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Dissertation Leucoderma
Dissertation Leucoderma
ON
LEUCODERMA
BATCH: 2003
CERTIFICATE
1. INTRODUCTION
2. AIMS AND OBJECTIVES
3. REVIEW OF LITERATURE
A. Skin components
B. Functions
C. Skin types
D. Skin layers
E. Pigmentation of skin
F. Skin tone variability
G. Genetics of skin colour variation
4. EPIDEMOLOGY AND GENETICS
5. CLINICAL COURCE AND PROGNOSIS
6. MATERIAL AND METHODS OF INVESTIGATION
7. MEDICAL AND SURGICAL THERAPIES
8. DISCUSSION: MIASMATIC EVOLUTION
9. HOMOEOPATHIC APPROACH FOR THE TREATMENT
10.HOMOEOPATHIC THERAPEUTICS
11.AUXILLARY TREATMENT
12.BIBLIOGRAPHY
13.ANNEXURES
A. Case Proforma
B. Graphics
C. Master Charts
D. Synopsis of Cases
INTRODUCTION:
The skin is the outer covering of the body, also known as the
epidermis, of an animal.It is the largest organ of the
integument system made up of multiple layers of epithelial
tissues, and guards the underlying muscles, bones, ligaments,
internal organs. The adjective cutaneous literally means "of
the skin" (from Latin cutis, skin).
Skin types
Skin layers
1.EPIDERMIS
Components
Layers
Sublayers
Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum germinativum (also called "stratum basale")
2.DERMIS
3.Mast cells which contain the mast cell granules and can
release histamine and several other substances with potent
biologic functions. These cells have a role in inflammatory,
immunologic and repair mechanisms.
Reticular region
3.HYPODERMIS
The hypodermis is not part of the skin, and lies below the
dermis. Its purpose is to attach the skin to underlying bone
and muscle as well as supplying it with blood vessels and
nerves. It consists of loose connective tissue and elastin. The
main cell types are fibroblasts, macrophages and adipocytes
(the hypodermis contains 50% of body fat). Fat serves as
padding and insulation for the body.
2.Oxyhemoglobin(red)
4.Melanin (brown)
The tone of human skin can vary from a dark brown to nearly
a colorless pigmentation, which may appear reddish due to
the blood in the skin. Europeans generally have lighter skin,
hair, and eyes than any other group on Earth, although this is
not always the case. For practical purposes, such as exposure
time for sun tanning, six skin types are distinguished following
Fitzpatrick (1975), listed in decreasing lightness.
Von
Tanning Hair and eye
Type Also called Luschan
behavior color
scale
Tends to have
freckles, red
Very light, also Often burns,
I or blond hair, 1-5
"Nordic" rarely tans.
blue or green
eyes.
II Light, or light- Usually Tends to have 6-10
burns, light hair,
skinned European sometimes blue/green or
tans brown eyes.
Light intermediate,
or dark-skinned Sometimes Tends to have
III European or burns, brown hair 11-15
"average usually tans. and eyes.
Caucasian"
Dark intermediate,
Sometimes Tends to have
also
IV burns, often dark brown 16-20
"Mediterranean" or
tans. eyes and hair.
"Olive"
Naturally Often has
Dark or "Brown"
V black-brown dark brown 21-28
type
skin eyes and hair.
Naturally Usually has
Very dark, or
VI black-brown black-brown 29-36
"Black" type
skin eyes and hair.
PATHOGENESIS-
2.Uveitis.
3.Sun sensitivity.
ACROFACIAL LEUCODERMA
ACROFACIAL LEUCODERMA
GENERALISED PATTERN LEUCODERMA
GENERALISED PATTERN LEUCODERMA
Prognostic factors
Leucotrichia.
Acrofacial lesions.
3.Lichen Planus
4. Lichen sclerosus
5. Psoriasis
6. Halo Naevus
7.Ichthyosis
3. Pernicious Anemia
4.Addison's Disease
5. Collagen Diseases
6.Grave's Disease
7. Diabetes Mellitus
Diagnosis
LABORATORY EXAMINATIONS
Disease mechanism
S L L Y Q
S H L Y Q
Treatment
Surgical therapies
All surgical therapies must be considered only after proper
medical therapy is provided. Surgical techniques are time-
consuming and expensive and usually not paid for by
insurance carriers. They are appropriate only for carefully
selected patients who have vitiligo that has been stable for at
least 3 years.
Melanocyte transplantation
Tattooing
MIASMATIC EVOLUTION:
2.Therapeutic medicine.
