NHR Apr-Sept 2019: Vitiligo of long standing and its successful homoeopathic treatment: A case report

Vitiligo of long standing and its successful homoeopathic treatment: A case report


Satarupa Sadhukhan*1, Eiphrangdaka L.Suchiang2, Shabana Yeasmin3

  1. Post Graduate Trainee, Dept. of Organon of Medicine, National Institute of Homoeopathy, Kolkata
  2. Post Graduate Trainee, Dept. of Practice of Medicine, National Institute of Homoeopathy, Kolkata
  3. Former Post Graduate Trainee, Dept. of Practice of Medicine, National Institute of Homoeopathy, Kolkata

*Correspondence: satarupadrsadhukhan@hotmail.com


ABSTRACT

Vitiligo is one of the causes of Hypo pigmentation. This is an acquired disease with progressive nature. Diseases of thyroid gland occur up to 30% of patients with vitiligo. This is a case of 53 years old, Hindu male, who is suffering from vitiligo in both the legs, for last 20 years. After being treated by individualized homoeopathic medicine, Lachesis in 50-millesimal potencies for about 20 months, marked recovery has ensued. Assessment with Modified Naranjo Criteria suggests a definite association between the medicine and the outcome. The patient has visited for the last time on Dec 19, 2018, complete cure is expected if treatment is continued.

Keywords: Case Report, Homoeopathy, Modified Naranjo Criteria, Vitiligo


INTRODUCTION

Vitiligo is one of the several causes of Hypo pigmentation. It may be generalized or localized. The differential diagnosis of localized hypomelanosis includes idiopathic guttate hypomelanosis, postinflammatory Hypo pigmentation, tinea (pityriasis) versicolor, vitiligo, chemical- or drug-induced leukoderma, nevus depigmentosus, piebaldism. Patients with vitiligo also have an increased incidence of several autoimmune disorders, including Hashimoto’s thyroiditis, Grave’s disease, pernicious anaemia, Addison’s disease, uveitis, alopecia areata, chronic mucocutaneous candidiasis, and the autoimmune polyendocrine syndromes (types I and II). Diseases of the thyroid gland are the most frequently associated disorders, occurring in up to 30% of patients with vitiligo. Vitiligo being an acquired disorder, is progressive in nature. Clinical features include symmetric areas of complete pigment loss. Commonly affected areas are around mouth, nose, eyes, nipples, umbilicus, anus, flexor wrists, extensor distal extremities.[1] In homoeopathy, the diseases, which display only one or two principal symptoms obscuring almost all others, are termed as one-sided disease.[2] The following case is also showing one principal symptom, thus belonging to the family of one-sided disease, and definitely to the class of chronic diseases. Proper investigation revealed some lesser accessory symptoms [2], which proved to be very useful in determining the choice of the remedy. The indicated medicine was given in proper small, gradually higher doses, each somewhat with renewed dynamization.[2] A case series[3] was published in the year 2017, where 14 patients with vitiligo was treated with individualized homeopathy. The best results were achieved in the patients who were treated in the early stages of the disease. Author has suggested large controlled clinical studies in this area.

 

CASE PROPER

A male patient, aged 53 years, residing at New Town, West Bengal came to the out-patient department of National Institute of Homoeopathy on April 25, 2017 (OPD No. 154215/17) with complaints of hypopigmented spots at both legs for last 20 years associated with itching of the affected parts that have a sensation of burning on scratching. The patient could not narrate proper history of the presenting complaint except that they appeared initially at the lower part of left leg. He also complained of pain at left arm – tingling of 2nd, 3rd, and 4th fingers when lying, feels better on lying on soft mattress. He was suffering from this complaint for last 5 years.

Past Illness:

Nephrotic syndrome 3 years before, treated by Allopathic medicines, and currently he is not having any symptom of nephrotic syndrome.

Hypothyroidism for last 3 years, Allopathic medicines was discontinued for last 1 and ½ years, by him.

Family History:

  • Mother: Had Jaundice, Ca(?)
  • Father: Vitiligo
  • Paternal Uncle: DM
  • Brother: DM, renal complaint, vitiligo

Personal History:

  • Married
  • Having one son, aged seven years
  • Irregular diet habit

Physical General:

  • General modalities – Prefers winter
  • Appetite – good
  • Desire – nothing as such
  • Thirst – good
  • Sweat – profuse, more at head and face
  • Stool – passes daily, satisfactory
  • Urine – clear
  • Sleep – satisfactory, sleep of 3-4 hours is sufficient
  • In the past, he used to have dreams of water bodies, and of some religious events

Mental General:

  • Desire loose clothing
  • Desire to be alone

Totality of symptoms:

  • Desire to be alone
  • Desire loose clothing
  • Profuse sweat at head and face
  • Sleep for 3-4 Hours/Day is adequate
  • White coated tongue

Clinical Examination:

          Tongue: White coated

(30.05.2017 – Photograph was taken on the second visit for the first time)

Table 1: Follow-up of the case

Date/ Visit No. Alteration in the Existing Complaint New (N) or Reappearance of Old (O) Symptoms Laboratory Investiga-tions Prescription
25th Apr 2017/ First Lachesis 0/1; 16 doses; OD; 16 days,

followed by

Lachesis 0/2; 16 doses; OD; 16 days

30th May 2017/ Second

 

Frequency of itching was lessened, though intensity being the same.

Tongue was moist and clean.

In this period he had frequent dreams of water bodies. Lachesis 0/3; 16 doses; OD; 16 days,

followed by

Lachesis 0/4; 16 doses; OD; 16 days

4th Jul 2017/ Third

 

Itching is better, aggravates when exposed to sweat and warmth.

No more dream of water bodies in this period.

Lachesis 0/5; 16 doses; OD; 16 days,

followed by

Lachesis 0/6; 16 doses; OD; 16 days

5th Sep 2017/ Fourth Itching is lessened further.

Spots reduced in size.

Tingling of arms and fingers subsided.

Lachesis 0/7; 16 doses; OD; 16 days,

followed by

Lachesis 0/8; 16 doses; OD; 16 days

16th Oct 2017/ Fifth Areas of hypo pigmentation and itching lessened further. Miliaria-like eruption all over the body, with itching. TSH: 10.80 μIU/ml Lachesis 0/9; 16 doses; OD; 16 days,

followed by

Lachesis 0/10; 16 doses; OD; 16 days

24th Nov 2017/ Sixth No burning sensation anymore,

Itching remaining by 20%. Miliria-like eruptions are better.

Lachesis 0/11; 16 doses; OD; 16 days,

followed by

Lachesis 0/12; 16 doses; OD; 16 days

4th Jan 2018/ Seventh No itching of the parts, no redness.

.

Occasional gum-bleeding. Teeth sensitive to food particles. Lachesis 0/13; 16 doses; OD; 16 days, followed by

Lachesis 0/14; 16 doses; OD; 16 days

14th Mar 2018/ Eighth Further reduction in size of the hypopigmented spots.

No more gum-bleeding.

Lachesis 0/15; 16 doses; OD; 16 days, followed by

Lachesis 0/16; 16 doses; OD; 16 days

21st Jun 2018/ Ninth Hypo pigmentation is better. Itching all over the body, without any eruption. Lachesis 0/17; 16 doses; AD,

followed by

Lachesis 0/18; 16 doses; AD

25th Sep 2018/ Tenth Hypo pigmentation is better. Lachesis 0/19; 16 doses; AD,

followed by

Lachesis 0/20; 16 doses; AD

19th Dec 2018/ Eleventh Hypo pigmentation is better. TSH: 19.1 μIU/ml Lachesis 0/21; 16 doses; Once in three days

 Table 2: Photographs in different timeline

S. No. Items Yes No Not sure /NA
1. Was there an improvement in the main symptom or condition for which the homoeopathic medicine was prescribed? +2
2. Did the clinical improvement occur within a plausible time frame relative to the drug intake? +1
3. Was there an initial aggravation of symptom? 0
4. Did the effect encompass more than the main symptom or condition, i.e., were other symptoms ultimately improved or changed? +1
5. Did overall wellbeing improve? +1
6. Did the course of improvement follow Hering’s Rule? +1
7. Did old symptoms (non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement? 0
8. Are there alternate causes (other than the medicine) that-with a high probability could have caused the improvement? (e.g. known course of disease, other forms of treatment and other clinically relevant intervention) +1
9. Was the effect confirmed by objective evidence as measured by external observation(s)? +2
10. Did repeat dosing, if conducted, create similar clinical improvement? 0

