Melanocytic Action of Ledum-palustre
NATIONAL JOURNAL HOMOEOPATHY 1993 Mar / Apr VOL II No 2.
Dr Kamal Kansal.
` Led.

Leucoderma of Vitiligo is a disease of unknown aetiology and variable course. Ledum-pal may be surprise prescription for all of us, but has proved a highly efficacious remedy tried on 76 patients during a period of 6 years.

Vitiligo is an idiopathic acquired circumscribed hypomelanosis which is familial in about 30 percent of cases and is characterised by localised or segmental 9one or more dermatomes) or generalised hypomelanosis. Occasionally vitiligo may become so extensive that nearly the whole skin becomes white. Characteristic distribution patterns of vitiligo involves extensor surfaces and bony prominences (elbows, knee), the small joints in the hand and the area around the eyes and mouth; the low back, axilla, wrist may also be involved. Genitalia, palms and soles and mucous membranes are often affected.

Most vitiligo patients are healthy, although Thyroid disease, Diabetes melitus, Addisons disease and Pernicious anaemia occur with increased frequency.

The pathogenesis of vitiligo is unresolved, but classic hypothesis include destruction of melanocytes by toxic melanin precursors of lymphocytes. Antidotes to normal melanocytes have also been reported.

Vitiligo is thus both a marker for multi system disease and also a tragic social problem for brown and black people. It should never be regarded as a problem but simply as a

Fig: 1: Melanogenesis in human skin, as seen in the light and the electron microscopes and at the molecular level.

Fig. 2: Morphologic and metabolic pathway of epidermal melanin pigmentation. "Action of Ledum palustre on the pathway cannot be ruled out" cosmetic disorder; conditions like subclinical Thyroid disease, Addisons disease, Pernicious anaemia and Polyglandular Endocrinopathy must be ruled out before commencing treatment of this condition.

Options for the treatment of vitiligo include sun screens, cosmetic cover-up, repigmentation or depigmentation, PUVA photochemotherapy, psoralene and ultraviolet A.

Why Ledum-pal? Conventionally used medicines for Leucoderma or Vitiligo did not give me satisfactory results even with the support of constitutionally indicated catalytic remedy. Prolonged treatment has also made it more frustrating. It so happened that a patient came to me for two small marks, white in colour at the site of a burn injury on the forehead and on the chest. Patient was noninformative. A look in Boerickes Materia Medica under skin of this remedy- "long discolouration of skin after injuries" made me think about it and I prescribed Ledum-pal 200, three times and to my surprise the skin started repigmentation. I have given this medicine in patients even without history of injury and have found most encouraging results.

Case report-B S, aged 20 years has spots on the face, neck, abdomen and legs for 7 years. He had been taking all kinds of therapies including Homoeopathy. He was given Ledum-pal 200 three times daily on 22^nd Nov 92. Photograph on 1^st Dec 92 and 22^nd Jan 1993 show evident repigmentation.

Conclusion-Materia Medica requires reproving of many drugs. It is not necessary that all symptoms of a drug have come out in earlier provings. The trial of Ledum-pal is an example to make reproving and reconfirmation of drugs a continuous process. The role of Ledum-pal on Melanin pathway cannot be ruled out.

References-

1. Braunwald E, et al, Harrisons principles of internal medicine, 11^th edition 1987, Mcgraw Hill book company, New York.
2. Boericke William; Pocket manual of Homoeopathic Materia Medica, export edition, 1984, Pratap Medical Publishers, New Delhi.

Derived from the Greek word melas black melanin is a protein bound polymer formed by the oxidation of tyrosine by tyrosinase to dihydroxyphenylalanine (DOPA) within melanocytes which are specialized epidermal dendritic cells of neural crest origin.
Skin colour is derived from the presence of melanin within the keratinocytes, which are the receptor cells for melanocytes formed melanin containing organ cells called melanosomes. Normal skin colour is genetic of constitutive that of habitually unexposed skin, as on the buttock,s and calculative that results from the sun induced tanning reaction or from increased pigmentation by the pituitary Melanocyte Stimulating Hormone (MSH).

Melanin pigmentation from the clinical point of view results from the Melanin present in the keratinocytes. In as much as the ration of keratinocytes to melanocytes in the epidermis is 36:1, it is apparent that the amount of melanin present in the keratinocytes must be a key factor in the determination of skin colour.

Hypomelanosis in general, results from a defect in the melanin pathway, such as absence of melancocytes, failure of formation of normal melanosomes to keratinocytes making the recognition of circumscribed hypomelanosis white spots easy.

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