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UDHAMPUR: Rashtriya Rifles battalion at Talwara under the aegis of Rashtriya Rifles Uniform Force Headquarters based at Reasi organised a medical camp as a part of operation Sadbhawana at village Chakal Salta near Mahore. The noble civic action initiative by the Army in coordination with the civil administration benefitted 290 people including women and children. Doctors and nursing assistants from the Army and civil administration joined hands in addressing the genuine medical needs and distributed free medicines.  The doctors also advised the residents on precautions to be taken during the rainy season to prevent water borne diseases.

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Bars (Vitiligo/Leucoderma)

Bars also known by variety of names such as Safed Daagh, Safed Kodh, Phuleri and Savitra. It is a skin-depigmenting disease which results in disfiguration of the skin. The disease negatively affects self-esteem, social status and ultimately, patient’s quality of life. It appears as single or multiple depigmented patches on any part of the body. These patches gradually increase in size and cause a lot of psychological stress to the patient. Eventually, it spreads to the whole body resulting in a condition called Bars-e- Muntashir (expanded vitiligo).

Vitiligo starts with localized loss of skin’s pigmentation. It occurs when skin pigment cells die or are unable to function. These patches are more commonly seen in sun-exposed areas, viz., the hands, feet, arms, face, and lips. Other areas of the body where this is commonly seen are the armpits and groin, the area around the mouth, eyes, nostrils, navel and genitals as well. According to Unani concept, Vitiligo is caused due to disarrangement of phlegmatic humour. It is believed that vitiligo onset is strongly affected by environmental factors.

Certain Facts about Vitiligo:-
Vitiligo is  neither contagious nor infectious disease. It is more of a social stigma than a disease.
Vitiligo is sometimes associated with autoimmune and inflammatory diseases.
Vitiligo is an acquired disease characterized by skin depigmentation due to destruction or malfunction of melanocytes (cells that produce melanin).

Vitiligo  is prevalent  worldwide. It is estimated that about 1 - 2 percent of world population which accounts to approximately 100 million people suffer from this disease.
The prevalence in different countries ranges from less than 0.1% to more than 8% of the general population.
In India, an estimated 2-3 percent of the population suffer from this condition. The rate is higher in coastal areas like Andhra Pradesh, West Bengal and Kerala.In Kashmir province Vitiligo cases are also seen as major dermatological problem with leaste  contemporary management.

There is no racial or gender bias for this disease but it is more widespread amongst the middle-aged women. Very few women in younger age suffer from this problem. Despite these data, worldwide awareness and knowledge of vitiligo are often rather inadequate.  Several misconceptions about this disease have become major challenges in the treatment.   These include “fate” or “evil eye” wrong ideas about contagiousness, akin to the victims of leprosy. Even there is misconception or misinformation among medical fraternity thinking that there is no cure.  They label vitiligo as a purely aesthetic problem, not worthy of treatment or research.

While vitiligo is not life-threatening, it has heavy psychosocial impact on the quality of life, particularly when areas, such as face and hands, are affected. The negative impact is even worse for patients with darker skin types, because of the higher contrast of white patches on their skin.

Depression, anxiety, social embarrassment and self-consciousness caused by vitiligo are very frequent, and the disease usually leads to highly significant decrease of the quality of life and restriction of participation in domestic and social life. Stigmatization, avoidance and concealment are the most typical reactions to vitiligo. Sometimes rejection, insult, discrimination at work and sexual difficulties, including being considered unfit for marriage, are also frequent in the society.

In recognition of the importance of this condition, the World Vitiligo Day is observed every year on June 25th to develop global awareness.

Signs and Symptoms (Alamaat) :-

The only symptom of vitiligo is the presence of whitish or pale patchy areas of depigmented skin which tend to occur on the extremities. It starts off as a single pale spot and spreads into multiple patches which become whiter, as skin loses its pigmentation. The patches are initially small, but often grow and change in shape. When skin lesions occur, they are most prominent on the face, hands and wrists. The loss of skin pigmentation is particularly noticeable around body orifices, such as the mouth, eyes, nostrils, genitalia and umbilicus. Some lesions have increased skin pigment around the edges.

Causes of Vitiligo (Asbaab-e-Bars)
The cause of Bars is still unknown. According to Unani Medicine it is caused due to the weakness of Transformative Faculty (Quwwat-e- Mughaiyirahwa Mushabbiha) of the skin and liver. Blood Impurities (Fasad-ud- Dam) and Coldness of Blood (Burudat-ud- Dam) also aggravate this condition. It occurs usually due to coldness (Burudat) of the temperament (Mizaj) of the organs. The quantity of phlegm (Balgham) increases in the blood and the nutrition doesn’t reach to the cells of the particular organ.

In Modern Medicine multiple theories have been suggested.  According to one view, skin pigmentation occurs mainly due to the malfunctioning of the endocrine glands and the liver.  It is also widely held that changes in the immune system are responsible for the condition. While genetic predisposition undoubtedly exists, it is also believed that vitiligo is strongly affected by environmental factors. Apart from this, exposure to certain chemicals such as phenol and injury to skin predisposes the disease. The severity of pigmentation problem is associated with several diseases and disorders.

