1. LEUCODERMA & ITS HOMOEOPATHIC MANAGEMENT-Dr.Rahul Garg

2. Leucoderma is a general term applied to decreasedmelanin pigmentation of skin.It is a cutaneous condition,which includes all depigmented (white) lesions of skin. 3. ETIOLOGY OF LEUCODERMA IDIOPATHIC CHEMICALS: Vitiligo :Substituted phenols (used in foot wear) adhesives (used in stick-on bindis) INFLAMMATORY SKIN DISEASES : Lupus vulgaris discoidlupus erythematosus( Ref: Synopsis of Dermatology by Neena Khanna) 4. Vitiligo is a continual and long term skin problem that produces white depigmentation patches that develop and enlarge only in certain sections of the skin. The term Vitiligo is derived from the latin word Vitilus - meaning calf and was first used by roman physician Celsus of 1st century AD.The characteristics white patches of disease resembled the white patches of a spotted calf in India. 5. EPIDEMIOLOGY 1.Incidence-occurs in about 1% of population. 2.Gender-no gender predilection 3.Age affects all ages,peak incidence between 10-30years. 6. ETIOLOGY OF VITILIGO Autoimmune: Autoimmune disorders like Thyroiddisorders (Hashimoto thyroiditis and Graves disease), Addison disease, diabetes mellitus, alopecia areata, pernicious anemia, and psoriasis are all associated with Vitiligo. Genetic: About 20% of affected patients have a positive family history of Vitiligo. Neural Theory: segmental Vitiligo is present along a dermatome in distribution of nerves.It has been hypothesized that a toxin,which destroys melanocyte,is released at the nerve endings. 7. HISTORY 1. There is a positive family history in 20% of patients. 2. Both sexes are affected equally. 3. Half of cases begin before age of 20 years.4. Patient may state that the first onset occurs after emotional stress,trauma,illness. 5. It progresses slowly over the years in a highlyvariable course. 6. Some patients have very stable disease , in others, it progresses at a alarming rate. 8. PHYSIOLOGY 9. CLINICAL FEATURES MORPHOLOGY:characterised by depigmented macules, which are chalky or milky white. sometimes,pigment loss is partial and occasionally, three shades (trichrome). 10. Hairs in the lesions mayremain pigmented, though in the older lesions the hairs may lose their pigment (leucotrichia). 11. Macules have a scallopedoutline and form geographical patterns on fusion with neighbouring lesions. 12. SITES De-pigmentation appearson the sunexposed areas. Common sites affected include: Bony surfaces -back of hands and fingers, elbows and knees. 13. Around bodyorifices - around the eyes, mouth and nose. Body folds - armpitsand groins. Others areas - 14. PATTERNS VITILIGO VULGARIS Commonest type. Occurs after second decade. May be slowly or rapidly progressive. Family history is frequently present.SEGMENTAL VITILIGO Occurs in children. Most frequently(50%) seen in distribution of trigeminal nerve. Has a stable course. Margins are feathery. 15. GENERALIZED VITILIGOvariants of generalized vitiligo are: Acrofacial Vitiligo: This type of vitiligo is considered onlywhen the appearance is mostly on the fingers or toes. Mucosal Vitiligo: The appearance of the depigmentationgenerally around the mucous membranes and lips. Focal Vitiligo: one or a few scattered white patches in a smallcertain areas. It is often noticeable in young children. 16. How will you confirm whether a white spot is leucoderma? If white spot has an outline darkness than the skin. If it slowly and gradually increases in size day by day. If it is irregular in appearance. If appears milky white in color under an ultraviolet light. If appears red in color in mucus membrane. 17. How is Leucoderma Diagnosed? Age of onset(usually not present at birth). Depigmented macules with scalloped borders. Leucotrichia Predilection for sites of trauma. In addition,medical and family history. Biopsy of the affected area can confirm the diagnosisof Vitiligo. 