Endogenous factor
Exogenous factor
3.Leucophlegmatic constitution-Catarrhal,flabby,water-
bagged constitution, with pale loose skin,sluggish in all
movements and activities,chilly and susceptible to cold.
(e)Miasm
(f)Diathesis
(h)Addiction,habits etc.
HOMOEOPATHIC THERAPEUTICS:
AUXILLARY TREATMENT:
BIBLIOGRAPHY
5. Hahnemann,Organon of Medicine
8. Allen’s keynotes
CASE PROFORMA
ACUTE/CHRONIC:……………………………………
IPD/WARD NO.:………..
RESIDENT/STUDENT:……………………………….
DOA…………
DOD…………
PATIENT’S NAME:……………………………………
AGE/SEX/RELIGION:……………………………
ADDRESS:………………………………………..
OCCUPATION:……………………………………………………
MARITAL STATUS:
……………………………………………………………
DIAGNOSIS CONSTITUTION
PROVISIONAL D……………………………
…………………………………………..
MIASMATIC D……………………………
…………………………………………..
THERAPEUTIC D…………………………… .
…………………………………………
FINAL D………………………….. ..
……………………………………….
CLINICAL HISTORY
CHIEF COMPLAINTS(including
causation,duration,location,character,sensation, extension or
radiation,modalities and concomitant)
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………
PHYSICAL EXAMINATION
GENERAL EXAMINATION
A. 1.Inspection……………………………………………………
………………..
2.Palpation……………………………………………………
…………………
3.Percussion…………………………………………………
…………………..
4.Auscultation…………………………………………………
………………...
B. Pulse……………..B.P………………Tempt……………………..
R.R……………..
Pallor……………. Cyanosis………...Oedema ………………….
Anaemia……….
SYSTEMIC REVIEW
GENERAL: (weight,height,gait)
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
Eye………………
Conjunctiva…………………….Pupil…………….Vision…………
….
Oral cavity (mouth,gums,teeth,tongue,throat)
……………………………………………...
Ear (pain,discharge,hearing,sound)
…………………………………………………………
………………………………………………………………………
………………………
GIT,ABDOMEN,PELVIS……………………………………………
………………………………………………………………………
………………………………………………………………………
……………………………………………………………………
UPPER ALIMENTARY TRACT(pain,vomiting,flatulence,water
brash,heart burn, dysphagia)
………………………………………………………………………
………………………………………………………………………
……………………………….
LOWER ALIMENTARY
TRACT(stool,diarrhea,constipation,pain,etc)
………………………………………………………………………
………………………………………………………………………
………………………………………………
LIVER AND GALL BLADDER(jaundice,pain,calculi)
………………………………………………………………………
………………………………………………………………………
………………………………………………
GENITAL SYSTEM
MALE(spermatorrhoea,urethral discharge,s.t.d.s,sexual
behaviour,secondary sex characters)
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
…………………………………………………………
FEMALE(vaginal discharge,s.t.d.s,sexual behaviour,secondary sex
characters)
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
CVS(dysponea,pain,palpation,cough,oedema,etc)
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
…………………
BLOOD(lassitude,infections,blood loss,etc)…
………………………………………………………………………
………………………
………………………………………………………………………
………………………
ENDOCRINE
SYSTEM……………………………………………………………
………
………………………………………………………………………
………………………
RESPIRATORY
UPPER RESPIRATORY LOWER
RESPIRATORY
NASOPHARYNGEAL CAVITY
NASAL DISCHARGE COUGH
Acrid/Bland Colour
Colour Consistency
Thick/Thin Odour
Smell Taste
Sneezing Characters
BREATHING
WHEEZE
CHEST PAIN
URINARY SYSTEM(pain,micturition,colour,smell)
………………………………………………………………………
………………………………………………………………………
………………………………………………
NERVOUS SYSTEM(reflexes,fits,strokes,gait,power)
………………………………………………………………………
………………………………………………………………………
………………………………………………
LOCOMOTOR SYSTEM(pain,articular affection,gait etc)
………………………………………………………………………
………………………………………………………………………
………………………………………………
SKIN
APPEARANCE……………………………….
ITCHING………………………
DISCOLOURATION…………………………
SUPPRESSION………………..
ERUPTIONS………………………………….
ULCERATIONS…………………
DISCHARGE………………………………… WARTS OR
MOLES……………
OBSTETRIC/GYANIC HISTORY
MENSTRUAL HISTORY
Menarche………………………………Duration
/cycle………………Flow……………..