Treatment (Elaaj)
Vitiligo has many stages and it is of different clinical types. It is therefore necessary for the physician to choose the right drug combinations according to the patient’s temperament (Mizaj).
Being chronic and long standing disease it always takes time to show response of the drug. Larger and older spots takes longer time and thus exact duration of treatment cannot be predicted at the initial stage of therapy.
Unani physicians use single as well as compound preparations. Both local as well as oral medicines are recommended for the treatment of Bars.
The treatment of vitiligo is of two types
2.Drug Therapy
3.Regimenal therapy.

1. Dieto therapy/ Role of diet in the treatment of Bars (Vitiligo):-

Diet plays an important role in the treatment of Bars. According to Unani philosophy all cold and phlegm producing food items are harmful in this condition. Frequent use of such items not only delays the response but also aggravates the lesions. There is not enough scientific evidence to prove how these food items adversely affect vitiligo. However, clinical experience has shown adverse effects of such items. The diets which have hot temperament (mizaj) are recommended.

Restricted Food items:-

1. Food items that are supposed to produce Blood impurities (Fasad-ud- Dam) for example:
Eggs, Fish, Beef, Brinjal and combination of heavy and light food mixed simultaneously.

2. Food articles that are supposed to increase the production of phlegm (Balgham) are:
Milk, Curd, Buttermilk, Lemon and Lime, Tamarind, Oranges and other citrus fruits, Red Sorrel, Parsley, Custard apple, Guaua, Prunus, Dates, Melon, Water melon, Tomatoes , Amla and Indian sorrel.

Recommended Food items
Wheat, Indian Millet, Pulses (specially Bengal gram), Pure Ghee obtained from butter, Broad Beans, French beans, Spinach, Bitter gourd, ridge gourd, Onion, Beet-root, Carrot, Chillies (red pepper), Black pepper etc.

2.  Drug Therapy
According to Unani approach, since the disease is caused due to disarrangement of phlegmatic humour (Balghami mawaad), it must be expelled out from the body. Further, the temperament (Mizaj) of an individual must be normalized by using some unani preparations in the form of Majoon (Semisolid preparation) like Majoon Kalkalanaj or in the form of Tablet (Qurs) like Qurs Bars and Tiryaaq and Mazruditoos orally.

Hot liniments (Garm tila) are used locally which cause redness on the affected area and absorb blood (Absorbefacient/Absorbent drugs). These drugs also increase blood circulation of that particular area.
Some of these drugs are babchi ( Psoralea corylifolia Linn), Khardal surkh (Brassica nigra Linn.), Kutki safed (Picrorhiza kurroa), Kutki Siyah (Black Picrorhiza), Maweezaj (Delphinium staphysagria), Nakchhikni (Centipeda minima Linn.), Choona (Lime), Hartal surkh (Arsenic oxide), Boorah Armani (A type of Borax found in Rome), Jangli Piyaz (Urginea indica (Salla indica), Aaqarqarha (Anacyclus pyrethrum DC.), Kalaunji (Nigella sativa Linn.), Post Bekh-e- Kibr (Capparis spinosa Linn.).

Some other drugs recommended  locally are Zarareeh/Telni Makkhhi (Cantharide), Sirka (Vinegar), Asl-e- Baladur (Semecarpus anacardium Linn.), Aqaqqia (Acacia arabica/nilloticaWilld.), Sakbeenaj (Ferula persica), Kabootarki Beet (Pigeon excreta), Banoli ke beej, Maazariyun (Daphne mezereum), Farfiyun (Euphorbia resinifera A. Berger).

Fundamentals of Treatment:-

The drugs which are Corrosive (Akkal), Caustic (Kaawi), Rubefacient (Muhammir) and Irritant (Laaz’i) are useful in the treatment of bars as these drugs increases the blood circulation of the particular area and ultimately nutrition reaches to the affected part.

Some Orally Used Drugs:-

Psoralea corylifolia Linn. and Ammi majus Linn. are mostly used single drugs in the treatment of Bars. Safoof Babchi and Majoon Atrilal are compound drugs usually recommended by unani physicians.

Some Locally Used Drugs:
Roghan-e- Bars is applied locally and Habbe Bars is used as liniment.
3.Regimenal therapy ( illaj bil tadbeer)
In AYUSH Unit SMHS Hospital Srinager combined pharmacological and regimenal therapeutic approach shows some positive clinical results insome localised vitiligo cases.

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SRINAGAR:  Dr. Khalid Shah the Professor of Medicine at Harvard Medical School, Boston, USA will deliver lecture on“Stem Cell therapies for Cancer: From Bench to Bedside"at SKIMS on 30th July at 4.30 PM. Dr. Khalid Shah,  Kashmir born US scientist  recently made headlines across world and back as he and his team  discovered a way of turning stem cells into killing machines to fight brain cancer.

Dr. Khalid who is also Principal Faculty at Harvard Stem Cell Institute in Boston  have pioneered major developments in the stem cell therapy field, successfully developing experimental models to understand basic cancer biology and therapeutic stem cells for cancer.

These studies have been published in a number of very high impact journals likeNature Neuroscience, PNAS, Nature Reviews Cancer, JNCI, Stem Cells and Lancet Oncology,validating the use of therapeutic stem cells alone and in combination with clinically approved drugs for cancer therapy. 

Dr. Khalid holds current positions on numerous councils, advisory and editorial boards in the fields of stem cell therapy and oncology. Recently, Dr. Khalid's work has caught the attention in the public domain and as such it has been highlighted in the media worldwide including features on BBC and CNN.