case study on vitiligo

IP Indian Journal of Clinical and Experimental Dermatology

Official Publication of Khyati Education and Research Foundation

Published by IP Innovative Publication Pvt. Ltd.

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

Short Communication

Author Details : Bushra Mushtaq , Javaid Ahmad Mir * , Onaisa Aalia Mushtaq

Volume : 9, Issue : 4, Year : 2023

Online ISSN : 2581-4729

Print ISSN : 2581-4710

Article Page : 244-248

https://doi.org/10.18231/j.ijced.2023.047

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

How to cite : Mushtaq B, Mir J A, Mushtaq O A, A comprehensive case study on vitiligo: Navigating challenges and treatment strategies. IP Indian J Clin Exp Dermatol 2023;9(4):244-248

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Received : 13-11-2023

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AbbVie Evaluates Vitiligo Comorbidities Using the IHD Analytics Platform

Download the Case Study

In this case study, we examine how an AbbVie research team used Panalgo’s IHD Analytics platform to evaluate comorbidities among vitiligo patients from a large U.S. commercial claims database. Vitiligo, a chronic autoimmune disorder, is a common disorder, affecting about 1 percent of the population worldwide.

In this case study, you’ll learn:

• The background of vitiligo and purpose of the study
• The methodology used to design and conduct the study
• What results and insights were gleaned
• Why sensitivity analyses are crucial and how to conduct them properly

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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]

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New Study Defines Severity Strata for Vitiligo Using Validated Physician Global Assessment Scores

These findings may provide guidance for future international definitions of degrees of activity and repigmentation in vitiligo.

Researchers from Belgium and the Netherlands recently published a paper in a special issue of the Journal of Clinical Medicine , Prevention and Treatment of Skin Pigmentation Disorders, defining severity strata for vitiligo using validated Physician Global Assessment (PGA) scores. 1

They anticipate that the research may aid in more closely defining detailed international definitions for the interpretation of degrees of disease activity and repigmentation.

Image Credit: © Ilnur - stock.adobe.com

Background and Methods

According to study authors van Geel et al, while disease scoring and improvement methods exist in this disease state, such as the Vitiligo Disease Activity Score (VDAS15 and 60) and Vitiligo Disease Improvement Score (VDIS15 and 60), 2 there remains a need for guidance regarding the definition and interpretation of these scoring tools. By introducing stratification based on outcomes, they noted potential positive implications for future studies' inclusion criteria and clinical profiling.

They sought to evaluate both the validity and reliability of a PGA score for disease worsening and improvement while simultaneously defining activity strata for the above scales/scoring metrics based on their PGA scoring.

The study was conducted at the dermatology department of Ghent University Hospital. Clinical images were used to assess the disease activity and repigmentation in vitiligo patients. Raters independently completed the VDAS15 and 60 and VDIS15 and 60, as well as a PGA on a 5-point scale for both worsening and improvement.

The study involved clinicians from Ghent University Hospital's dermatology department, including 5 dermatology residents, one dermatologist, and one vitiligo expert. The same group conducted preliminary pilot sessions with 66 patients.

Patients of any age with non-segmental vitiligo were eligible if they had at least two clinical photo sets taken 6 (±2) or 12 (±2) months apart. Those with segmental vitiligo were excluded. Their validated PGA scores for activity and repigmentation were used as anchors to stratify the Vitiligo Extent Score (VESplus), VDAS15 and 60, and VDIS15 and 60 results.

For 34 patients, the interval between photo sets was 6 (±2) months, while for the remaining 32 patients, it was 12 (±2) months. The affected body surface area (BSA) measured by VESplus varied widely among patients, ranging from 0.01% to 36.43%, with a median VESplus of 1.3% and an average of 3.2%. The average age of participants was 37 years (median 39 years), and the average number of vitiligo-involved areas at baseline was 5.89, with a median of 6.

The study confirmed the construct validity of the PGA activity (worsening) score by verifying predefined hypotheses. The correlation between the change in affected BSA and the PGA scores for both activity and repigmentation was strong.

Additionally, very strong correlations were observed between PGA activity/repigmentation and VDAS15 or VDIS15 scores. Multiple regression analysis revealed that changes in disease extent and the number of changing locations significantly contributed to all PGA values for both worsening and improvement.

The interrater reliability of the PGA activity score had an ICC of 0.707. For the PGA repigmentation score, the ICC was 0.701. The intrarater reliability of the PGA activity score was 0.770, while the PGA repigmentation score had an ICC of 0.726.

Small changes in BSA (>0.3%) were sufficient to warrant a PGA activity score of 1. Moderate worsening (PGA = 3) corresponded to more than 27.71% increase in BSA, while much worsening (PGA = 4–5) corresponded to more than 128.75% increase. For repigmentation, an improvement of more than 0% was classified as slightly improved, and more than 4.87% as moderately improved. A PGA score of much improved corresponded to a repigmentation of more than 36.88%.