18. Blood tests done: To check the thyroid functions To look for the presence of anti-nuclear antibodies (that would point towards auto-immune cause) To rule out pernicious anemia Examination of the spots under Wood's lamp can beused to diagnose and evaluate Vitiligo especially when the changes are not appreciated with the naked eye. 19. DIFFERENTIAL DIAGNOSIS: Nevus achromicus Pityriasis alba leprosy Tinea versicolor Albinism 20. Nevus achromicus Onset-present at birth Distribution- segmental/focal Morphology-feathered margins,uniform pigment dilution Hair- no leucotrichia 21. Pityriasis alba Morphology- scaly hypopigmented macule Sensation-Normal Nerves- not thickened Leprosy Hypopigmented/ertythematous macules,nodule,plague may bepresent. Sensation- less Hair- decrease in no 22. Tinea versicolor Located on upper trunk,less frequently on forearms/face. Morphology-small perifollicular,scaly macules which maybecome confluent. Sensation- normal. Albinism It is an autosomal recessive disorder At birth,there is complete absence of pigment in skin, hair& eyes. 23. What is the Homoeopathic approach ? As a rule, Homoeopathy never looks at Leucoderma as a localdisease. Leucoderma has been considered as a local expression of a system disturbance hence a constitutional remedy has to be evolved, which calls for individual case study in every case of leucoderma. That is why there is no single specific remedy for all the cases of leucoderma. The exact treatment is determined only on in-depth evaluation of individual case. 24. Like all other chronic diseases, two factors are necessary tocause leucoderma (i) Inherited and / or acquired miasmatic dyscrasia (ii) Environmental factors in the form of physical trauma,chemical irritants, emotional upset etc. No true aetio-logical factors have yet been demonstratednosologically but a homoeopath knows that all true chronic diseases are nothing but the products of three basic miasmatic states, Psora, Sycosis and Syphilis. The aetiologieal factors mentioned in the text books of medicine for skin diseases are but precipitating factors. Unless the basic miasmatic state is there, these environmental factors can never cause leucoderma. 25. Miasmatic Diagnosis 26. Complete absence or diminution of melanocytes from thevery birth is due to Syphilitic miasmatic state and requires antisyphilitic medicines for cure. Cases where the function of the melanocytes is defective resulting in relative melanin deficiency is due to Sycotic miasmatic state as it represents a state of in coordination. Secondary depigmentation during the course of an illness may be due to Psora or Sycosis or Syphilis or a combination of two or three of them. This can easily be elicited from the past history, personalhistory -and family history of the patient. 27. Homoeopathically, Leucoderma is a one sided diseasehaving its-chief or only manifestation on the skin to start with. In aphorism no.185, Dr. Hahnemann discussed aboutone sided disease with local manifestations. 28. ONE-SIDED DISEASES(Diseases with too few symptoms and chiefly of chronic nature) Principal symptomsInternal ComplaintPhysical Complaint Mental ComplaintExternal Complaint Local Diseases or Local Maladies 29. Local Disease A kind of one sided disease in which the changesand ailments appear locally on the external parts of the body.External causeArising from external lesionsInternal causeArising from the internal malady 30. Naturally, it is very difficult to cure, because we do notget the exact-sensations, modalities or concomitants in such cases. But if we-believe in miasmatic concept of diseases and treat these patients with suitable antimiasmatic medicines, supplemented by proper hygienic measures and removal of the possible obstacles in the way of cure, then, in most cases, we may be able to cure these patients. But it must be remembered that melanisation of thepatches from where melanocytes have completely disappeared is a most difficult task to perform and requires a prolonged course of treatment and patience both on the part of the patient and the physician. 31. Plan of Treatment 32. Whatever may be the nature and type of Leukoderma, we must first of all, try to ascertain the miasmatic background of the patient. Once this is done the major problem is over. The next step is to select a medicine which covers the constitutional totality of the patient including the miasmatic background. 