a case study vitiligo

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A comprehensive case study on vitiligo: Navigating challenges and treatment strategies

2023, IP Indian Journal of Clinical and Experimental Dermatology

This in-depth case study examines the complex terrain of vitiligo and the difficulties that thirty-year-old Mrs. A. must overcome. The storey is told via a thorough analysis of her clinical appearance, which includes the emergence of distinct, symmetrical white spots on several body regions. Given Mrs. A's medical history of general health and her elevated stress levels prior to the depigmentation, the diagnostic procedure is carefully broken down, including physical examinations, medical history evaluations, and pertinent laboratory testing. Examining the epidemiology of vitiligo, the study clarifies its worldwide frequency, age at start, genetic predispositions, autoimmune correlations, and subtle effects on people from various ethnic origins. This case study stands out for its examination of the discrepancy between traditional textbook representations and the dynamic, Mrs. A's emotional and psychological reactions to vitiligo require individualised care. A multidisciplinary approach guides the development of treatment strategies that include photo therapy, topical corticosteroids, and specialised psychological support. The storey ends with a discussion of the follow-up procedure, an assessment of the effectiveness of the treatment, emotional healing, and the continued difficulties of long-term care. This case study provides insightful information about the comprehensive care of vitiligo sufferers, highlighting the significance of customised, team-based approaches in addressing the complex aspects of this skin disease. Keywords: Vitiligo, Challenges, Nursing, Skin disease, Case study

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British Journal of Dermatology

Jackie Gardner

Background Vitiligo is a chronic autoimmune disease affecting melanocytes, resulting in skin depigmentation. Patients with vitiligo often have reduced quality of life and comorbid autoimmune conditions and have reported a lack of available treatments for their vitiligo. Objectives The Vitiligo and Life Impact Among International Communities (VALIANT) study is the first global survey to explore the natural history and management of vitiligo from the perspectives of patients and healthcare professionals (HCPs). Methods The survey recruited adults (≥ 18 years) diagnosed with vitiligo and HCPs treating patients with vitiligo via an online panel in 17 countries. Patients were queried regarding clinical characteristics and vitiligo treatment. HCPs were queried regarding diagnosis and management of patients with vitiligo. Results Included in the analysis were 3541 patients and 1203 HCPs. Nearly half (45.2%) of the patients had > 5% affected body surface area; 57.1% reported family histo...

Journal of Women Medical and Dental College

Psychosocial problems influence the mental health as well as daily living of individuals. Vitiligo is one of those diseases which are strongly associated with psychosocial problems among its victim. Individuals with this disease are found to experience marriage delay, workplace discomfort, anxiety, depression, and remained to fail to cope with their skin condition. To determine psychosocial problems among vitiligo cases and to evaluate the role of psychotherapy in case management of vitiligo patients, this study employed a quantitative correlational study design. Data was collected from skin clinics in Islamabad from 15th December 2017 to 15th April 20018. A sample of 100 respondents including 60 cases and 40 controls was selected through convenient sampling technique. Questionnaires on self-esteem, depression, and Dermatology life quality index (DLQI) were used for data collection. Descriptive and inferential analysis was performed for data analysis. Pearson correlation between vit...

Interface: Comunicação, Saúde e Educação

Emerson Do Bú , Maria Edna Silva De Alexandre , Anderson Scardua

This study aimed to show the comprehension that patients bearing vitiligo have over their condition, also assessing the association with their health and disease concepts. It is a qualitative research with descriptive and exploratory purposes, carried out from an epidemiological survey throughout the years of 2010-2013, with records from a dermatology outpatient care sector of a seminal hospital located in the city of Campina Grande – Paraíba, Brazil. It was identified that from the 832 existing records, 13 were of vitiligo patients and, from them, eight agreed to be part of this study, answering a semi-structured questionnaire. Data examination was made using the thematic Content Analysis technique, identifying four categories. Results indicated that the process of being stricken with the disease is directly related to social practices that target the “stained” subject, over whom vitiligo has imprinted its patches.

Dermatologic Clinics

Roopal Kundu

Indian journal of pharmaceutical sciences

suja abraham

Vitiligo is a pigmentary disorder associated with many disease conditions that necessitates multiple drug regimens, which make the treatment complicated. This stigmatic disease forces the patient to approach all system of medicines as well as alternative medicines of non proven value, which further worsens the situation. At the same time the nonadherence to the treatment reflects poor prognosis, which is misunderstood for lack of response resulting in poor faith to the medications. The aim of this work was to assess the patient compliance and the factors affecting, and to monitor the adverse effects as well as drug interactions. The study was carried out in the Institute of Applied Dermatology for a period of one year. Patient compliance was assessed using Morisky Medication Adherence Scale and found that 71% of the patients were low adherent to medications. Family support, faith in doctor, higher educational status and effectiveness of the treatment were some of the reasons for med...

