Vitiligo (Shwitra Kushta)

तव्दोतेनमण्डलमरुणंपरुषंपरिध्वंसिच।
पित्तेनपध्मपत्रप्रतीकाशंसपरिदाहंच,
श्लेष्मणाश्वेतंस्निग्धंबहलंकणडूमच्च॥ (सु.नि.५/१७) ॥

What Is Vitiligo

Vitiligo is an acquired skin ailment characterized clinically by totally chalk white round or oval or elongated shaped with convex margins “macules, or “spots,” due to total absence of pigment producing cells in the skin called melanocytes.

 

Melanocytes are the skin pigmentation cells, which produces melanin which gives color and protects the skin from harmful sunrays. The mechanism involves progressive destruction of selected melanocytes cells, probably by cytotoxic T-cell lymphocytes.

Who Gets Vitiligo

The condition is not life-threatening and non infectious. Vitiligo is a long-term disease and appears to affect at least 1% to 2% of the population, of any age (usually appears before age 30), gender or ethnic group (more noticeable in people with darker skinned).

 

At birth, a few cases are reported of vitiligo. Rarely there is sign of vitiligo in old age also. Over 30% of affected individuals may report a positive family inheritance.

Ayurvedic reference of Vitiligo-Shwitra Kushta

Classification of Vitiligo

Vitiligo can be classified on clinical grounds and based on the pattern of depigmentation and is of three types:

Generalized Vitiligo

This is most common type, in which there is widespread distribution of white spots, often in a remarkably symmetrical array. Extensive generalized vitiligo also referred as “Vitiligo Universalis“ is complete loss of pigmentation of skin, the largest body part.

Focal Type Vitiligo

The focal type is characterized by one or more macules on a single site; in some cases, this may be an early evolutionary stage of one of the other forms of the disease. Typical spots occur in the fingers, elbows, knees, lower back, and genital area.

Segmental Vitiligo

This is uncommon type, is characterized by one of several spots on one side of the body and the affected part of skin area doesn’t expand with time and no new vitiligo spots appear.

Causes of Vitiligo

Both genetic (predisposing) and environmental  (precipitating) factors contribute to vitiligo. Some are:

  • Autoimmune condition.
  • Family history (heredity).
  • A psychological factor, such as emotional stress.
  • Severe sunburn may precipitate vitiligo.
  • Skin trauma, such as contact with a chemical.
  • People suffering from health ailments like thyroid disease and diabetes mellitus have more risk for development of vitiligo.

Symptoms of Vitiligo

Vitiligo signs include:

  • Patchy loss of skin color, which usually first appears on the hands, face, and areas around body openings and the genitals.
  • Premature whitening or graying of the hair on your eyelashes, eyebrows, beard, or scalp.
  • Loss of color in the tissues (mucous membranes) that line the inside of your mouth and nose.

“All white patches which look like Vitiligo is a great misconception. The main aim of an intuitive practitioner is to reach the accurate diagnosis first before seeking any medical aid”. 

 

-Allergist, Dr. Sahil Gupta

Bachelor of Ayurveda Medicine & Surgery
Master’s in Health Administration

NOT ALL WHITE SPOTS ARE VITILIGO

Few health concerns are as patterned and identical as vitiligo. The accurate diagnosis of Vitiligo can be made on clinical examination and history of a patient. Woods light examination is done by a medical practitioner to examine all the spots. Sometime the patches match on both extremities in a mirror-image. Differential diagnosis is to be made with following diseases:

 

Lupus erythematosus, Pityriasis alba, Piebaldism, Tinea versicolor, Chemical leukoderma and Post-inflammatory hypomelanosis.

  • Lupus erythematosus
  • Pityriasis alba
  • Piebaldism
  • Tinea versicolor
  • Chemical leukoderma
  • Post-inflammatory hypomelanosis

Ayurvedic Concepts of Vitiligo (Shwitra Kushta)

Shwitra is a disease described under the heading of Kushta by ancient Ayurveda Scholars. In Shwitra, Dhatus (Body Tissues) like Rakta (Blood), Mansa (Muscle Tissues) and Meda (Fat Tissue) are involved with Tridosha (3 Life Forces) to produce white patches or pale-yellow spots on the skin. Shwitra can be correlated with Leukoderma, which is a common skin disorder.

 

Shwitra is not a major disease or physical condition. Depression is often observed in these patients because of white patches on the skin. The disease also creates disturbance to personal and social life.

Diagnosis of Vitiligo (Shwitra Kushta) As Per Ayurveda

In IAFA vitiligo is understood and diagnosed by Nidan Panchak.

Causes of Vitiligo (Shwitra Kushta) as per Ayurveda:  Causative factor of the disease is called as Nidan.

