Medical Treatment of Vitiligo

 

Skin discolorations such as vitiligo were known thousands of years ago. White spots caused by vitiligo and other disorders have caused a significant social disgrace throughout history and today for those who have been disfigured due to these pigmentary disorders. Treatments have been desperately sought with only partial success. Recent developments suggest that vitiligo and other pigment disorders may soon be cured.

Leukoderma, white spots ve vitiligo

Perfect, flawless skin color is desired by everyone for its beauty and attractiveness. However, like all biologic systems, pigmentation can be abnormal. There can be dark spots or light spots, both of which are disfiguring. These problems have caused distress to people for millennia. Already in 1500 to 1000 BCE, Indian writers described “kilas” and “palita,” translated as white or yellowish white spots.

The Ebers Papyrus describes people with white spots. In these early writings, the precise condition being described is not known, although leprosy and vitiligo are just two of many possible candidates. There are numerous references to white spots in the Old Testament. Typically these were considered leprosy but it is plausible that much of what was considered to be leprosy was vitiligo or other disorders of skin color.

In the Far East prayers known as Makatominoharai dating from 1200 BCE recognized white skin, possibly vitiligo. In the sixteenth century, Hieronymus Mercurialis6 published his book on diseases of the skin. In it he devotes an entire chapter, entitled “On Leuce and Alphos,” to disorders of abnormal skin color.

He cites early Arabic, Greek, and Latin scholars about white spots and notes that the word “…‘vitiligo’ is a Latin word derived from either ‘vitium’ (blemish) or ‘vitulum’ (small blemish)…” The word vitiligo might have been first used by Celsus. Mercurialis suggests that phlegm accumulating under the skin was the source of leukoderma, a theory that he confirms from the writings of “…divine Plato…that white phlegm has two effects in the body….if it begins to vent through the exterior of the body, it will cause …vitiligo.”

Herodotus in Greece noted white spots on foreigners and suggested they be banished immediately, their having sinned against the sun. In China and Korea, writers discussed white spots and white skin. In Korea vitiligo and other pigmentary disorders, such as nevus depigmentosus or tinea versicolor, were described in Doney Bogam, published in the seventeenth century.

A portrait of Chang-Myeong Song, a high ranking official of the Yi dynasty of Korea, was painted about this time that shows the typical depigmentation of vitiligo. In the seventeenth century, William Byrd described “An Account of a Negro-Boy that is, dappel’d in several places of his Body with White Spots.” The depigmentation began at age 3 years and continued to spread. Byrd conjectures that in time the boy would become all white. The leukoderma was obviously mysterious in origin.

Study skin, color, white spots

Skin color was a mystery until modern times after the invention of the microscope, the techniques of biopsy, and the discovery of histochemical stains. Before the seventeenth century, the origin of skin color was based on myths, folklore, and religious theories. Explanations attempted to explain the origin of dark skin color, not why some skin was very light. Jean Roland in separated the epidermis from the dermis of a black individual.

He was able to observe the upper layer of skin (epidermis) was pigmented, the lower dermal layer not pigmented. He proposed that sunlight and heat caused dark skin, a theory that might explain dark skin at the equator but not why Europeans remained white when traveling to southern climes. Another scientist, Thomas Browne, noted this discrepancy and decided skin color was a genetic trait carried within the sperm.

Theories about the mechanism for production of skin color came and went. Many famous investigators all studied skin color usually in deeply pigmented Ethiopians, often on cadavers but occasionally in living subjects. However, without proper instruments and techniques, the origins of pigmentation remained a mystery. More mysterious back then were the mechanisms for loss of skin color. Benjamin Rush suggested that black skin of Negroes was a form of leprosy and that vitiligo was an indication of spontaneous cure.