Ebu Press Ltd

There is widespread misinformation, taboos, and a lack of scientific analysis about vitiligo. In Bangladesh, there is a scarcity of research on vitiligo, though advanced treatments are widely available. This study aimed to investigate the treatment efficacy of vitiligo in a selected dermatology clinic and analyze the factors that impact the efficacy level. This was an analytical cross-sectional study among vitiligo patients who attended a dermatology clinic for treatment and were followed up for at least six months. Patients were treated by experienced physicians through a holistic treatment approach. An interviewer-administered questionnaire was used to collect information after obtaining informed consent. The data was processed by Microsoft Excel 2013 and analyzed by SPSS 25.0. The mean age of the study participants was 25.14 ± 13.32 years, where 60% were female. Acrofacial (33%), focal (27%), and acral (14%) are the most common types of vitiligo, and the face (n=73) is the most common body part. We have seen excellent treatment efficacy as proven by 94% of patients' lesion sizes decreased and 96% gained repigmentation at six months' follow-up. Our study revealed there is a negative impact of the presence of systemic disease and co-morbidities on vitiligo. The efficacy of the treatment was significantly affected by advanced age, body surface area, hypertension, diabetes, and anemia (P<0.05). Our analysis revealed a good treatment efficacy of holistic treatment for vitiligo in selected clinic. For more effective treatment, control of co-morbidities is essential. The findings of this study will help clinicians in their decision making during the treatment process of vitiligo.

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Vitiligo is an important skin disease having major impact on quality of life of patients, many of whom feel distressed and stigmatized by their condition. Society greets vitiligo patients in much the same way as it does any one else who appears to be different. They are started at or subjected to whispered comments, antagonism, insult or isolation. The chronic nature of disease, long term treatment, lack of uniform effective therapy and unpredictable course of disease is usually very demoralizing for patients suffering from vitiligo. It is important to recognize and deal with psychological components of this disease to improve their quality of life and to obtain a better treatment response.

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Updates on potential therapeutic approaches for vitiligo: janus kinase inhibitors and biologics.

1. Introduction

2. jak inhibitors—tofacitinib, 3. jak inhibitors—ruxolitinib, 4. other jak inhibitors in vitiligo, 5. biologics, 6. discussion, 7. limitations, 8. conclusions, author contributions, data availability statement, conflicts of interest.

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Pala, V.; Ribero, S.; Quaglino, P.; Mastorino, L. Updates on Potential Therapeutic Approaches for Vitiligo: Janus Kinase Inhibitors and Biologics. J. Clin. Med. 2023 , 12 , 7486. https://doi.org/10.3390/jcm12237486

Pala V, Ribero S, Quaglino P, Mastorino L. Updates on Potential Therapeutic Approaches for Vitiligo: Janus Kinase Inhibitors and Biologics. Journal of Clinical Medicine . 2023; 12(23):7486. https://doi.org/10.3390/jcm12237486

Pala, Valentina, Simone Ribero, Pietro Quaglino, and Luca Mastorino. 2023. "Updates on Potential Therapeutic Approaches for Vitiligo: Janus Kinase Inhibitors and Biologics" Journal of Clinical Medicine 12, no. 23: 7486. https://doi.org/10.3390/jcm12237486

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Vitiligo Research

Vitiligo Advancements and Discoveries

There has been an increase in the amount of research being undertaken in vitiligo over recent years and dermatologists have an improved understanding of the natural history and different types of the condition. Here you will find a brief summary of research into several areas, with references to the original research articles, for those of you who wish to follow these up.

Researchers are looking at:

• The effectiveness of existing treatments;
• Possible causes of vitiligo;
• How the condition develops;
• Segmental vitiligo;
• The association of vitiligo with other conditions;
• The psychological effects of vitiligo.

It is hoped that the improvements in scientific understanding will in future lead to more effective treatments for vitiligo.

Are psychological interventions important for vitiligo patients?

Yes, a survey of vitiligo patients and healthcare professionals found that psychological interventions are important for managing the impact of vitiligo on patients’ lives.

A survey was conducted to identify psychological interventions for vitiligo. The survey was funded by the UK Dermatology Clinical Trials Network and involved patients and health professionals. The survey recorded personal data and focused on the effect of vitiligo on normal life, as well as the most difficult problems faced by patients and which approaches would be helpful.

• Patients with vitiligo reported key issues such as acceptance of their disease, the duration of the disease and managing embarrassment.
• Other concerns were participating in sporting activities and exposure to sunlight.
• Interventions considered useful by professionals to address these issues included cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness therapy.

Psychological interventions for vitiligo are a research priority, but there is little published on appropriate therapy from both patient and clinician perspectives. The unique survey referenced here is therefore of value to the future treatment of vitiligo patients.

Will piperine treat vitiligo?

Although promising results have been seen in cell and animal studies, and early work toward clinical trials in humans is underway, the effectiveness and safety of piperine as a treatment for vitiligo in humans has yet to be fully established.

Ongoing research is being conducted, but funding is needed to support further studies. Therefore, it is unclear at this time whether piperine will ultimately prove to be an effective treatment for vitiligo.

Amala Soumyanath led the research that discovered piperine as a potential treatment for vitiligo. In her own words, she shares the story of her research journey and provides an update on the latest developments. Become a member today and access more resources and stories like this.

How was piperine discovered as a potential treatment for vitiligo?

Piperine was discovered as a potential treatment for vitiligo through research and testing of herbal extracts , where a water extract of black pepper was found to stimulate melanocyte growth and dendrite formation. The compound responsible for this effect was identified as piperine, which could be developed for use in treating vitiligo.

How was piperine validated as a “lead” molecule for the treatment of vitiligo?

Piperine was validated as a “lead” molecule for the treatment of vitiligo through studies conducted at King’s College London. They tested extracts from various herbs and found that piperine from black pepper was the most effective at stimulating the growth of pigment cells. Further studies were conducted to make chemical variations (analogs) of piperine and two of these analogs showed good activity.