  • Virudha Aahar (wrong food combinations).
  • Vegvidharana (suppression of natural urges. e.g. vomiting).
  • Atibhojana (consuming excess food).
  • Intake of atyamala (sour), lavana (salty), madhur (sweat) and pungent food excessively.
  • Intake of navinanna (heavy intake of freshly harvested grains), dahi (curd), atimansahar (excess meat eating).

Predominant Symptoms of Vitiligo (Shwitra Kushta) as per Ayurveda: Before the disease occurs, some symptoms are developed by the body are called Poorvarupa. It can help in diagnosis.

  • Excess or absence of perspiration.
  • Discolored patches on the Skin.
  • Itching, pricking, pain, erection of skin hair, physical exhaustion, mental fatigue.

Signs of Vitiligo (Shwitra Kushta)as per Ayurveda: Signs of the disease is called Rupa.

  • Daruna– When Dosha vitiliates the Rakta Dhatu (Blood), the patches will be red in colour.
  • Aruna– When Dosha vitiliates the Mansa Dhatu (Muscle Tissue), the patches will be copper in colour.
  • Kilasa– When Dosha vitiliates the Meda Dhatu (Fat Tissue), the patches will be white in colour. This is the most common Rupa of Shwitra hence it is also called Kilasa.

Upshyay: To rule of disease whose manifestation don’t clear Upshyay can be used. It helps in proper diagnosis.

 

Stages of Formation of Vitiligo (Shwitra Kushta) as per Ayurveda: Stages of Formation of disease is known as Samprapti.

 

All three Doshas (Vata,Pitta,Kapha i.e. Life Forces) gets aggravated with Dhatus (Body Tissue) like Rasa, Rakta (Blood), Mansa (Muscle), Meda (Fat) and results in white patches on the skin.

Diet Management of Vitiligo (Shwitra Kushta) As Per Ayurveda

As per Dominance of Dosha (Life Force),

Pathya (Dos)

  • Consume old food grains, green gram, laghu (light food), patola (bitter gourd).
  • Take 200ml lauki juice with mentha (pudina) 5 leaves, ocimum (tulsi) 2 leaves and a pinch of black pepper (kaali mirch) in the morning if possible.
  • Drink water early in the morning placed in copper vessel at night.
  • Drink Wheat Grass Juice If possible.
  • Drink pomegranate juices if possible.

Apathya (Don’t s)

  • Virudha aahar (wrong food combinations).
  • Guru (heavy food), vidahi (spicy and pungent), vistambhi (food which creates constipation), kanda-moola (roots), masha (black gram).
  • Amla, katu, lavana ras (avoid sour, pungent and salty food items).
  • Excessive consumption of anupa mansa (aquatic animals).
  • Donot take these dals- urad and kulthi.
  • Seasame, jaggery (gur), fine flour (maida products).
  • Vegetables like- brinjal, muli, capsicum, mushroom, ladyfinger, lemon, tomato and garlic.
  • Dahi and dairy products/milk preparation including sweets that includes milk.
  • Use black pepper instead of red chillies.
  • Avoid fast and junk food completely.
  • Green tea if possible avoids coffee and chemically prepared teas.
  • Avoid fruits like oranges, melons, pears, blueberries, guava prunes and grapes.
  • Aviods nut like cashew, almonds, pistachio and peanuts.

Lifestyle Improvement In Vitiligo (Shwitra Kushta) As Per Ayurveda

  • Avoid day time sleep after lunch.
  • Use chemical free products for skin.
  • Regular meditation, exercise and yoga.
  • Avoid late night awakenings.
  • Protect skin from harmful UV sun rays.

Yoga And Asanas In Vitiligo (Shwitra Kushta)

Yoga detoxifies mind, soul and the body.

  • Nadishodhana Pranayama
  • Bhramari Pranayama
  • Sitkari Pranayama
  • Kapalbhati
  • Shavasana

Ayurvedic Treatment for Vitiligo

In Switra roga, all three types of treatment i.e. The principal of treatment is threefold in Ayurveda as Nidana Parivarjana (removing the cause of disease), Apakarshana (Sodana therapy) and Prakriti Vighata (palliative /Samana therapy) are to be followed while treating. Selection of any of them depends upon Roga Bala, Rogi Bala, Kala, Vaya, Agni, And vyadhi Avastha etc. When the morbid Dosha are more potent, the patient should be treated with Shodhana. Long term course of treatment is needed to eliminate vitiated Dosha and brings doshas to equilibrium. The patient with Switra requires quick approach towards management, because it becomes Asadhya (difficult to treat) very quickly.