Conclusions

Potential limitations of the study, as noted by its authors, included its single center design and primary patient demographics of Fitzpatrick skin types II to III and individuals with limited BSA involvement. Severity strata differences in patient age groups may also be considered a limitation.

"The current study confirmed the construct validity and reliability of the PGA for activity (worsening) and repigmentation (improvement), as well as identified potential strata for the VESplus, VDAS15&60 and VDIS15&60," according to study authors. "These strata can be used to interpret numerical results generated by the VESplus, VDAS15&60 and VDIS15&60 and can guide treatment decisions in vitiligo management."

• van Geel N, Delbaere L, Mertens L, et al. Exploring the severity strata of disease activity and repigmentation in vitiligo based on validated Physician Global Assessment (PGA) scores. J Clin Med . 2024; 13(9):2680. https://doi.org/10.3390/jcm13092680
• van Geel, N.; Depaepe, L.; Vandaele, V.; Mertens, L.; Van Causenbroeck, J.; De Schepper, S.; Van Coile, L.; Van Reempts, A.; De Vos, A.S.; Papeleu, J.; et al. Assessing the dynamic changes in vitiligo: Reliability and validity of the Vitiligo Disease Activity Score (VDAS) and Vitiligo Disease Improvement Score (VDIS). J Eur Acad Dermatol Venereol . 2022, 36, 1334–1341.

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Mental wellbeing of patients who have Vitiligo: Tips, tricks, ways to motivate patients

V itiligo is a skin condition that causes white patches to appear on the skin due to loss of pigmentation and has a significant impact on the mental well-being of an affected individual because coming to terms with the changes in appearance, daily social ostracization, non-inclusion and the resulting sense of isolation can be emotionally draining for vitiligo patients. It is essential to acknowledge that these challenges stem from ignorance and stigma and that collective action is essential to remedy the situation.

In an interview with HT Lifestyle, Dr Vikram Vora, Medical Director at Indian Subcontinent – International SOS, shared, “There are numerous strategies to help promote self-acceptance and foster resilience in those impacted by this condition. However, these need to be credible, comprehensive and coordinated. Due to prior experiences, vitiligo sufferers may have a lesser degree of faith in people. Building trust and empathy with the affected individuals, demonstrating a genuine understanding of their experiences and acknowledging the emotional impact of living with vitiligo is a good start. Many vitiligo sufferers may have developed self-stigma about their condition and educating them is crucial to help manage their mental well-being effectively. Accurate information about causes, symptoms and available management options, along with clearing any misconceptions about the condition can alleviate their anxiety. With increased awareness and knowledge, these individuals can develop a better understanding of their condition and feel more in control.”

He highlighted, “As vitiligo impacts one’s self-esteem and body image, the development of a positive self-image can be achieved by helping them focus on their strengths and talents rather than solely their appearance. Psychologists suggest that self-compassion and reducing negative self-talk can assist in building a more realistic and positive self-perception. Acceptance of the condition can be achieved by encouraging overall well-being rather than a singular focus on physical appearance. Regular exercise, healthy eating, and engaging in hobbies or creative pursuits are self-care strategies that definitely help. Encouraging adoption of relaxation techniques and the practice of mindfulness reduces stress and anxiety and helps to challenge and counter negative thought patterns.”

According to him, having a robust support network comprising of family, friends, colleagues and managers provides a sense of belonging and support, through experience-sharing. Dr Vikram Vora revealed, “ This support can be in-person or even online via multiple available forums. Local support groups, counselling services in the community and EAPs at the workplace can also offer ways for patients to share their stories, gain insights, develop adaptive coping mechanisms and receive validation of their efforts. Empathy can create a safe space for expressing emotions and begin the healing process. Addressing the mental well-being challenges of those who have vitiligo requires an honest and empathetic approach. Keeping them away from normal social discourse and interactions is something that should not and cannot be accepted in today’s world. All sections of society need to work together, towards promoting a society that embraces diversity and inclusion. For those impacted, self-acceptance, resilience, and a positive self-image that ensures a fulfilling life, can only happen when we make this effort.”

Adding to the list of few simple methods to motivate patients with vitiligo, Dr Sushil Tahiliani, Consultant Dermatologist at PD Hinduja Hospital and Medical Research Centre in Mumbai, suggested, “Post-diagnosis, it is extremely important to normalise the disease as only the loss of colour from the body. It is crucial to establish that their bodies are healthy and because it does not affect their health, if they don't get bogged down psychologically, they can achieve goals which a lot of vitiligo patients have achieved in their life because they did not look at vitiligo as a very serious disease which should finish their aspersions and aspirations in life but rather continues to follow and achieve them. The second most important thing that I have definitely incorporated in my practice is examining the patients without gloves if not required. By touching the lesions and trying to win their confidence and reassure them about the non-contagious nature of this condition.”

He explained, “By also sharing statistics and success stories of patients being affected by vitiligo would create a sense of confidence in the patients. Translating that into figures to tell them that at least 28 million Indians must be having vitiligo - would help in reducing the feeling of being the odd one out. Additionally, inform them about the modern ways of treating vitiligo and give them guarded optimism because in good 60% odd cases, you can re-pigment them. While they are being re-pigmented, they are also given options of using camouflage creams on the open areas of the body, because it goes a long way in building confidence because when they look at the world, they can discuss what they've gone to discuss, they can study what they're going to study and the topic doesn't get diverted to vitiligo, which can be an irritant and harm the self-confidence.”

He concluded, “While also highlighting to them that in case the medicines don't work in some of the stable vitiligo cases, especially the segmental vitiligo cases, we have surgical options which work very well. And in those cases where everything fails, and they got two colours, and about 40, or 50% of the body turns white, I give them the option of removing the balance pigmentation to give them a uniform colour. Added-on tips would include protecting their skin against excessive sun exposure because they don't have melanin to protect their skin, and thus will be at a higher risk of skin ageing. The challenge is bigger if we have a child as a patient because we had to do hand holding and counselling for the parents first so that they don't cry in front of the child and they don't have drop jaws and sad faces. It's very important for the child to have encouragement and support from the parents and for the parents to keep the child happy and give the child a lot of confidence that does half the job done. The more you normalise the disease, the better it would be for those affected.”

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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:

Serum brain-derived neurotrophic factor and vitamin D: Two concordant players controlling depression among alopecia areata and vitiligo patients: A case-control study

Affiliations.

• 1 Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Shebine Elkom, Egypt.
• 2 Department of Neuropsychiatry, Faculty of Medicine, Menoufia University, Shebine Elkom, Egypt.
• 3 Department of Biochemistry, Faculty of Medicine, Menoufia University, Shebine Elkom, Egypt.
• PMID: 36999446
• DOI: 10.1111/jocd.15725

Background: Depression is a common psychiatric comorbidity among chronic dermatology patients. There is extreme lacking in the research studying biomarkers responsible for it. Both brain-derived neurotrophic factor (BDNF) and vitamin D have a significant role in the development of depression.

Aim: To assess BDNF and vitamin D serum levels in different clinical verities of alopecia areata (AA) and vitiligo patients, correlating them with depression prevalence and quality of life.

Methods: In all, 30 AA patients, 30 vitiligo patients, and 30 healthy volunteers were included. Both alopecia and vitiligo severity and activity were evaluated using the suitable clinical scores. Depression was assessed using Beck depression inventory (BDI) scale and quality of life was recorded using Dermatology Life Quality Index (DLQI). Both serum BDNF and vitamin D levels were investigated using ELISA.

Results: In both alopecia and vitiligo patients, serum BDNF and serum vitamin D were significantly lower compared to controls (p = 0.001 for both). Both were associated and negatively correlated with BDI and DLQI. Regarding alopecia, they showed a significant decline in more sever disease and with longer disease duration. However, in vitiligo, BDNF (p = 0.001) and vitamin D (p = 0.03) correlated negatively with disease activity, but not with disease severity. Serum BDNF and vitamin D correlated positively with each other (p = 0.001) in both AA and vitiligo cases.

Conclusion: The inverse association of both serum BDNF and vitamin D with depression, and the positive correlation noted between their serum levels, may indicate a potential combined effect of these two players on development of depression and its negative health-related outcomes.

Keywords: alopecia areata; brain-derived neurotrophic factor; depression; vitamin D; vitiligo.

© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

• Alopecia Areata* / complications
• Alopecia Areata* / epidemiology
• Brain-Derived Neurotrophic Factor
• Case-Control Studies
• Quality of Life
• Vitiligo* / complications
• Vitiligo* / epidemiology
• BDNF protein, human

Supplementary concepts

• Diffuse alopecia

AVITA Medical Achieves Milestone with First Case Using RECELL GO

VALENCIA, Calif., June 05, 2024 (GLOBE NEWSWIRE) — AVITA Medical, Inc. (NASDAQ: RCEL, ASX: AVH), a commercial-stage regenerative medicine company focused on first-in-class devices for wound care management and skin restoration, today announced that the Joseph M. Still Burn Center at Doctors Hospital of Augusta is the first U.S. burn center to treat a patient using its RECELL GO™ System. Recently FDA-approved, RECELL GO is a next-generation autologous cell harvesting device that harnesses the regenerative properties of a patient’s own skin to treat thermal burn wounds and full-thickness skin defects.