All three compounds, piperine, THP, and RCHP, were found to stimulate the growth of pigment cells in mice, causing their skin to visibly darken. These studies allowed the researchers to secure international patents for the use of piperine and its analogs to treat vitiligo.

How was piperine’s effectiveness and safety in treating vitiligo validated?

Piperine’s effectiveness and safety in treating vitiligo were validated through a detailed plan for a clinical trial of piperine in patients with vitiligo. Prior to the clinical study, experiments were conducted to investigate the effects of piperine on human pigment cells, including melanocytes from the uninvolved skin of a vitiligo patient.

Piperine was found to stimulate the replication of human melanocytes in culture and when grown within a reconstructed skin model. Colleagues in OHSU’s Biomedical Engineering and Dermatology departments used innovative optical methods to image pigmentation and melanocytes in the skin models.

What were its effects on human pigment cells and melanoma?

Experiments funded by AdPharma, Inc. showed that piperine has an inhibitory effect on cultured melanoma cells and prevents melanoma cell growth in a reconstructed full-skin model. To further study this aspect, the HGF mouse model of melanoma was introduced to OHSU.

The effects of piperine in this model are currently being studied with pilot funding from the Department of Dermatology’s Jesse Ettelson Fund for the Advancement of Dermatology Research. These ongoing studies are essential to establish the safety of piperine.

What is the status of piperine for treating vitiligo in humans?

In 2013, the appointment of Professor Sancy Leachman, a dermatologist and expert in pigment cell biology, gave a significant boost to the project of developing piperine as a new treatment for vitiligo. Dr. Pamela Cassidy and Eric Smith also joined the team, and a core group is working to bring this discovery to the clinic. The current status of piperine as a treatment for vitiligo in humans remains unclear.

Amala Soumyanath’s Personal and Professional Journey to Develop a Treatment for Vitiligo

Amala Soumyanath’s journey began when she received a phone call from Maxine Whitton, an MBE-awarded vitiligo service provider, sparking an idea to develop piperine as a potential treatment for vitiligo. With dedication and persistence, Amala’s knowledge of drug development processes led her to develop piperine to the point of being tested in humans.

Her personal experience with vitiligo, developing noticeable patches in 2006, fueled her drive to find a treatment for this difficult condition. Alongside a team of talented researchers at OHSU, they continue to evaluate piperine’s efficacy and understand its effects on melanocytes, with Dr. Sancy Leachman leading the project and Amala as the ongoing champion.

Is piperine the new treatment for vitiligo?

Amala Soumyanath and her team at OHSU are developing piperine as a potential treatment for vitiligo. A “proof of concept” human study demonstrating piperine’s safety and efficacy could attract large pharmaceutical companies to move forward with the project, but funding is needed. Donations of any size can make a real difference to the project’s progress. While piperine shows promise as a treatment for vitiligo, further research is required before it can be established as a new treatment.

How can you help?

The team at OHSU is reaching out to the general community for funding to support their ongoing studies on piperine for vitiligo at both the clinical and basic science levels. Donations of any size from those affected by vitiligo or anyone interested in supporting the research can be made online to the Vitiligo Research Fund .

Read Amala Soumyanath’s full story here .

What impact does vitiligo have on a person’s quality of life?

Vitiligo can have a moderate to severe impact on a person’s quality of life, including depression, stigmatization, and impaired sex lives. The location of the lesions and cultural values related to appearance and status may also play a role. Research has found that:

• Quality of life is closely related to the patients’ apprehensions about their disease, psychosocial adjustment, and psychiatric morbidity.
• British Asian women with vitiligo often feel visibly different and have experienced stigmatization due to cultural values related to appearance, status, and myths linked to the cause of the condition.
• Quality of life impairment in women affected with vitiligo assessed using the DLQI was equal to the impairment caused by psoriasis.
• Vitiligo had a negative impact on the sex lives of women with vitiligo.

To learn more about the impact vitiligo has on an individual and their quality of life you can find the full articles below:

• Quality of life of patients with vitiligo attending the Regional Dermatology Training Center in Northern Tanzania
• Depression, anxiety and health‐related quality of life in children and adolescents with vitiligo
• Quality of life and psychological adaptation of Korean adolescents with vitiligo
• Vitiligo linked to stigmatization in British South Asian women: a qualitative study of the experiences of living with vitiligo
• Effect of vitiligo on self‐reported health‐related quality of life
• The Problems in Sexual Functions of Vitiligo and Chronic Urticaria Patients

Can thyroid issues cause vitiligo?

There is evidence to suggest that thyroid issues can be associated with vitiligo. The frequency of thyroid disease in vitiligo patients is higher compared to the general population, and it is recommended that all patients with vitiligo have their thyroid function checked.

In the course of their clinical work, dermatologists discovered:

• the frequency of thyroid disease in vitiligo patients was 15.1%, 
• autoimmune thyroid disease was 14.3% 
• and the presence of thyroid-specific autoantibodies was 20.8%.

To learn more about the association between thyroid issues and vitiligo you can find the full article here .

Does vitiligo increase your risk of skin cancer?

Although patients with vitiligo have a tendency to burn in the sun, a survey conducted by a team from The Netherlands found that patients with vitiligo have a threefold lower probability of developing malignant melanoma and non-melanoma skin cancer. The reasons for this are not yet fully understood.

Read the entire survey here and learn more about this on BBC iPlayer .

What is segmental vitiligo?

Segmental vitiligo is a form of vitiligo that presents with patches distributed unilaterally and locally . It has been compared with a possible mosaic or neurogenic background, but its distribution pattern is not entirely similar to any other skin condition. Cutaneous mosaicism may be involved in segmental vitiligo. However, the underlying mechanism of segmental vitiligo is still unknown.

Learn more about the distribution pattern of segmental vitiligo here .

How is vitiligo classified?

Segmental vitiligo is classified separately from all other forms of vitiligo, with the term ‘vitiligo’ being used as an umbrella term for all non-segmental forms, including mixed vitiligo in which segmental and non-segmental vitiligo are combined and which is considered a subgroup of vitiligo.

Experts recommend that disease stability is best assessed based on the stability of individual lesions rather than the overall stability of the condition.

Read the entire article about the classification of vitiligo here .

What is the Koebner phenomenon in relation to vitiligo and how can it be assessed?

The Koebner phenomenon (KP) refers to the development of vitiligo within an area of skin that has been damaged by localised, often mild trauma (e.g. an injury). Dr. N van Geel and colleagues of Ghent have looked at this phenomenon. They developed a new assessment method for KP, taking into account both the history and clinical examination of people with vitiligo; this seems to be a useful and valuable tool for assessing KP in daily practice.

The results support the hypothesis that KP may be used to assess and predict the course of vitiligo (access the entire article here ).

What is the relationship between Halo Nevi and vitiligo?

Halo nevi are common moles with a white ring around them, showing the sort of pigment loss that is seen in vitiligo. They may represent a distinct condition, but in some cases, they may be an initiating factor in the development of vitiligo, according to research by Dr. van Geel and researchers (access the entire article here ).

What are the mechanisms of pathogenesis of vitiligo?

The pathogenesis of vitiligo is believed to involve oxidative stress, which leads to an imbalance between reactive oxygen species (ROS) and the body’s ability to detoxify them. (Access the entire article here ).

According to research (access the entire article here ): 

• Mitochondria within melanocytes and blood cells generate reactive oxygen species (ROS) that may be relevant in vitiligo development.
• Modification of membrane lipid components in vitiligo cells may cause mitochondrial impairment and the production of intracellular ROS after exposure to mild stress.
• Autoimmunity plays a role in the pathogenesis of vitiligo, with tyrosine hydroxylase identified as an autoantigen target.
• Tyrosine hydroxylase antibodies are more frequent in people with active non-segmental vitiligo (23%) but not in the segmental type.

How does vitiligo affect the layers of skin?

Genetic studies show that susceptibility to vitiligo is related to proteins or parts of the pigment cell involved in the immune system (access the entire article here ). Research from Dalian, China, reveals that alterations in skin biophysical properties, such as stratum corneum (SC) hydration, melanin and erythema index, are lower in vitiligo-affected skin (access the entire article here ). 

However, no difference in skin surface acidity was observed, and the SC integrity was similar in involved and uninvolved areas. Barrier recovery in vitiligo-involved areas was significantly delayed compared to uninvolved areas.

What are the systemic treatment options for vitiligo?

It is difficult to find a systemic treatment for vitiligo at the moment (one that affects the whole body). Some of the commonly used systemic treatments for vitiligo include:

• Ginkgo biloba – taking 60 mg of Ginkgo biloba BID was associated with a significant improvement in total Vitiligo Area Scoring Index (VASI) and Vitiligo European Task Force (VETF) scores, but more clinical trials are needed (access the entire article here ).
• Piperine – has been suggested as a potential treatment for vitiligo, yet only a few studies have been conducted and most have been on animals (access the entire article here ).
• Cosmetic camouflage – not only conceals the depigmented patches but has been shown to improve the quality of life in patients (access the entire article here )

What are the surgical treatment options for vitiligo?

Surgical treatment options for vitiligo involve transplanting melanocytes from normally pigmented skin to the depigmented areas and are only suitable for patients with stable vitiligo. It has been proven that suspending melanocytes in the patient’s own serum (plasma in the blood) can improve the effectiveness of the transplant (access the entire article here ).

Another new procedure called ReCell involves taking a sample of normal skin, separating out the skin cells, and spraying them onto the vitiligo patches (access the entire article here). Studies comparing Recell with conventional transplantation have shown varying degrees of repigmentation, but it is not widely available in the UK (access the entire article here ).

What are effective topical treatments and light therapies for vitiligo?

Creams or ointments, known as topical immunomodulators, are usually the first line of treatment for vitiligo. Topical tacrolimus and pimecrolimus have been found to be effective for localised vitiligo. Targeted narrow-band ultraviolet B (UVB) light treatment using the Excimer laser is also known to be effective, but not widely available. Other lasers such as the Q-switched ruby laser have been shown to induce depigmentation more quickly, but with more discomfort.

To learn more about effective topical treatments and light therapies for vitiligo you can find the full articles below:

• Comparative Therapeutic Evaluation of Different Topicals and Narrow Band Ultraviolet B Therapy
• Pimecrolimus: a new choice in the treatment of vitiligo?
• Laser for treating vitiligo: a randomized study
• Treatment of vitiligo: advantages and disadvantages, indications for use and outcomes

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Vitiligo: A study of 120 cases

Introduction

Vitiligo is a common pigmentary disorder seen in our country. It is an acquired idiopathic depigmentary condition. It is characterised by completely depigmented milky white macules of varying sizes and shapes. Besides loss of colour there is no other structural changes. This disorder does not result in restriction of capacity to work or expectancy of life, but it causes cosmetic disfigurement leading to psychological trauma to the patients. The reported incidence of vitiligo in various dermatological clinics now in India varies from 0.5% to 1%. [1] An OPD based study of analysis of basic data like, age, sex, occurrence in family and associations of vitiligo was undertaken to know various aspects of vitiligo.