Internal Medications for Vitiligo

  • Panchatiktaguggulu ghrita
  • Tiktaka ghrita
  • Mahatiktaka ghrita
  • Arogyavardhini
  • Krimikutara rasa
  • Bakuchi rasayana
  • Manibadragula
  • Switrahara churna
  • Marichaditaila

  • Jatyadi Ghrita
  • Mahamarkava Ghrita
  • Mahaneela Ghrita
  • Maha vajraka Ghrita
  • Neelaka Ghrita
  • Neeli Ghrita
  • Kanakabindvarista
  • Madhwasava

External medicines for Vitiligo

  • Aragwadhayadya Thaila
  • Citrakadya Thaila
  • Jyotishmati Thaila
  • Laghu maricadya Thaila

  • Maha Vajraka Thaila
  • Manasiladya Thaila
  • Maricadya Thaila
  • Visha Thaila

Single herbs used in Vitiligo as per Ayurveda

  • Bakuchi (Psoralia corylifolia)
  • Maricha (Piper nigrum)
  • Markava (Eclipta prostrata)

  • Khadira (Acacia catechu)
  • Jyotishmati (Cilantros panniculitis)

Article Written By: Dr. Sahil Gupta, Ayurvedic Allergist

Frequently Asked Questions

Question: Can Ayurveda cure vitiligo?

Answer: Frankly, vitiligo is not high on Ayurveda list. Ancient people have used herbs and natural remedies to treat chronic, metabolic, and stress-related conditions in past centuries. The primary principle is on disease prevention and promoting longevity. Traditional treatment for vitiligo in India begins with calming the imbalanced doshas (body energies) and restoring digestion.

Question: How long it will take to treat vitiligo from ayurveda?

Answer: Treatment prognosis will vary by person to person and type of vitiligo. Thumb rule is that you will need to follow up at least 4 to 6 months continuosly before you begin to see first positive pigmentation from IAFA treatment, and you may expect satisfactory results within 12-18 months.

Question: What necessary investigations are in vitiligo?

Answer: Vitiligo diagnosis is confirmed by physical examination method like skin analysis under woods lamp. But to rule out some associated health disorders and nutritional deficiency is also beneficial in result oriented medical treatment. These are:

  • Autoantibodies to be ruled out [Anti-nuclear antibody (ANA), Anti-Thyroid Peroxidase Antibody (ATPO), Anti-Parietal Gastric Cell Antibody (APGC), Anti-Thyroglobulin Antibody (ATG)]
  • Basal Glycaemia level may be Elevated.
  • Vitamin B12 serum levels may be decreased in vitiligo patients.
  •  Folic Acid serum levels may be decreased in vitiligo patients.
  • Thyroid Function may be disturbed.

Question: Is vitiligo curable at early stages?

Answer: Early disease manifestation is always helpful, before extensive tissue and organ damage has occurred. Treatment might stop or slow the discolouring process. Vitiligo is curable when:

  • The hair color on the patches is not white
  • The patches are in less number
  • The patches are not interlinked with each other
  • The patches have recently occurred

Question: What are the side effects of oral and topical steroids in vitiligo?

Answer: long term steroids can suppress the immune system and reduce the signs and symptoms of many conditions. But these drugs also carry a risk of serious side effects. Side effects of oral steroids:

  • Increased risk of infections with common bacterial, viral and fungal microorganisms
  • Cataracts (clouding of the lens)
  • Glaucoma (elevated pressure in the eyes)
  • Fluid retention (causing swelling in your legs and arms)
  • Thinning bones (osteoporosis) and fractures
  • High blood pressure
  • High sugar levels (a concern for people with diabetes)
  • Psychological effects, such as confusion or delirium, mood swings, memory fluctuations,
  • Fatique, loss of appetite, nausea and muscle weakness
  • Weight gain, with fat deposits in your abdomen, face and the back of your neck.

Side effects of topical steroids:

  • Increased risk of infections on skin with common bacterial, viral and fungal microorganisms
  • Acne
  • Skin thinning
  • Bruising and slower wound healing
  • Red skin lesions
  • Facial flusing
  • Insomnia

Question: Does Leukoderma shorten your life?

Answer: No. Leukoderma is not a major life-threatening condition.

Question: Is there is any difference between Vitiligo and Leukoderma?

Answer: Vitiligo and leucoderma are both characterized by white patches over the skin. Although both vitiligo and leucoderma have different onset, the line of treatment for both remains the same. Due to similar characteristic and treatment plan leucoderma is a form of vitiligo.

Question: Shall I take vitamin D for my vitiligo?

Answer: Consuming 1,000–4,000 IU (25–100 mcg) of vitamin D3 daily in the prevention of different inflammatory and chronic diseases like vitiligo generally recommended so that people with vitiligo keep their vitamin D levels in the mid-upper range of normal.

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