Treatment of Vitiligo with Oral Vitamin B12 and Folic Acid

Current therapies rarely support in vitiligo repigmentation. According to the previous report, some of the vitiligo patients were having low levels of vitamin B12 and folic acid and they also responded slowly to the therapy of aggressive replacement. By getting encouragement by this report, an uncontrolled and non blinded study of vitamin B12 and oral folic acid supplementation was conducted by the investigators in Sweden in which 100 patients having vitiligo disease.
The age range of the patients were from 9 to 79 years; women were 67 and 64 women out of 67 were having active vitiligo disease. By starting the age range from 1 to 65 years, 1 to 43 years of vitiligo were presented. Tablets of 5 mg of folic acid and 1 mg of vitamin B12 were given to all patients on two times daily basis and patients were instructed to take medicine in this combination for around 3 months or even more. UVB exposure was also encouraged to all patients throughout the year. Folate levels and baseline of vitamin B12 were reported normal in the test of subgroup.
Treatment of all patients was continued to 12 months. In 52 patients fractional repigmentation occurred and it was mostly in those areas which were sun exposed. Best success was predicted in the age less than 26 years, 10 years of less vitiligo duration, 7 to 12 months of vitiligo treatment and UVB exposure’s combination.

Cancer

Cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected.
Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumors can grow and interfere with the digestive, nervous, and circulatory systems, and they can release hormones that alter body function. Tumors that stay in one spot and demonstrate limited growth are generally considered to be benign.

More dangerous, or malignant, tumors form when two things occur:

1. a cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue in a process called invasion
2. that cell manages to divide and grow, making new blood vessels to feed itself in a process called angiogenesis.

When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is very difficult to treat.
In 2007, cancer claimed the lives of about 7.6 million people in the world. Physicians and researchers who specialize in the study, diagnosis, treatment, and prevention of cancer are called oncologists.

What causes cancer?

Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, cancer begins to form. Unlike regular cells, cancer cells do not experience programmatic death and instead continue to grow and divide. This leads to a mass of abnormal cells that grows out of control.

Genes - the DNA type

Cells can experience uncontrolled growth if there are damages or mutations to DNA, and therefore, damage to the genes involved in cell division. Four key types of gene are responsible for the cell division process: oncogenes tell cells when to divide, tumor suppressor genes tell cells when not to divide, suicide genes control apoptosis and tell the cell to kill itself if something goes wrong, and DNA-repair genes instruct a cell to repair damaged DNA.
Cancer occurs when a cell's gene mutations make the cell unable to correct DNA damage and unable to commit suicide. Similarly, cancer is a result of mutations that inhibit oncogene and tumor suppressor gene function, leading to uncontrollable cell growth.

Carcinogens

Carcinogens are a class of substances that are directly responsible for damaging DNA, promoting or aiding cancer. Tobacco, asbestos, arsenic, radiation such as gamma and x-rays, the sun, and compounds in car exhaust fumes are all examples of carcinogens. When our bodies are exposed to carcinogens, free radicals are formed that try to steal electrons from other molecules in the body. Theses free radicals damage cells and affect their ability to function normally.

Genes - the family type

Cancer can be the result of a genetic predisposition that is inherited from family members. It is possible to be born with certain genetic mutations or a fault in a gene that makes one statistically more likely to develop cancer later in life.

Other medical factors

As we age, there is an increase in the number of possible cancer-causing mutations in our DNA. This makes age an important risk factor for cancer. Several viruses have also been linked to cancer such as: human papillomavirus (a cause of cervical cancer), hepatitis B and C (causes of liver cancer), and Epstein-Barr virus (a cause of some childhood cancers). Human immunodeficiency virus (HIV) - and anything else that suppresses or weakens the immune system - inhibits the body's ability to fight infections and increases the chance of developing cancer.

What are the symptoms of cancer?

Cancer symptoms are quite varied and depend on where the cancer is located, where it has spread, and how big the tumor is. Some cancers can be felt or seen through the skin - a lump on the breast or testicle can be an indicator of cancer in those locations. Skin cancer (melanoma) is often noted by a change in a wart or mole on the skin. Some oral cancers present white patches inside the mouth or white spots on the tongue.
Other cancers have symptoms that are less physically apparent. Some brain tumors tend to present symptoms early in the disease as they affect important cognitive functions. Pancreas cancers are usually too small to cause symptoms until they cause pain by pushing against nearby nerves or interfere with liver function to cause a yellowing of the skin and eyes called jaundice. Symptoms also can be created as a tumor grows and pushes against organs and blood vessels. For example, colon cancers lead to symptoms such as constipation, diarrhea, and changes in stool size. Bladder or prostate cancers cause changes in bladder function such as more frequent or infrequent urination.
As cancer cells use the body's energy and interfere with normal hormone function, it is possible to present symptoms such as fever, fatigue, excessive sweating, anemia, and unexplained weight loss. However, these symptoms are common in several other maladies as well. For example, coughing and hoarseness can point to lung or throat cancer as well as several other conditions.
When cancer spreads, or metastasizes, additional symptoms can present themselves in the newly affected area. Swollen or enlarged lymph nodes are common and likely to be present early. If cancer spreads to the brain, patients may experience vertigo, headaches, or seizures. Spreading to the lungs may cause coughing and shortness of breath. In addition, the liver may become enlarged and cause jaundice and bones can become painful, brittle, and break easily. Symptoms of metastasis ultimately depend on the location to which the cancer has spread.

