Abstract
BACKGROUND
Vitiligo is a de-pigmenting disorder characterized by the development of white patches in various distributions, which are due to the loss of melanocytes from the epidermis. More than 150 million people worldwide suffer from vitiligo. No country is immune, although each has different prevalence rates. India shows the highest incidence in the world (up to 8.8 %).([2]) However, it is difficult to get a true picture of the prevalence of vitiligo. The largest epidemiological study of the prevalence of vitiligo is based on 47,033 inhabitants of the island of Bornholm in Denmark, showing an incidence of 0.38 %. Though vitiligo can develop at any age, in 70 % to 80 % cases, it arises before the age of 30. Absence of melanocytes in the skin lesion due to their destruction has been suggested to be the key event in the pathogenesis of vitiligo. Non-segmental vitiligo (NSV) results from autoimmune destruction of melanocytes. The altered levels of various cytokines have been proposed in the pathogenesis of vitiligo. Etiopathogenesis of this disorder is not fully understood. The trigger for development of autoimmune reaction against melanocytes is still under study. However, the exact immune mechanisms have not yet been fully elucidated. We wanted to investigate the frequency of intestinal parasitic infestation in cases of vitiligo and to establish aetiopathological relationship if any.
METHODS
Laboratory reports of a total of 160 Vitiligo patients enrolled at Regional Research Institute of Unani Medicine, Mumbai for treatment with coded unani medicine were analysed retrospectively. Patients with vitiligo treated in Out Patient Department of Regional Research Institute of Unani Medicine, Mumbai are investigated for complete blood count (CBC), complete liver function tests (cLFT), stool examination for ova/cyst and complete renal function test. Data of RRIUM Laboratory was collected and analysed retrospectively. Reports of Stool examination done on two consecutive days in all patients treated with coded Unani drug before administering the trial medicine were analysed. Data of patients enrolled for treatment for over a period of three years was collected and analysed retrospectively.
RESULTS
Out of 160 patients with Vitiligo, 133 (83.12 %) were positive for intestinal parasites confirmed by faecal examination on two consecutive days out of which, 64 (48.12 %) for Ascaris lumbricoides, 55 (41.35 %) for Tapeworm, 14 (10.52 %) for mixed infection. Stool examination of 27 (16.87%) patients did not show intestinal helminthiasis. The data was collected and analysed retrospectively. The Data was statically analysed using Karl Pearson's Coefficient Correlation method which shows significance at 95 % C.I, p < 0.05.
CONCLUSIONS
The pathogenesis of vitiligo, though, partially understood still remains complex and enigmatic to a great extent. However, the presented scientific approaches in recent years have yielded some interesting clues giving credence to both oxidative stress and autoimmune hypotheses with potential clinical relevance. Although the condition may be precipitated by multiple aetiologies, the interaction of oxidative stress with immune system clearly appears to be the key convergent pathway that initiates and/or amplifies the enigmatic loss of melanocytes. Parasitic infection and host parasite interaction may be a factor which triggers the autoimmune destruction of melanocytes. Further study to show the variation in cytokines and inflammatory markers concentration and their interaction with oxidative stress and immune system of vitiligo patients with helminthiasis is to be carried out to establish the aetiopathological correlation of vitiligo and helminthiasis. Based on the above results and discussion, it can be concluded that intestinal helminthiasis may have an active role in vitiligo development and in its pathogenesis and may also act as an index of disease severity. The suggested role of helminthiasis in vitiligo development is not studied and its exact effect is not fully certain. More studies on a large scale of vitiligo patients are needed to confirm our results.