Table 3: Assessment by Modified Naranjo score

The final causal attribution score in this case was assessed using the Modified Naranjo Criteria, as proposed by the HPUS Clinical data Working Group, June 2014[4]. The total score was 9, thus suggesting a ‘definite’ association between the medicine and the outcome [definite: ≥ 9; probable 5-8; possible 1-4; and doubtful ≤ 0]. Reporting of this case adhered to the Hom-CASE-CARE guidelines [5].

DISCUSSION

Diseases of the thyroid gland are the most frequently associated disorders, occurring in up to 30% of patients with vitiligo. The patient described in this case is also suffering from hypothyroidism for last 3 years, Allopathic medicines was discontinued for last 1 and ½ years, by him. This information came to the light in the 4th visit, and in the 5th visit, the patient came with the report TSH: 10.80 μIU/ml. His old symptoms (non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement. Like, he used to dream of water bodies in the past, which was reappeared in the initial one month of the treatment (Table 1). In the last picture in Table 2, we can see the hypopigmented spots are almost confined to the lower part of left leg. The patient has informed that, this was the specified spot, where the hypo pigmentation had started to appear (in the reverse direction of spread of the symptom). During the period of treatment, the patient has experienced “itching” twice, first one along with “Miliaria-like eruption” and the other one being without any such eruptions. After assessing the case according to modified Naranjo score (Table 3), we can find a ‘definite’ association between the medicine and the outcome. The patient though otherwise better, had developed itching all over the body, therefore the repetition of the medicine was made more infrequent, i.e., the patient was asked to take on alternate days. On the eleventh

visit, i.e., almost 14 months after the fifth visit, his TSH levels have elevated (TSH: 19.1 μIU/ml). So, the patient was advised to take the medicine at an interval of two days. Again, as this parameter is elevated, we can assume that old symptom is reappearing in the course of treatment. But, whether it is merely temporary in nature or need thorough and further treatment, which could only be answered after a few more visits. We, the homoeopathic practitioners base our expectation that a medicine will work on the experience that specific symptoms of the patient indicate specific medicines. This principle is having a strong mathematical foundation in Bayes’ theorem, identifies homoeopathic symptoms as prognostic factors, and offers an interesting perspective of individualized research. We can therefore focus more on prognostic factor researches [6].

CONCLUSION

The patient was suffering for almost 20 years. After 20 months of treatment marked recovery has been seen in this case. When the case was assessed as per modified Naranjo criteria, ‘definite’ association between the medicine and the outcome has been found. New practitioners should save all possible sorts of records or reports related to the case in hand. This can provide confidence to them. Sufficient and carefully accumulated data can be extended to evidence-based research later.

REFERENCES

  1. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison‟s Principles of Internal Medicine; 19th Edition; Vol I; Mc Graw Hill Education; 2015; 357-358
  2. Hahnemann S. Organon of Medicine; Indian Books & Periodicals Publishers; New Delhi; 2006; 108-132
  3. Mahesh, Seema & Mallappa, Mahesh & Tsintzas, Dionysis & Vithoulkas, George. Homeopathic Treatment of Vitiligo: A Report of Fourteen Cases; American Journal of Case Reports; 2017; 18. 1276-1283. 10.12659/AJCR.905340.
  4. Rutten L. Data collection: Treat every variable as a treasure. Homeopathy. 2015;104(3):190-196.
  5. Van Haselen RA. Development of a supplement
  6. (HOM-CASE) to the CARE clinical case reporting guideline. Complement Ther Med. 2016; 25:78-85.

Rutten L. Prognostic factor research in Homoeopathy. Indian J Res Homoeopathy 2016;10:59‑65. DOI: 10.4103/0974-7168.179143

Cite this article as: Sadhukhan S, Suchiang EL, Yeasmin S. Vitiligo of long standing and its successful homoeopathic treatment: A case report. National Homoeo Recorder 2019; 15(2,3):

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