifying your regular diet by adding some foods abundant in folate can help boost your intake of folate easily.  Make sure you have cereals rich in folate in your regular breakfast. Also, adding nutritious foods, such as spinach, broccoli, black-eyed peas, and asparagus, in your daily diet can help boost your folate levels and help in reversing vitiligo significantly.

 

Diet in Vitiligo:

Vitiligo is an auto-immune disease affecting various people of any age, sex, and constitution. There is a loss of normal skin color and the skin turn white when an individual suffers from vitiligo. There are some foods which are known to hinder the formation and production of melanocytes (pigment-forming cells). So, you need to avoid harmful foods and add healthy foods to your vitiligo diet. Here are some dos and don’ts that you should follow for a speedy recovery from vitiligo.

 

 

Do this

Avoid this

Include fresh fruits (not sour) and vegetables in your daily vitiligo diet.

Eat vegetarian foods as much as possible

Sour foods like lemons, oranges, tomatoes ketchup, pickles, raw mango, sour curd, over fermented foods, Chinese foods (or foods containing vinegar and soy sauces)

Get exposed to the early morning/ setting sun for 10-15 minutes daily. Use a good sunscreen if you step out in the sun between 10 am to 4 pm

Sea-food, such as fish, prawns, crabs, lobsters, shrimps, needs to be completely avoided in your diet for vitiligo.

Be happy, distressed

We also encourage our patients to avoid non-veg foods and foods with artificial colors and preservatives along with the canned foods for a better recovery.

Avoid this :

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*Please note that results and duration of treatment may vary depending on the constitution of your body.