Dysmen………………………………...L.M.P………………………
..E.D.D…………….
FAMILY HISTORY
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
SOCIAL STATUS…………………………………..
NUTRITIONAL STATUS………………………….
GENERAL SYMPTOMS
PHYSICAL GENERALS
Appetite
Thirst
Desires
Aversions
Sleep
Dreams
Perspiration
MENTAL GENERALS
WILL(love,hate,emotion,perversion)………………………………
UNDERSTANDING(delusion,hallucination, illusion)…………….
INTELLECT(memory,concentration)……………………………..
INVESTIGATIONS
URINE BLOOD
Reaction Blood Group
Sp.Gr. Hb%
Albumin T.L.C.
Sugar D.L.C.
Acetone E.S.R.
Microscopic Blood Urea
Culture & Sensitivity Bl.Sugar
STOOL EXAMINATION T3,T4,TSH
Serum creatinine
SPECIAL INVESTIGATIONS
S.G.P.T.
S.G.O.T.
CHOLESTEROL
AUSTRALIA ANTIGEN
EVALUATION OF SYMPTOMS
MENTAL……………………………………………………………
……………………………………………………………………..
GENERAL…………………………………………………………
……………………………………………………………………..
PARTICULAR………………………………………………………
……………………………………………………………………..
CONSULTATION FROM MATERIA
MEDICA/REPERTORY……………………………………………
……………………………………………………………………….
THERAPEUTIC FINAL
DIAGNOSIS…………………………………………………………
……………………………………………………………………….
SURGICAL/MANUAL INTERVENTION(if any)………………….
………………………………………………………………………..
PROGRESS REPORT
GRAPHICS
Age group
Graph showing the prevalence of disease (leucoderma)
in different age groups,showing the highest risk between
10-20 yrs. Of age.Both sexes are equally affected.
MASTER CHART
SYNOPSIS OF CASES
CASE 1:
Patient A,35 year old male reported us with a complaint of
bilaterally symmetrical moderate size spots of leucoderma
present on his legs,ankles and knees since 2.5 years.Patient
was treated with steroid with no changes in the size of
spots..
Along with his skin complications,he suffered from painful
defecation due to hard stool.His appitite was normal and he
used to crave for sweet and fatty food.He had profuse
perspiration and disturbed sleep patterns.
He had prolonged depression which had been caused due to
grief of fathers death,the stress of his mother’s illness and
his elder brother separation from family.He was very
chearfull but dull and lazy .
Based on detailed case study he was prescribed Sulph 200
for his complaints.After 1 month his leucoderma patches
over knees and ankles were better.His bowel symptoms
were relieved to a certain extent.After 3 months his
leucoderma was better by 30%.
CASE 2:
Patient B ,a 18 years old female,reported with bitaterally
symmetrical,moderately depigmented patches on
legs,ankles,knees and upper legs,groin and lower back.
She also suffered from menstrual complaints.She had
dysmenorrhoea with profuse flow.She was of social
nature,hardly get angry and if did mostly left
unexpressed.She have family history of cancer.
She had craving for cold drinks and ice creams.She had a
calm and sound sleep and usually on right side.
Based on the history she was prescribed Carcinocin
200.After 15 days she reported with relief in menstrual
complaints and disappearance of spots later on.
CASE 3:
Patient C ,a 28 years old male had depigmented pathes on
chest and lower back since 2 years.he was also suffering
from loss of appetite and chronic constipation.he had
suffered from frequent cold in his childhood.
He had marked weeping tendencies,especially if could not
perform well in competitions.He used to get hurt easily.He
hated partiality of any kind.
His father was hypersensitive and mother suffered from
cervical spondilitis.His parental grandmother suffered from
lung cancer and maternal grandparents suffered from
Ischaemic heart diseases.
Based on the history he was prescribed Kali ars.200 and
after 4 months,leucoderma patches had faded up upto 15%.
CASE 4:
CASE 5:
CASE 6:
CASE 7:
CASE 8:
CASE 9:
CASE 10:
CASE 12:
CASE 13:
CASE 14;
CASE 15:
CASE 16:
CASE 17:
CASE 18:
Patient R,37 year male reported with complaint of
depigmented patches on abdomen and back since 1 year.
Patches were surrounded by slight redness. He was short
tempered, punctual and fastidious.He was prescribed Apis
mel. 30 on therapeutic basis but no improvement was noted
even after 2 months.
CASE 19:
CASE 20: