FAQ Vitiligo

Vitiligo: introduction

Vitiligo is an acquired de-pigmenting skin condition that results from loss of functioning melanocytes. It is a major cosmetic and psychosocial disorder among the Indian population. The prevalence of this disease is approximately 0.5-3% of dermatological consultations in India.  Vitiligo, known as 'leucoderma', is a social stigma. Vitiligo is appearance of single or multiple de-pigmented patches on any part of the body. These patches gradually increase in size & cause lot of psychological stress in the patient. It is an autoimmune condition and may have a genetic predisposition in up to 20% of the cases. Treatment of Vitiligo usually takes a long time, several years at least. Medical treatment may not help to arrest the spread of de-pigmentation in all patients.  In majority of the cases, bio-medical therapy fails to cause re-pigmentation completely. However, re-pigmentation in cases of 'stable Vitiligo' can be achieved by various dermato-surgical techniques although in such lesions might recur.  PUVA therapy is the “gold standard” in the management of Vitiligo in Western medicine. However it is not been successful in producing complete relief to all patients of Vitiligo and continues to be unavailable & expensive in rural India.  No single therapeutic regimen prevents relapse or halt progression. Therefore, search for new treatments is continuous by both doctors and patients.

Will integration of therapies help?

The Institute of Applied Dermatology carried out a clinical research project on integrating ayurveda and modern medicine for Vitiligo patients during 2003-04. This study was supported by Mahatma Gandhi institute for rural industrialization, a unit of Indian Institute of Technology, New Delhi & KVIC, Mumbai. Results revealed that ayurveda might have significant role in halting the progression and regimenting in non hairy areas.  Another study was conducted during 2004-05, supported by Kerala State Council for Science, Technology and Environment gave additional evidence that integration works and that addition of homeopathy in select cases reduces the disease induced stress, thus accelerating repigmentation in non-hairy areas.

The assumption here is that integration of therapies would help in several probable ways

• To reduce the pitta dusti/prakopa and help to reduce the disease activity
• Complete shodhana karma done as 14-30 days hospitalized treatment helps the body to react to the medicines in a better way than giving the medicines with out this procedure. This is done only in selected cases
• Monthly pulses of controlled induced purgation help in maintaining the repigmentation
• Internal medications of ayurveda & homeopathy have their own basis of repigmentation as explained in their classical texts.

However all the systems of therapy agrees that recurrence does occur in most patients on long term follow up and therefore one has to take prolonged treatment or repeat the treatment if necessary

What are the methods practiced in Institute of Applied Dermatology of treating Vitiligo patients using integrated therapy?

1. Counseling is the first step: patients decide if they want to take the treatment or not
2. Patients give written consent for the treatment
3. Complete evaluation of clinical presentation by allopathic dermatologist, ladies by lady dermatologist and gentlemen by a male dermatologist; ayurveda doctor and homeopathy doctor
4. Woods lamp examination of patients to know if any areas not seen for visible light is involved
5. There are several patient care protocols developed by Institute of Applied Dermatology
6. All of them in common have hospitalized shodhana karma unless the procedure is not contraindicated to the patient. Ayurvedic shodhana karma is regarded as the fundamental procedure before any therapy to obtain the best results. However patients can opt for their preferred treatments protocols with or with out shodhana karma
7. Follow up at the interval of 4 months, 6 months, 9 months and one year is proposed

Advantages

• Patients’ preference is taken into consideration
• Treatment aims to slow the disease progression
• Combination of different systems of medicine are used for the defined role of each, unique to them
• Repigmentation of white patches is the major thrust of treatment