Localised Type:
a) Focal - One or more maculesin two single areas but not segmented.
b) Segmental - One or more macules in a dermatomal pattern.
c) Mucosal - Involvement of mucous membrane alone.
Generalised Type :-
a ) Acrofacial - Involvement of face and distal extremities.
b ) Vulgaris - Scattered macules in symmetrical or asymmetrical distribution.
c ) Universalis- Total or nearly whole body involvement.
There are certain precautions which can dealy or stop the onset of the disease.
1. Maintain good general health and immunity.
2. It is a non communicable disease.
3. Any patch should be thoroughly examined first.
4. Application of any unconfirmed tropical medication on skin should be avoided.
5. Use of synthetic clothes should be restricted.
6. Avoid excess intake of Sour things.
7. Avoid Steroids.
It is a myth that leucoderma occurs by drinking milk over the fish. There is no relevance in avoiding anything to eat or drink which is white in colour as assumed by some people similarly in cases of Jaundice for Yellow coloured things.
Etiologically - Though the exact cause is unknown. Still following are the factors considered to be responsible are:-
1. Diet:- Poor in proteins and cupro minerals
2. Gastro intestinal disorders
3. Run down state of health
4. Psychogenic streses
5. Occasionally endocrine disorders sply. The Thyroidism Histological studies of vitiliginous areas have shown deficiency or loss of dopa and tyrosine positive melanocytes (cells responsible for the skin colour)
Clinical Features
1. It is characterised by completely depigmented macules, patches and sheets
2. Patches are of different shapes and sizes, the borders are hyperpigmented.
3. No structural change occurs
4. Patches enlarge slowly and may affect the whole body but this involvement is very seldom complete.
5. Common sites of vitiligo affected are Face, Dorsum of Hands, Waist and Legs. Hair may or may not become depigmented in the vitiliginous areas.
Differential Diagnosis or conditions lookalike of vitiligo
1. Albinism:- It is congenital, present at birth. Distribution is complete or partial. There are no Hyperpigmentary border. Hair and eyes may be affected. Hereditary in origin cause is stationary.
2. Nevus Depigmentosus:- It is congenital, present at birth. Distribution is unilateral. Does not increase in size or change shape. It is not hereditary in origin and there are no Hyperpigmentary border.
3. Leprosy:- It can occur at any age and may affect any areas. Course is progessive Hyperpigmentary border are inflammatory and it occurs in patches which have no sensation, nerves are thickened.
4. Pityriasis versicolor:- It can occur at any age mostly affect upper trunk and neck course is progressive. There are no Hyperpigmentary borders. In patches there is furfuraceous scaling on microscopic examination fungus is seen.
Prognosis :- It has improved considerably in recent years because the etiological factors are better understood. According to the reports available it is found that progress of disease could be controlled in about 90-95% of cases and could be cured in about 60-75% of cases. Patches which could not be cured medically but could be controlled were treated with therapeutic tattooing and by thin skin grafts. Homoeopathy has a major role in the treatment and cure of this disease. As many a patients have already been cured with homoeopathy.
The cases which have failed to respond have usually shown the following features
1. Poor nutritional state or digestion
2. The presence of vitiligo on resistant sites like the hands and the feet, the front of wrists, the elbows, the waist and the eyelids.
3. Achromotrichetic hair in vitilignous areas
4. Age above 40
5. Irregular Treatment , as the treatment of this problem takes long time to show the effect and cure most of the time patients loose patience and stop the treatment or switch over to some other therapy while getting carried away by the gimmickry advertisements of ¡°Get rid of the ugly White Patches¡± which unfortunately turns out to be mere ads and the patients loose a good amount of money without being treated properly.
Treatment
1. A control of the etiological factors. The patient's nutritional state must be improved as far as possible. This is of particular importance when the vitiligo is active and progressively increasing.
2. In the diet cheese, butter milk, apples, figs germinating grams and bael fruit are added with benefit.
3. Patients are advised to expose themselves to sunlight in the morning.
4. In certain cases application of Baubchi oil or Psoralea Cor has helped in bringing the normal colour of the affected patches.
Allopathy - Commonest drug used is Psoralen ,Melanocyl etc to be use locally followed by sun exposure. In few cases oral Antioxidants are also being used. The latest application of Placentex is also used.UltraViolet Rays exposure or PUVA.
Ayurveda - Local application of Babchi Oil over the depigmented areas, Use of Coper utensils.
Others- Applying Coloured Dyes, Silver Nitrate etc . Latest being permanent Colouring.
Surgical measures- Grafting etc.
Homoeopathy- Offers a comprehensive treatment as it goes to the root of the problem by helping build up immunity and eventually restores the pigmented patches back to the normal skin colour. I have observed in my clinic that there are some definite connection in the patients who are being treated for Hypothyroidism then getting Hyperthyroidism show patches of leucoderma as drugs induced leucoderma. Miasmatically Syphlytic.( destruction of melanocytes) predominance
Psoric- Though in Aphorism 195, Dr.Hahnemann states that "In chronic local maladies that are not obviously veneral, the internal antipsoric treatment alone requisite" suggests that it is Psoric in nature.
Sycotic- As sycosis is the miasm which disturbs the pigment metabolism and produces hyperpigmentation and depigmentation in patches or diffuse in different parts.