33. At the same time we must take care of the environmental or precipitating factors. Unless the exciting factors are properly dealt with, no cure, in the truest sense of the term, is possible in spite of proper antimiasmatic treatment. The reason is obvious. The presence of these factors act asobstacle in the formation of melanocytes. Vaccinosis in the past and abuse of drugs mustbe antidoted as and when necessary during the course of antimiasmatic treatment. 34. Frequently, a change in the plan of treatment is necessary to effect a complete cure (e.g. antisyphilitic treatment followed by anti-psoric oranti-sycotic as the case may be followed again by anti-syphilitic and so on) In this way a prolonged course of treatment (may even be for years together) is absolutely necessary. Any attempt to remove only the patches of leucoderma by Homoeopathic medicine is bound to be futile as far as this is the reason why we fail in Homoeopathy to cure such cases. 35. CASE TAKING & SELF CARE MEASURES 36. Formation of complete picture by noting- The exact character of local affection. All the changes, sufferings, symptoms observable inpatients health. Symptoms which may have been previously noted whenno medicine had been used. 37. Selection of Homoeopathic medicine whose peculiarpathogenetic effect corresponds to the totality of symptoms of the case. External application is prohibited even though it isspecific Homoeopathically. External treatment is always injurious. 38. Potency and Repetition of the selected drug 39. LM potencies yield best results in such cases as thereis less chance of aggravation and they may be repeated safely for a fairly long period of time. 40. A word of Caution 41. We must not be afraid of a few newly depigmentedareas during the course of treatment because these may occur due to the action of well indicated medicine and should be considered as a favourable sign instead of considering it a bad sign provided the old spots must, at the same time, show some signs of improvement as mentioned above or the patient as a whole feels better. 42. Self Care Measures with Diet and Regimen 43. It is also no less important to make care of diet andother hygienic precautions. Lemon, sour and citric acid containing food stuffs are to be avoided as they may act as hindrance in the way of cure. Some studies show that avoidance of meat may expedite cure though the reason is not yet clear. Use of cosmetics (especially the use of lipstick, vermilion etc.) is to be avoided or restricted as a routine. 44. Assurance: The patient must be assured that the diseaseis not at all incurable and not infectious or contagious. Otherwise, persistent mental anxieties and worries due to wrong conception of the disease will doubtlessly act as an impediment in the way of cure Hence the patient should be assured that the disease is not a sin and there is nothing to be ashamed of. From Homoeopathic view point these cases are never to betreated with local medicines because that will lead to suppression and, consequently, destruction of some of the vital organs. 45. SPECIAL INSTRUCTIONS FOR PATIENTS 46. Expose the affected areas of the body to the earlymorning sun for 20-30 minutes daily. Use a mild soap while bathing. Avoid using any cosmetic applications on skin. 47. Make sure that your diet containsenough iron, cereals, beans and green leafy vegetables which are some of the best sources of iron. Avoid consuming sour foods,citrus fruits, fish,red meat, crabs and prawns. Use of synthetic clothes should berestricted. 48. Avoid steroids. Avoid stress and learn to relax. Keep a positive attitude. 49. Thus, it is possible to be leucoderma free withHomeopathic treatment, hence one must consider Homeopathy for healthier living. 50. For LEUCODERMA 51. ACCORDING TO KENTS REPERTORY: SKIN-DISCOLORATION--WHITE:Apis,Ars,Kali.c:fl-ac -SPOTS:Ars,sil.:Calc,Carb-v,Lac-c,Sumb:Alum,Aur,Berb,Calc,Merc,Nat.c,Phos ,Sep,Sulp. :Am.c,Carb.an,Coca 52. ACCORDING TO BOERICKE REPERTORY: Leucoderma--Ars.s.fl -Nat.m,Nit.ac,Sumb 53. Recent CCRH Research For Leucoderma In Clinical Research Publication in Indian Journal of HomoeopathicResearch in Homoeopathy CCRH. -Dr. Ravi Kumar -A Case of Vitiligo treated with PHOSPHORUS (Indian Journal of Research in Homoeopathy 2008;page-49-57) -Dr. Jha , Dr. L.Debata-A Case of Vitiligo treated by SULPHUR(Indian Journal of Research in Homoeopathy 2009;page-34-40) ((website-ccrhindia.org/list%2of%20publication.as)) 54. Cont......... Clinical Research Publication Book of CCRH-ClinicalResearch series-1,2,3 -Dr.R.V.R Prasad,Ch.Ravendar,Bharatha Lakshmi k singh,Dr.A.K Vichitra,Praveen Oberai,Renu Mittal -Clinical Evaluation of Predefined Homoeopathic Medicines in Vitiligo. (Clinical Research studies series-ii,2009,page-85-92.) .......