How is cancer classified?

There are five broad groups that are used to classify cancer.

1. Carcinomas are characterized by cells that cover internal and external parts of the body such as lung, breast, and colon cancer.
2. Sarcomas are characterized by cells that are located in bone, cartilage, fat, connective tissue, muscle, and other supportive tissues.
3. Lymphomas are cancers that begin in the lymph nodes and immune system tissues.
4. Leukemias are cancers that begin in the bone marrow and often accumulate in the bloodstream.
5. Adenomas are cancers that arise in the thyroid, the pituitary gland, the adrenal gland, and other glandular tissues.

Cancers are often referred to by terms that contain a prefix related to the cell type in which the cancer originated and a suffix such as -sarcoma, -carcinoma, or just -oma. Common prefixes include:

• Adeno- = gland
• Chondro- = cartilage
• Erythro- = red blood cell
• Hemangio- = blood vessels
• Hepato- = liver
• Lipo- = fat
• Lympho- = white blood cell
• Melano- = pigment cell
• Myelo- = bone marrow
• Myo- = muscle
• Osteo- = bone
• Uro- = bladder
• Retino- = eye
• Neuro- = brain

How is cancer diagnosed and staged?

Early detection of cancer can greatly improve the odds of successful treatment and survival. Physicians use information from symptoms and several other procedures to diagnose cancer. Imaging techniques such as X-rays, CT scans, MRI scans, PET scans, and ultrasound scans are used regularly in order to detect where a tumor is located and what organs may be affected by it. Doctors may also conduct an endoscopy, which is a procedure that uses a thin tube with a camera and light at one end, to look for abnormalities inside the body.

Extracting cancer cells and looking at them under a microscope is the only absolute way to diagnose cancer. This procedure is called a biopsy. Other types of molecular diagnostic tests are frequently employed as well. Physicians will analyze your body's sugars, fats, proteins, and DNA at the molecular level. For example, cancerous prostate cells release a higher level of a chemical called PSA (prostate-specific antigen) into the bloodstream that can be detected by a blood test. Molecular diagnostics, biopsies, and imaging techniques are all used together to diagnose cancer.

After a diagnosis is made, doctors find out how far the cancer has spread and determine the stage of the cancer. The stage determines which choices will be available for treatment and informs prognoses. The most common cancer staging method is called the TNM system. T (1-4) indicates the size and direct extent of the primary tumor, N (0-3) indicates the degree to which the cancer has spread to nearby lymph nodes, and M (0-1) indicates whether the cancer has metastasized to other organs in the body. A small tumor that has not spread to lymph nodes or distant organs may be staged as (T1, N0, M0), for example.
TNM descriptions then lead to a simpler categorization of stages, from 0 to 4, where lower numbers indicate that the cancer has spread less. While most Stage 1 tumors are curable, most Stage 4 tumors are inoperable or untreatable.

How is cancer treated?

Cancer treatment depends on the type of cancer, the stage of the cancer (how much it has spread), age, health status, and additional personal characteristics. There is no single treatment for cancer, and patients often receive a combination of therapies and palliative care. Treatments usually fall into one of the following categories: surgery, radiation, chemotherapy, immunotherapy, hormone therapy, or gene therapy.

Surgery

Surgery is the oldest known treatment for cancer. If a cancer has not metastasized, it is possible to completely cure a patient by surgically removing the cancer from the body. This is often seen in the removal of the prostate or a breast or testicle. After the disease has spread, however, it is nearly impossible to remove all of the cancer cells. Surgery may also be instrumental in helping to control symptoms such as bowel obstruction or spinal cord compression.

Radiation

Radiation treatment, also known as radiotherapy, destroys cancer by focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide. Radiotherapy utilizes high-energy gamma-rays that are emitted from metals such as radium or high-energy x-rays that are created in a special machine. Early radiation treatments caused severe side-effects because the energy beams would damage normal, healthy tissue, but technologies have improved so that beams can be more accurately targeted. Radiotherapy is used as a standalone treatment to shrink a tumor or destroy cancer cells (including those associated with leukemia and lymphoma), and it is also used in combination with other cancer treatments.