“Completing the first case with RECELL GO at the Joseph M. Still Burn Center is a defining moment for AVITA Medical,” said Jim Corbett, Chief Executive Officer of AVITA Medical. “Following FDA approval, our swift product deployment ensured prompt delivery to the center. The center embraced our initiative, and together with our team, their clinicians successfully completed the first case last Friday, with additional cases completed over the past three days. With the integration of RECELL GO, we believe their clinicians will be empowered to expand treatment capabilities, reaching more patients and achieving optimal outcomes, thus setting a new standard of care in wound care management. We eagerly await the success stories of patients treated at this facility in the coming months.”

AVITA Medical will continue to rollout RECELL GO to top U.S. burn treatment centers in June, while other existing accounts will be converted throughout the year. New accounts will receive RECELL GO with their first order, eliminating the need for conversion.

"As the largest U.S. burn center, we are committed to adopting technology that provides the best possible care for our patients," said Dr. Zaheed Hassan, President of Joseph M. Still Burn Centers, Inc. and Chairman of Burn Reconstruction Center of America. "By integrating RECELL GO into our hospital, we are providing our clinical staff with cutting-edge technology that allows us to focus more on our patients. Our team is proud to be the first in the U.S. to use this innovative device, and we are eager to see the positive impact it will have on our patients' lives."

RECELL technology offers clinicians and their patients a range of benefits compared to traditional skin grafting. The innovative device allows for improved healing using significantly less donor skin1, leading to reduced pain, faster closure, and enhanced aesthetic appearance.2 Additionally, patients often require fewer procedures for definitive closure and experience a reduced length of stay for burns covering less than 50% total body surface area.2,3,4

RECELL GO introduces enhanced features that streamline the preparation of Spray-On Skin™ Cells. This next-generation device significantly reduces the training burden on medical staff, improves workflow efficiency in the operating room, and controls the RECELL Enzyme™ incubation time to ensure optimal cell yield and viability. These advancements simplify the user interface, enabling medical teams to provide quality care readily and consistently to their patients.

About AVITA Medical, Inc.

AVITA Medical® is a commercial-stage regenerative medicine company transforming the standard of care in wound care management and skin restoration with innovative devices. At the forefront of our platform is the RECELL® System, approved by the U.S. Food and Drug Administration for the treatment of thermal burn wounds and full-thickness skin defects, and for repigmentation of stable depigmented vitiligo lesions. RECELL harnesses the regenerative properties of a patient’s own skin to create Spray-On Skin™ Cells, delivering a transformative solution at the point-of-care. This breakthrough technology serves as the catalyst for a new treatment paradigm enabling improved clinical outcomes. AVITA Medical also holds the exclusive rights to market, sell, and distribute PermeaDerm®, a biosynthetic wound matrix, in the United States.

In international markets, the RECELL System is approved to promote skin healing in a wide range of applications including burns, full-thickness skin defects, and vitiligo. The RECELL System is TGA-registered in Australia, has received CE-mark approval in Europe and has PMDA approval in Japan.

To learn more, visit www.avitamedical.com.

Forward-Looking Statements

Statements in this announcement may contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Such forward-looking statements are subject to significant risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. Forward-looking statements generally may be identified by the use of words such as “anticipate,” “expect,” “intend,” “could,” “may,” “will,” “believe,” “estimate,” “look forward,” “forecast,” “goal,” “target,” “project,” “continue,” “outlook,” “guidance,” “future,” and similar words or expressions, and the use of future dates. Forward-looking statements in this announcement include but are not limited to statements concerning our product development activities, regulatory approval of our products, the potential for future growth of our business, and our ability to achieve financial goals. These statements are made as of the date of this announcement, and the Company undertakes no obligation to publicly update or revise any of these statements, except as required by law. For additional information and other important factors that may cause actual results to differ materially from forward-looking statements, please see the “Risk Factors” section of the Company’s latest Annual Report on Form 10-K and other publicly available filings for a discussion of these and other risks and uncertainties.

Authorized for release by the Chief Financial Officer of AVITA Medical, Inc.

1 Instructions for Use. RECELL® Autologous Cell Harvesting Device.

2 Holmes JH, Molnar JA, Carter JE, et al. A comparative study of the RECELL® device and autologous split-thickness meshed skin graft in the treatment of acute burn injuries. J Burn Care Res . 2018;39(5):694-702.

3 Kowal S, Kruger E, Bilir P, et al. Cost effectiveness of the use of autologous cell harvesting device compared to standard of care for treatment of severe burns in the United States. Adv Ther. Published online May 7, 2019. doi:10.1007/s12325-019-00961-2.

4 Holmes JH, Molnar JA, Carter JE, et al. A comparative study of the RECELL® device and autologous split-thickness meshed skin graft in the treatment of acute burn injuries. J Burn Care Res. 2018;39(5):694-702.

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