(website-ccrhindia.org) 55. Specific Remedies (Ars.sul.fl , Ars.iod)Homoeopathic RemediesConstitutional Remedies (Kali.c,Cal.c,Apis.m, Nat.m,Nit.ac,Gel.)InterCurrent Remedies (Thyr.,Tub.) 56. Arsenicum Sulfuratum Flavum(Ars.s.fl) Good remedy for Leucoderma Squamous Syphilides. Skin chafed about genitals. 57. Arsenicum Iodatum Skin-Dry,Scaly,Itching. Marked exfoliation of skin in large scales,leaving a raw exuding surface beneath. Ichthyosis Debilitating night sweats. Emaciation. Acne hard,shotty,indurated base with pustule at apex. Acrid excoriating discharge. 58. cont Modalities-< weather, dry cold, windy foggy, cold wind, cold bath, wet weather, exertion, lying on painful side, warmth, warm room, warm wraps, walking fast, exercise, during menses, when Hungry, Apple,Tobacco,Smoke. 59. cont > from eating, open air, Rest, uncovering. 60. Apis Mellifica Swelling or Puffing up of various parts. Oedema Red rosy hue, Burning sensation Stinging pain Soreness Intolerance of heat-Warm blooded(worse in warm andclosed room Intolerance of slightest touch(agg.from touch) 61. cont.. Awkwardness (let things fall from hands) Right sided troubles Modalities-< Heat in any form, touch, pressure, late in afternoon, in closed and heated room rt.side > in open air, uncovering, cold bathing. 62. Kali-carb. Chilly(worse by cold) Wants company(aversion to being alone) Rt.sided Inclined to obesity Lying on painfull side aggravates. Broken down constitution(pale,anaemic,poordigestion,acidity,dyspepsia,neuralgia,dropsy) 63. cont. Sharp , cutting pain. Stinging pain in muscles. Burning as from a mustard plaster Modalities < after coition, in cold weather, from soup and coffee, in morning(about 3o clock), lying on lt. side and painful side > warm weather, though moist, during day, while moving about. 64. Carbo-Veg. Disintegration. Imperfect oxidation(low vitality)- feeble circulation. Blue,cold ecchymosed. Marbled with venous over distension. Itching eructations, from fanning, from cold. 66. Natrum-Mur. Face-oily , shiny , as if greased. Liable to take cold. Craving for salt. Worse from over exertion in sun Weeping tendency. Consolation aggravation. Cannot bear heat of sun. Ailment with silent grief. Hypochondriac anxiety. Mental exertion aggravates. 67. cont Fear of Thunderstorm. Indifference Ailments from mortification. Modalities-< noise , music, warm room, lying down, abt.10 a.m at seashore, 68. cont. mental exertion, consolation, heat talking, > open air, cold bathing, going without regular meal, lying on rt. side, pressure against back, tight clothing. 69. Tuberculinum Intense Itching. Worse at night. Tuberculosis in their Family. Light complexion,blue eyes,tall,slim, narrowchested,active & precocious mentally,weak physically. Susceptible to cold. Emaciation on while eating well. 70. cont.. Modalities-< Motion, music, before a storm, standing, dampness, droughts, early morning, after sleep. > open air. 71. Thyroidinum Stupor,alternating with restless melancholy,irritable. Worse least opposition,goesinto a range of trifles. Psoriasis associated with adiposity. Skin-dry,impoverished. Cold Hand and Feet. Browny swelling. Itching without eruption < at night. Excessive obesity. Marked sensitiveness to cold Hypothyroidism after acute dis,ie.weakness. Easy fatigue Weak pulse 72. cont Tendency to fainting,palpitation,cold hand andfeets,low B.P,chilliness & sensitive to cold. Modalities< cold, cold weather, sexual excesses, during menses, during pregnancy, during labour, during puerperal period, during menopause. > lying on abdomen. 73. Bibliography Synopsis of Dermatology -By KHANNA NEENA Skin Disease -By P.HABIF THOMAS Organon of Medicine(5th and 6th Edition) -By DUDGEON R.E Lectures on Homoeopathic Materia Medica -By KENT J.T Pocket manual of Materia Medica and Repertory -By BOERICKE WILLIAM Systemic Materia Medica of Homoeopathic Remedies -By MATHUR K.N Website- ccrhindia.org/list%2of%20publication.as 74. Thankkkk uuuuuuuu .