Chemotherapy

Chemotherapy utilizes chemicals that interfere with the cell division process - damaging proteins or DNA - so that cancer cells will commit suicide. These treatments target any rapidly dividing cells (not necessarily just cancer cells), but normal cells usually can recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is generally used to treat cancer that has spread or metastasized because the medicines travel throughout the entire body. It is a necessary treatment for some forms of leukemia and lymphoma. Chemotherapy treatment occurs in cycles so the body has time to heal between doses. However, there are still common side effects such as hair loss, nausea, fatigue, and vomiting. Combination therapies often include multiple types of chemotherapy or chemotherapy combined with other treatment options.

Immunotherapy

Immunotherapy aims to get the body's immune system to fight the tumor. Local immunotherapy injects a treatment into an affected area, for example, to cause inflammation that causes a tumor to shrink. Systemic immunotherapy treats the whole body by administering an agent such as the protein interferon alpha that can shrink tumors. Immunotherapy can also be considered non-specific if it improves cancer-fighting abilities by stimulating the entire immune system, and it can be considered targeted if the treatment specifically tells the immune system to destroy cancer cells. These therapies are relatively young, but researchers have had success with treatments that introduce antibodies to the body that inhibit the growth of breast cancer cells. Bone marrow transplantation (hematopoetic stem cell transplantation) can also be considered immunotherapy because the donor's immune cells will often attack the tumor or cancer cells that are present in the host.

Hormone therapy

Several cancers have been linked to some types of hormones, most notably breast and prostate cancer. Hormone therapy is designed to alter hormone production in the body so that cancer cells stop growing or are killed completely. Breast cancer hormone therapies often focus on reducing estrogen levels (a common drug for this is tamoxifen) and prostate cancer hormone therapies often focus on reducing testosterone levels. In addition, some leukemia and lymphoma cases can be treated with the hormone cortisone.

Gene therapy

The goal of gene therapy is to replace damaged genes with ones that work to address a root cause of cancer: damage to DNA. For example, researchers are trying to replace the damaged gene that signals cells to stop dividing (the p53 gene) with a copy of a working gene. Other gene-based therapies focus on further damaging cancer cell DNA to the point where the cell commits suicide. Gene therapy is a very young field and has not yet resulted in any successful treatments.

How can cancer be prevented?

Cancers that are closely linked to certain behaviors are the easiest to prevent. For example, choosing not to smoke tobacco or drink alcohol significantly lower the risk of several types of cancer - most notably lung, throat, mouth, and liver cancer. Even if you are a current tobacco user, quitting can still greatly reduce your chances of getting cancer.
Skin cancer can be prevented by staying in the shade, protecting yourself with a hat and shirt when in the sun, and using sunscreen. Diet is also an important part of cancer prevention since what we eat has been linked to the disease. Physicians recommend diets that are low in fat and rich in fresh fruits and vegetables and whole grains.
Certain vaccinations have been associated with the prevention of some cancers. For example, many women receive a vaccination for the human papillomavirus because of the virus's relationship with cervical cancer. Hepatitis B vaccines prevent the hepatitis B virus, which can cause liver cancer.
Some cancer prevention is based on systematic screening in order to detect small irregularities or tumors as early as possible even if there are no clear symptoms present. Breast self-examination, mammograms, testicular self-examination, and Pap smears are common screening methods for various cancers.

Psoriasis

Psoriasis is a chronic skin disorder. Basically, this is of five types – erythrodermic psoriasis, inverse psoriasis, pustular psoriasis, guttate psoriasis and plague psoriasis. Psoriasis is characterized by red, thick, silvery patches on the skin. This is also referred to as inflammatory skin ailment. This condition affects both the genders and generally appears during 15 – 30 years. Seasonal changes, skin infections, injury to skin, heredity factor and abnormality in metabolism of proteins and amino acids are some causes of psoriasis. Certain effective home remedies for psoriasis are discussed in the below lines.

Home Remedies for Psoriasis:
Following are some effective home remedies for psoriasis:

• Bitter gourd can be considered as an effective remedy for psoriasis. Take a cup of fresh bitter gourd juice and add a tablespoon of lime juice and drink it on an empty stomach every day, for 4 – 6 months.
• Apply freshly extracted cashew nut oil on the psoriasis afflicted area. This acts like a best remedy for psoriasis.
• Apply avocado oil on the affected area. This is another natural cure for psoriasis.
• Another useful remedy is curd. Pour buttermilk on the affected sites. You may also add some herbs like holy basil to it and pour it on the regions.
• As psoriasis is considered to be a metabolic disorder, cucumbers, grapes, carrots and beetroots help in curing this skin ailment as they have cleansing properties.
• Fruits, grains, nuts, seeds, vegetables particularly organically grown vegetables, sunflower seeds and sesame seeds are good and favorable to cure psoriasis naturally.
• All animal fats that include eggs, processed or refined foods, butter and milk must be avoided. It is said that these cause psoriasis.
• Foods that contain whit sugar or hydrogenated fats and all condiments, coffee and tea must be avoided.
• According to the recent research, vitamin E therapy has been very effective in treating this skin ailment. You can take a daily dose of 200 – 800 IU to heal psoriasis.
• Cabbage leaves can also be used for treating this condition. Make a compress with cabbage leaves and apply it over the affected areas. Let it stay for a few minutes and then rinse with water. This is another beneficial home remedy for psoriasis.