Materials and Methods

Our study was conducted among the patients attending out patient department of Dermatology of a service hospital. A total number of 120 cases showing definite clinical evidence of vitiligo were taken up for this study. A clinical diagnosis of vitiligo was made only when there was unequivocal evidence of depigmented patches of milky white colour. The cases showing white patches due to secondary causes were excluded from this study. Details of dietary habit and family history was taken in each case. History of associated disease notably diabetes mellitus, thyroid disorder, pernicious anaemia, and alopecia areata were noted. History of precipitating/ initiating factors especially physical trauma, sun exposure, acute mental/ emotional stress, contact with chemicals/ synthetic foot wears etc were noted. Routine laboratory investigation of urine and stool, blood cell counts, hemoglobin, fasting and post prandial (PP) blood sugar estimations were carried out in all cases.

The youngest patient in this series was a 2 year- old girl and oldest patient was 65 year of old male [Table - 1] . In 52 (43.2%) patients disease started before the age of 20. The duration of disease varied from 2 months to ten years. Eight cases gave the family history of vitiligo [Table - 2] . In one occasion, both mother and her two daughters had vitiligo. Twenty six (28.3%) were married, but there was no divorcees. Exposed areas of body were most commonly affected in 80 (66.6%) cases [Table - 3] . Bilaterally symmetrical lesions were present in 8 (6.6%) cases. The legs were the commonest site in 60 (50%) cases [Table - 4] . Circumscript type of vitiligo was seen in 56 (46.6%) cases [Table - 5] . Ninety- six (79.9%) patients had multiple lesions. All routine laboratory investigations were within normal limits, except for the presence of Giardia lambiia in the stool of 14 (12%) cases and Ascaris Lumbricoides in 12 (10%) cases. Raised blood sugar with fasting blood sugar, 130-160 mg% and PP 220-240 mg% was found in two (2.6%) cases.

The untiring efforts of the scientists, over a period of many years, have failed to lift up the curtain of ignorance till today and as we know, the aetiology of vitiligo is still an enigma. Various theories of origin, genetic, [2] toxic, [3] neurogenic, [4] and auto-immune [5] have been proposed by different workers, yet none is definite.

The male:female ratio in vitiligo was observed in our study to be nearly equal, meaning there by that this disease has no predilection for any sex. Similar observations were also noted by various workers. [6] , [7] Further, the incidence of vitiligo was 43.2% cases in 0-20 year of age as compared to a low incidence of only 9.9% in individuals over 40 years of age [Table - 1] which means more and more younger people are getting afflicted with this disorder. Because of social stigma in the community young females tend to report earlier due to matrimonial anxiety.

In our study, out of 8 (6.6%) patients who gave the family history of vitiligo, only in one occasion both mother and her two daughters had vitiligo. In the rest seven patients only one relative was suffering from vitiligo. Universal vitiligo was found in 2 (1.6%) cases and both of them had a positive family history. A positive family history has been reported in 10% of cases by Sarin et al and 6.25% of cases by Behl et al. [7] The mode of transmission seems to be by autosomal dominant gene with variable penetrance. [8]

In our study the lesions were typically milky white and border was not hyperpigmented. Hairs in the involved patches were of black colour in younger patients but in 13% of older patients the hairs were white. Besides loss of pigment no other abnormality was detected in the vitiliginous patches. The legs seems to be most frequently affected in majority (50%) of cases. Hands, face and bony prominence were the next commonest site followed by feet, trunk and neck.

Exposed areas of the body were most frequently affected in majority of patients (66%) in our study [Table - 4] . The lesions were present mostly on the front of the legs in 60 (50%) cases, hands in 44 (36.6%), feet in 22(18.3%) and bony prominence in 28 (23.3%) patients. The development of vitiligo at the site of physical trauma is a koebner phenomenon. This may be explained as due to release of antigens of injured melanocytes into the blood and production of antibodies against them resulting in further loss of melanocytes. [9]

Among the various types, vitiligo vulgaris showing circumscript, scattrered macular variety was found to be the commonest. This indicates that the process of depigmentation (either immune mediated or toxic) may occur simultaneously or subsequently at unrelated sites. [9]

Our study also revealed association of diabetes mellitus in 2 (2.6%) cases. Other conditions with proposed auto-immune mechanisms like thyroid disease, alopecia areata, and pernicious anaemia were not found in any of our cases. Diet [10] did not play an important role in the causation of the disease. However, it is interesting to note that about 90% of the cases were not on a purely vegetarian diet in our study. They were on mixed diet. More intensive comparative study is required to establish the role of the non vegetarian diet as an exciting factor in the aetiology of vitiligo.

Higher incidence of association of conditions like giardiasis, ascariasis and worm infestations is difficult to correlate and just reflect their higher incidence in tropical population.

The non occurrence of vitiligo in other family members throughout their life, strengthen our assumption that genetic tendency is far from significant, unless and until there is repeated insult on the melanocytes, either by nutritional aberrations, recurrent infections/their toxins, repeated antibiotic therapy, taking of fast ready food that has an alarming high concentration of lethal preservatives, additives, colorants, drinking of polluted, chemical laden water and eating of vegetables grown in fields using water contaminated with industrial wastes. [10] , [11]

Suggested read for related articles:

• Family vitiligo impact scale: A scale to measure the… December 30, 2021
• Vitiligo Impact Scale (VIS)-22: A measure of the… August 30, 2022
• Risk factors for poorly controlled and… August 30, 2022

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Vitiligo and cutaneous melanoma. A case study

Affiliation.

