Vitiligo is a skin disorder characterized by skin depigmentation caused by the loss of melanocytes. The causes of melanocyte loss are unclear, but a relevant number of observations lead researchers to ascribe cellular immunity as having an important role in vitiligo pathogenesis. Acting at the origin of the inflammatory phenomena, rebalancing the immune response with specific low dose SKA interleukins and antibodies and stimulating melanocytes to produce melanin via up-regulation of transmembrane receptors through SKA low dose basic-Fibroblast Growth Factor, represents the proposed Low Dose Medicine approach for Vitiligo treatment.

Vitiligo is an acquired depigmentary skin disorder characterized by white maculae on the skin associated with social stigma. Vitiligo has major impact on the quality of life due its high cosmetic value, chronic nature of disease and long term ineffective treatments. Vitiligo patients suffer from low self-esteem and poor body image that affects their emotional and psychological well-being. To investigate quality of life of Vitiligo patients, psychological impact of unpredictable course of disease and long term treatment among South Indian population. A total of 155 Vitiligo patients, undertaking treatment in dermatology clinic at the Central Research Institute of Unani Medicine (CRIUM), who completed the Dermatology Quality of Life Index (DLQI) questionnaire, participated in this study. Patients with Vitiligo averaged at about 27.4% of maximum psychological impairment as measured by the DLQI summary score. Disability in patients was highest in treatment category with 54.6% of impairment followed by symptoms and feelings (41.83%). Dark skin, unmarried, slow responders to the treatment and those having chronicity more than 5 years showed worse quality of life and had 70%, 61%, 62%and 76.5% of impairment in the treatment front of DLQI respectively when compared to light skin (50%), married (52.5%), rapid responders (26%) and chronicity less than 5 years (52%). There was no significant difference in the quality of life between male and female Vitiligo patients (p=0.88). Our results show that Vitiligo patients suffer in all aspects of life especially in treatment aspect of DLQI. Psychological impairment strongly affects the social well-being of Vitiligo patients.

Back ground: Topical application of bFGF related deca peptide followed many hours after with sun /UVA exposure was found effective in the earlier conducted clinical trials to treat Non-segmental, segmental, PUV-A resistant and fast spreading vitiligo either by itself or in combination with PUV_A, or oral steroids. The deca peptide lotion is marketed in India since 2004 to treat vitiligo.

Objectives: A multicentre randomized double blind phase IV clinical trial on bFGF related deca peptide to treat vitiligo was conducted with the following twin objectives. One was to evaluate the efficacy and safety of topically applied deca peptide in vehicle in combination with narrow band ultra violet light (NBUVB) in patients with vitiligo. The second objective was whether deca peptide is effective to repigment vitiligo macules on sun protected areas without sun exposure.

Methods: This was a multi-centre study. Two chosen macules on each patient that were non-sun exposed areas on patients with stable non segmental vitiligo were selected. The duration of treatment of volunteers was for 3 months starting with or without the topical application of deca peptide in vehicle on 30 volunteer patients with NBUVB and on 32 volunteers with deca peptide in vehicle.

Results: The results demonstrated that with NB-UVB plus deca peptide in vehicle group, 9 patches out of 30 repigmented by more than 40% compared to only 5 out of 62 patches treated with NBUVB alone and with peptide alone groups indicating that NBUVB and peptide act synergistically in repigmentation of the macules. In addition, the mean value of repigmentation at the end of 3 months in all the 30 macules of 30 patients with NBUVB+ peptide was 229 mm square compared to only 90 only with NBUVB in vehicle alone. More repigmentation occurred with NBUVB+ peptide at all-time points of evaluation. Conclusions: The results demonstrated that NB-UVB plus deca peptide act synergistically and produced more repigmentation of the macules right from the start compared to control even though deca peptide application was in effect for 3 days in a week. NBUVB+ peptide was superior to NBUVB alone in repigmenting vitiligo macules. The deca peptide in absence of sun exposure of vitiligo macule may not be as effective to repigment vitiligo macules as with sun exposure. NBUVB and peptide were well tolerated.

Vitligo and melasma are acquired pigmentary disorder of the skin and also the leading cause for dermatologist consultation in South Asian countries like Nepal. Vitiligo vulgaris and melasma are common examples for depigmentary and hyperpigmentary conditions respectively. Even with the presence of multiple proven medical, surgical and combined modalities of managing them the challenges in South Asian countries with Fitzpatrick skin types III-V are the psychosocio-cosmetic morbidities associated with them.