The above mentioned home remedies for psoriasis may give relief to some extent. If the symptoms does not subside, consult the health care provider for further assistance.

Vitiligo

Vitiligo (pronounced /ˌvɪtɨˈlaɪɡoʊ/), is a chronic disorder that causes depigmentation of patches of skin. It occurs when melanocytes, the cells responsible for skin pigmentation, die or are unable to function. The cause of vitiligo is unknown, but research suggests that it may arise from autoimmune, genetic, oxidative stress, neural, or viral causes. The incidence worldwide is less than 1%. The most common form is non-segmental vitiligo.

THERAPEUTICS

Presently, there is no universally effective medical or surgical modality for vitiligo therapy; however, there are a number of active therapeutic approaches that are known to be effective. In addition to these medical and surgical therapies that are listed later in text, one has to always keep in mind adjunct therapies, such as broad-spectrum sunscreens to prevent photodamage of vitiliginous skin, and cosmetic camouflage of disfiguring skin with stains or make-up in exposed areas of vitiligo.

Medical/Nonsurgical Treatment

Psoralen Plus UVA (PUVA) Therapy Oral or topical application of psoralen followed by long-wave UVA exposure is the most popular therapy for vitiligo and a detailed guideline has recently been well described. The basic concept of this therapy was developed from an ancient form of psoralen phototherapy in middle and far eastern countries, consisting of topical application of plant extracts or ingestion of seeds.
Khellin and UVA Therapy (KUVA)
Khellin, a furanochromone previously used in the treatment of angina pectoris and asthma, is now being used for the treatment of vitiligo. Khellin and UVA have been reported to be as effective as PUVA in the treatment of vitiligo. KUVA reportedly does not lead to the phototoxic erythema seen with PUVA. This advantage permits the patient to use KUVA at home.

Phenylalanine and UVA Therapy
Several investigators have reported a successful application of L-phenylalanine and ultraviolet light UVA to treat vitiligo patients. L-Phenylalanine is a precursor of tyrosine, a substrate for melanin synthesis in the presence of tyrosinase. After their patients underwent treatment of 6 to 8 months, Cormane et al reported a complete to partial response in 26.3% and partial to minimal.
Corticosteroids Intradermal and topical corticosteroids have been used to treat vitiligo with mixed results. Intralesional triamcinolone acetonide given for 5 weeks produced 90% repigmentation in 30 of 52 depigmented macules, but caused skin atrophy in 26 of 52 macules treated. Topical therapy using betamethasone valerate and clobetasol propionate was successful in regimenting some vitiliginous.

Pseudocatalase and Calcium with UVB Therapy
Schallreuter et al reported successful treatment of vitiligo depigmentation with topical application of pseudocatalase and calcium followed by short-term UVB light exposure. According to their study, repigmentation occurred in the majority of cases after 2 to 4 months treatment. Complete repigmentation of face and dorsum of hands appeared in as many as 90% of the treated group.

Other Medical Therapies Other medical therapeutic approaches, although based upon a limited number of cases, include topical application of melagenine, human placental extract, and systemic administration of levamisole. The topical melagenine treatment resulted in as much as 84% success rate in 80 vitiligo patients studied for 3 to 11 months. According to Pasricha et al, levamisole seems to be a

Surgical Treatment

Several surgical procedures for the treatment of depigmented skin have been reported to be effective in patients who have experienced difficulty in receiving good responses from medical treatments. The surgical therapeutic approaches include thin
Autologous Epidermal Graft Autologous epidermal grafts are the most frequently used surgical technique for treating vitiligo. This method involves transplanting a patient's normal epidermal sheet into the vitiliginous macule. Several different methods of obtaining autologous epidermis for grafting have been investigated. Full-thickness punch grafts have been used to replace depigmented skin. This technique, although

Autologous Melanocyte Grafts
Recent advances in culturing pigment cells from humans have made it possible to begin the transplantation of autologous melanocytes into areas of skin that are depigmented. This technique involves harvesting melanocytes from a

Other Surgical Therapies
In addition to autologous grafts, there are a number of surgical procedures applicable for repigmentation of vitiligo. Vitiliginous skin can be dermabraded, and 5% 5-fluorouracil (Effudex) applied twice daily for 7 to 10 days. Repigmentation can be developed.