• 1 Department of Dermatology, University of Hamburg, FRG.
• PMID: 1809584
• DOI: 10.1159/000247693

The examination of 623 melanoma patients in North Germany yielded the depigmentation disorder vitiligo in 23 cases (i.e. 3.7%). In 11 patients, the disease preceded their tumor, whereas in 11 patients, vitiligo developed after diagnosis of primary and/or metastatic melanoma into the regional lymph nodes. In 1 case, the onset of melanoma in relation to the tumor remained undefined. The prevalence of vitiligo increased with tumor risk factors based on tumor thickness and anatomical site of tumor location (i.e. for low risk 1.75%, intermediate risk 5.2% and high risk 5.8%). A comparison of the prevalence of vitiligo to the normal population of Northwestern Europe (i.e. 0.38-0.57%) showed a 7- to 10-fold increase for the patients with melanoma. A reverse analysis of the data yielded a 180-fold higher prevalence of melanoma in the group of patients with vitiligo. These results strongly support a more thorough examination of patients with vitiligo for primary melanoma.

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Study Highlights Global Prevalence of Vitiligo, Regional Trends

This systematic review and meta-analysis looks at trends around the world regarding patients with vitiligo, highlighting prevalence and incidence.

Credit: Pexels

A new study highlights the global impact of vitiligo and uses subgroup analyses to explore prevalence around the world, with investigators concluding that overall prevalence of the skin condition is lower than previously believed and that females and males are equally impacted. 1

These findings and more resulted from a systematic review and meta-analysis led by Morten Bahrt Haulrig from the department of dermatology and allergy at the Herlev and Gentofte Hospital in Denmark.

Haulrig et al. noted that vitiligo is commonly described as widespread, adding that there is an estimated global prevalence ranging from 0.5% - 1%. The investigators also pointed out that the condition was believed to impact all age groups equally, regardless of skin type, sex, or ethnicity. 2

“We investigated the incidence and the global, regional, and country-specific prevalence of vitiligo,” Haulrig and colleagues wrote. “Additionally, we investigated the prevalence through subgroup analyses based on age, sex, study type, sample size, study quality and publication year.”

Background and Design

The research team carried out a comprehensive search, using the EMBASE, PubMed, and Web of Science databases and evaluating included records from inception through to August 2023. Specific medical subject headings were implemented in the team’s search, including words such as ‘vitiligo,’ ‘pigmentary,’ and ‘leukoderma.’

The investigators also looked at relevant studies’ references, as well as previously published reviews. Their overall aim was on research that looked into the prevalence and/or incidence of vitiligo among general populations, with 4 study authors independently screening abstracts and titles, thoroughly assessing full-text articles.

The research team only included duplicate studies if they featured different subgroups’ data that was also from the same population. In circumstances in which multiple point prevalence estimates were seen within the same population, the team only considered the most recent data.

Quality and potential risk of bias assessments were also conducted by the investigators, with the team implementing the Appraisal tool for Cross-Sectional Studies (AXIS) and the Newcastle-Ottawa Scale (NOS) for cohort and case-control research. The so-called AXIS tool, made up of 20 items, had been designed to evaluate the results, methods, discussion sections, and biases in cross-sectional research.

Studies assessed by the investigators were classified based on their risk of bias, with the team ranking each study as low (7−9 items met), moderate (4−6 items met), or high (0−3 items met). They additionally categorized the research into predefined subgroups, defining children and adolescents as subjects aged up to 19 years, with adults being categorized as having a minimum age range of 18 years.

Some other subgroups assessed by the research team included study type, sample size (≥5000 participants), patients’ sex, quality of research (low risk of bias), and publication year.

Study Results

Among the 7,838 studies identified first by the team, there were 171 deemed suitable for analysis, and these involved a total of 572,334,973 participants. The investigators reported that vitiligo’s overall incidence rate was 1.59 per 10,000 person-years (95% CI: 0.70−2.83) and that the rate of the disease’s prevalence was 0.40% (95% CI: 0.37−0.44).

In a notable finding, the investigators concluded that there was not a significant distinction between the rates of female subjects (0.50%, 95% CI: 0.36−0.66) and those of males (0.49%, 95% CI: 0.35−0.65). The greatest prevalence was determined to be in West Asia, at 0.77% (95% CI: 0.44−1.10), and the research team concluded that East Asia had the lowest rate of prevalence at 0.12% (95% CI: 0.10−0.14).

In terms of prevalence in specific countries, the investigators found that Jordan was shown to have the highest prevalence at a rate of 1.34% (95% CI: 0.12−3.87). They noted that Sweden had the lowest prevalence rate at 0.19% (95% CI: 0.08−0.34).

In their comparison of age cohorts, the research team reported that children and adolescents were found to have a lower rate of prevalence at 0.27% (95% CI: 0.24−0.31) versus adult patients, among whom the rate of prevalence was 0.70% (95% CI: 0.59−0.81).

Questionnaire-based research was also found by the team to have led to a higher reported rate of prevalence of 0.73% (95% CI: 0.52−0.98) versus examination-based research at 0.59% (95% CI: 0.46−0.73) and register-based research at 0.13% (95% CI: 0.10−0.17).

“The subgroup analysis categorised by study types influenced the prevalence,” they wrote. “There is a lack of incidence studies and prevalence studies conducted in South America, Africa, Central Asia, and Oceania.”

• Haulrig MB, Al-Sofi R, Baskaran S, Bergmann MS, Løvendorf M, Dyring-Andersen B, et al. The global epidemiology of vitiligo: a systematic review and meta-analysis of the incidence and prevalence. JEADV Clin Pract. 2024; 1–10. https://doi.org/10.1002/jvc2.526.
• Ezzedine K, Lim HW, Suzuki T, Katayama I, Hamzavi I, Lan CCE, et al. Revised classification/nomenclature of vitiligo and related issues: the vitiligo global issues consensus conference. Pigm Cell Melanoma Res. 2012; 25(3): E1–13. https://doi.orrg/10.1111/j.1755-148X.2012.00997.x.

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Digital humanities in US academic libraries: case studies

• Kelda Habing , Lian Ruan
• Published in Digital Transformation and… 16 August 2024

23 References

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Homeopathic Treatment of Vitiligo: A Report of Fourteen Cases

Seema mahesh.

1 Centre for Classical Homeopathy, Vijayanagar, Bangalore, Karnataka, India

Mahesh Mallappa

Dionysios tsintzas.

2 Department of Orthopedics, General Hospital of Aitoloakarnania, Agrinio, Greece

George Vithoulkas

3 International Academy of Classical Homeopathy, Alonissos, Greece

Case series

Patient: —

Final Diagnosis: —

Symptoms: Skin lesions

Medication: —

Clinical Procedure: —

Specialty: Dermatology

Unusual or unexpected effect of treatment

Background:

Vitiligo, also known as leukoderma, is an autoimmune skin condition that results in the loss of melanin pigment. Vitiligo is not a rare condition but is difficult to treat and is associated with psychological distress.

Case Reports:

A series of 14 cases of vitiligo are presented that were treated with individualized homeopathic remedies that were based on plant, animal, or mineral compounds. There were 13 women and one man in the case series, with a mean age 29.8 years, and a mean follow-up from treatment of 58 months. The mean time between the onset of the appearance of vitiligo and the first consultation at our clinic was 96 months. Homeopathic treatment for patients is holistic and was performed on an individualized basis as described in this case series. Photographic images of the skin are presented before and after treatment.

Conclusions:

In 14 patients with vitiligo treated with individualized homeopathy, the best results were achieved in the patients who were treated in the early stages of the disease. We believe that homeopathy may be effective in the early stages of vitiligo, but large controlled clinical studies are needed in this area.

Vitiligo is an acquired autoimmune condition that is characterized by the destruction of epidermal melanocytes causing loss of skin pigment [ 1 ]. Vitiligo may progress to involve the dermal follicular reserve and to destroy melanocyte stem cells [ 1 ]. Although the global prevalence of vitiligo is less than 1%, in some populations, it may be as high as 3% of the population [ 1 ]. Classically, vitiligo has been classified into segmental and non-segmental variants, depending on the distribution of skin depigmentation [ 2 ]. Vitiligo can cause psychological stress, especially in dark-skinned individuals for whom it causes concerning cosmetic skin changes. Also, in some parts of the world, such as in rural India, vitiligo is considered to be a social stigma, particularly for young girls.

Vitiligo is an autoimmune condition in which multiple immune response genes are believed to be involved [ 3 ]. Studies have shown that vitiligo may be caused by a response to oxidative stress, mediated by T-cells and involving mediators such as tumor necrosis factor alpha (TNFα), heat shock protein 70 (Hsp70), and interleukin 1 alpha (IL-1α) [ 4 – 6 ]. Melanocyte destruction is initiated by an imbalance in the production of reactive oxygen species (ROS) that causes free radical damage to the skin melanocytes, leading to protein structural damage, cell apoptosis, activation of cytokines, and damage to cell endoplasmic reticulum (ER) [ 4 – 6 ]. The severity of vitiligo may be assessed by measuring superoxide dismutase, a byproduct of oxidative stress that increases when vitiligo is active but regresses when the lesions become stable [ 4 – 6 ]. Cytokines and chemokines such as C-C chemokine ligand 5 (CCL5), CXC chemokine ligand 12 (CXCL12), interleukin 1 alpha (IL-1α), and tumor necrosis factor alpha (TNFα) have been shown to have a major role in inducing autoantigen presentation and recruitment of antigen-presenting cells (APCs) and activated T-cells and to have a role in destruction of the skin melanocytes, supporting the autoimmune etiology of vitiligo [ 1 , 7 – 11 ].

Currently, the available treatment options for patients with vitiligo have limited effectiveness, particularly for patients with vitiligo of the acral areas, which are resistant to treatment due to the lack of hair follicles that can serve as reservoirs for melanocytes [ 1 , 2 ]. The criteria for assessing the response to the treatment of vitiligo include: cessation of spread; the appearance of skin re-pigmentation; and overall quality of life during treatment [ 1 , 12 – 14 ]. However, no therapeutic study has yet shown long-term benefits using these criteria, and further research is required to establish evidence for the effective treatment of vitiligo [ 1 , 12 – 14 ]. There has been at least one prospective observational clinical study that has investigated the effectiveness of classical homeopathic treatment of vitiligo [ 15 ], with a further prospective observational clinical study involving homeopathic treatments given based on characteristic individualized patient symptoms [ 16 , 17 ]. However, to our knowledge, we now report the first retrospective case series describing the long-term effects of the homeopathic treatment of vitiligo.

Case Report

A series of 14 cases of vitiligo are presented that were treated with individualized homeopathic treatments that were based on plant, animal, or mineral compounds ( Table 1 ). There were 13 women and one man in the case series, with a mean age 29.8 years, and a mean follow-up from treatment of 58 months. The mean time between the onset of the appearance of vitiligo and the first consultation at our clinic was 96 months. Homeopathic treatment for patients is holistic and was performed on an individualized basis. Photographic images of the skin are presented before and after treatment ( Figures 1 ​ 1 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ – 14 ). All patients were treated were treated according to the laws of classical homeopathy [ 18 , 19 ].

Case 1. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 2. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 3. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 4. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 5. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 6. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin before treatment. ( C ) The appearance of the skin during treatment. ( D ) The appearance of the skin during treatment.

Case 7. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 8. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 9. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 10. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 11. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 12. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 13. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Case 14. ( A ) The appearance of the skin before treatment. ( B ) The appearance of the skin during treatment.

Summary of homeopathic treatments and outcome in 14 patients with vitiligo.

The selection of the homeopathic treatment for these 14 patients was made according to the individual patient symptoms. Initially, each patient was assessed in detail for their psychological and physical symptoms, and the homeopathic treatment was selected for each patient ( Table 1 ). In most 12 out of the 14 cases, more than one homeopathic remedies was prescribed and was used sequentially ( Table 1 ). Patients were followed-up during treatment for a mean time of 58 months. The cases that were treated in the early stages recovered more quickly and completely. However, in other cases, where the skin de-pigmentation had been established for a long period and did not resolve, once the homeopathic treatment began, other health problems improved well while the skin lesion covered very slowly.

This retrospective study of a series of 14 cases of vitiligo treated with individualized homeopathic compounds showed that although vitiligo is a primary autoimmune disease of the skin, patients with vitiligo may have involvement of multiple systems of the body. This case series showed that prolonged periods of psychological stress might be involved in the onset and progression of the vitiligo. These associations may support the view that psychological stress and the onset of autoimmune conditions are closely connected [ 17 ].

Homeopathic medicine includes a holistic approach to the understanding of the patient and integrates this approach to provide individualized patient treatment [ 18 , 19 ]. Certain diseases may manifest when genetic predisposition combines with stress, and homeopathy recognizes these factors [ 18 ]. Homeopathy considers the patient’s susceptibility to certain kind of stress, which means that homeopathy can be more successful during the early development of a disease, even before conventional medicine usually begins [ 18 , 19 ].

The range of action of homeopathic medicine aims to strengthen the action of the immune system through the primary understanding that symptoms are an attempt by the immune system to achieve balance [ 18 , 19 ]. ’Through the application of the principle of resonance, the basis of homeopathic medicine is that if a substance is capable of producing a similar symptom profile in a healthy organism, then the likelihood of its strengthening of the body’s defense mechanisms in a diseased body with the same symptoms is great [ 18 , 19 ]. The fundamental pillar of the science of homeopathy is that ‘like cures like’ [ 19 ]. The basis for homeopathy is that any substance (plant, animal, mineral, or metal) that can affect the human health can serve as a medication, when in the right form. Homeopathic medicines are prepared through serial dilutions and using a frictional process called ‘succussion’ or potentization, resulting in no traceable ‘material’ left in the solution, therefore enabling a safe use of toxic substances that may otherwise prove fatal [ 20 ]. The symptoms obtained through ‘proving’ of the homeopathic compounds on healthy humans serve as the basis for their prescription in diseased individuals. Because the main therapeutic rule in homeopathy is Similia Similibus Curentur ( let like be treated by like ), homeopathy has the advantage of taking the causes of diseases and their effects into account [ 20 ]. Therefore, homeopathic treatment, when given in a timely fashion, may bring lasting improvement for autoimmune disease, when homeopathy is applied in the early stages [ 20 ].

The experience of a homeopath treating vitiligo is that the lesions may firstly stop spreading, and existing lesions do not increase in size, and no new lesions appear. Secondly, re-pigmentation may occur, and the borders of the lesions that were formerly diffuse become more clearly marked, indicating cessation of spread. The quality of life for the patient may improve and the symptoms of associated diseases, such as thyroid dysfunction, may also improve [ 21 , 22 ]. These clinical responses to homeopathic treatment in patients with vitiligo may be considered to be an ideal response to treatment [ 13 ]. However, for an optimal response to homeopathic treatment to occur, treatment should begin when the body has not suffered the effects of the disease for long and before the immune response becomes irreversible.

In the 14 cases of vitiligo treated with homeopathy and presented in this case series, the longer the time that elapsed between the onset of vitiligo and the homeopathic consultation, the more difficult it was to obtain a good clinical response. The cases of vitiligo that presented in the advanced stages required more homeopathic remedies and in a correct sequence to see clinical change. An explanation of these findings may have been that the health level of the patients had worsened with time and that the immune system needed more stimulation and time to bring about a positive clinical effect on vitiligo [ 23 ].

Conclusions

In 14 patients with vitiligo treated with individualized homeopathy, the best results were achieved in the patients who were treated in the early stages of their disease. We believe that homeopathy may be effective in the early stages of vitiligo, but large controlled clinical studies are needed in this area.

Abbreviations:

Conflict of interest

References: