Vitiligo - Causes, Symptoms, Stages, Why Is Vitiligo Dangerous, How And How To Treat It?

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Video: Vitiligo - Causes, Symptoms, Stages, Why Is Vitiligo Dangerous, How And How To Treat It?

Video: Vitiligo - Causes, Symptoms, Stages, Why Is Vitiligo Dangerous, How And How To Treat It?
Video: Vitiligo: When the Immune System Attacks & Causes Skin Discoloration 2023, March
Vitiligo - Causes, Symptoms, Stages, Why Is Vitiligo Dangerous, How And How To Treat It?
Vitiligo - Causes, Symptoms, Stages, Why Is Vitiligo Dangerous, How And How To Treat It?

Causes, symptoms, stages, how and how to treat vitiligo?


  • Vitiligo - white spots on the skin
  • Vitiligo symptoms
  • Vitiligo causes
  • Vitiligo stages
  • Why is vitiligo dangerous?
  • Is vitiligo transmitted?
  • How and how to treat vitiligo?
  • What vitamins to take?
  • Vitiligo drugs
  • How to mask spots?

Vitiligo - white spots on the skin

Vitiligo is a type of skin disease when the dermis loses its natural pigmentation against the background of melanin destruction. As a result of this process, some areas of the skin lose color, which creates the effect of white spots or variegation. The disease has been known for a long time, and in Russia, among the common people, it was called "dog", which is most likely due to the patient's appearance.

In medical practice, in addition to the name "vitiligo", you can find another definition of this skin pathology, which sounds like leukoderma. If we turn to Latin, then we can understand the origin of this word, in translation it means white skin.

As for statistics, according to some data, up to 1% of the world's population suffers from vitiligo. The disease does not depend on the specific population, however, in dark-skinned people, the spots are more noticeable. Most often, the disease manifests itself at the age of 10 to 30 years, this period accounts for up to 50% of all cases of pathology.

Vitiligo symptoms

The main symptom of the disease is the appearance of spots on the skin that have a milky white color and clearly defined borders. The most susceptible to vitiligo are body parts such as the face (the area around the mouth, ears, eyes, nose), hands and feet (their backs, fingertips, elbows, feet, knees), the groin and the anal area. Spots can appear on the scalp, including the beard and mustache in males.

There are several types of spots, the following types of depigmentation can be noted:

  • In the place of transition of the skin subject to a pathological process into a healthy one, a pigmented contour is observed, the spots themselves have three colors.

  • Spots of four colors, which are limited by a border with pronounced pigmentation.
  • Spots are inflamed areas that are bounded by a slightly raised shaft.
  • Spots with a bluish color.

In addition, the following symptoms may accompany the disease:

  • Baldness of the nest form;
  • Choreoretinitis, in which the back of the eye and the retina become inflamed;
  • Hair graying or lightening in areas affected by vitiligo;
  • Scleroderma;
  • Psoriasis;
  • Lichen planus;
  • Chronic gastrointestinal diseases;
  • In the affected areas, sweating processes are disrupted, the skin ceases to respond to cold and other stimuli, muscle-hair and vasomotor reflexes disappear;
  • Often, vitiligo is accompanied by all sorts of dermatitis;
  • Decreased liver ability to resist toxins.

As for other subjective symptoms, the patient does not experience them and for the most part suffers only from a cosmetic defect. Therefore, people with this type of skin disease should avoid contact with the sun, as the spots on tanned skin are more prominent.

Depending on the localization of the pathological process, it is customary to distinguish the localized clinical form of vitiligo, when pathological foci are located on a certain area of the skin:

  • Mucous leukoderma, when mucous membranes are included in the affected area;
  • Segmental leucoderma, when the lesions are located on an area of the skin that is supplied with a single nerve (cranial or spinal);
  • Focal leucoderma, when the code spots are found singly, are localized in one or two skin areas.

Separately, the generalized form of vitiligo can be distinguished, which manifests itself in the fact that the skin changes are quite extensive:

  • Acrofacial leukoderma, when the face and limbs are included in the pathological process;
  • Vulgar leukoderma, when foci of the disease are located throughout the body;
  • Total or universal leukoderma is characterized by the fact that large areas of the skin are affected, up to 80%;
  • Mixed leukodkerma, when there is a combination of acrofascial and vulgar forms of the disease, or segmental, vulgar and acrofascial forms.

Vitiligo causes


Vitiligo is not born, this skin pathology begins to form under the influence of a number of external and internal factors. Moreover, it is extremely rare that the disease manifests itself at an early age, namely up to 10 years. A connection has been established with the onset of vitiligo and periods of increased solar activity in the summer and spring.

Among the reasons provoking the development of the disease are:

  • Autoimmune disruptions in the body are factors that provoke the development of the disease. At the same time, a failure occurs in the functioning of the immune system and antibodies produced to destroy foreign agents begin to infect healthy tissues. Such conclusions about the relationship between vitiligo and autoimmune processes were made on the basis of the fact that people with skin lesions often have concomitant rheumatoid arthritis, thyroid diseases, systemic lupus, etc.

  • Vitiligo's link to genetics has been proven experimentally. Scientist R. Spitz, who works at the University of Colorado, has established a familial predisposition to the development of this skin pathology. In addition, it has been scientifically proven that if a person has brown eyes, then the risk of developing the disease is higher than that of those with gray and blue eyes.

  • Endocrine gland. Serious malfunctions of the endocrine gland, as well as fluctuations in the level of hormones, can provoke the onset of the disease. This group of causes will be combined into neuroendocrine ones. In addition, disturbances in the work of the pancreas, ovaries, pituitary and adrenal glands can have an impact.

  • Violations of the trophism of the skin, which are caused by its various injuries (burns, including sunburn, scars and microtrauma). Vitiligo begins to form in previously damaged areas, since an inflammatory reaction with an autoimmune component is triggered in these places. In this case, the cells that produce melanin are destroyed. Moreover, the more often a person exposes the skin to the sun's rays, the faster the depigmentation process develops. That is, trophic disorders are another reason for the formation of vitiligo.

  • Taking some medicines can trigger the onset of a pathological process.

  • Liver diseases, which lead to stagnation of bile and changes in the parenchyma of the organ, which has a direct effect on the development of vitiligo.
  • Diseases of the gastrointestinal tract, such as dysbiosis, malabsorption syndrome. Violation of the process of absorption of enzymes leads to the fact that the skin does not receive the necessary nutrients (zinc, copper, manganese, magnesium) for the normal formation of melanin.

  • Exposure to various chemicals on the skin. These can be low-quality cosmetics, phenol and reagents containing it, formaldehyde, etc.

Doctors reasonably believe that vitiligo is the body's most powerful signal of trouble in general. Indeed, quite often the disease starts after viral infections, after intoxication, after physical injury, especially after head injury.

The thyroid gland as a cause of vitiligo

The fact that disorders in the functioning of the thyroid gland cause the development of vitiligo are evidenced by the numbers. So problems with this organ are observed on average in 10.4% of patients with this skin pathology.

Among the diseases associated with thyroid disorders in vitiligo are:

  • Goiter 1 and 2 degrees, without changing the function of the thyroid gland is very common, the number of patients reaches 86%. At the same time, an increase in TSH, AT TG and AG TPO hormones is observed, against the background of a decrease in T4.

  • 12% of patients with vitiligo have hyperthyroidism. In this pathological process, there is an increased production of hormones with all the ensuing consequences: weight loss, anxiety, nervousness, increased blood pressure, etc.

  • Hypothyroidism with vitiligo is much less common, only 2% of patients. At the same time, there are symptoms such as: a decrease in pressure, lethargy, fatigue, passivity.

As it becomes clear from the above statistics, the link between vitiligo and thyroid dysfunction is obvious.

Vitiligo stages

It is customary to distinguish several stages of the disease. Among them are:

  • The progressive stage of the disease. This stage is said to be when, within three months, there is a significant increase in the spot in size, the growth of old depigmented areas begins, or all new formations appear. Vitiligo can progress slowly, when new lesions appear next to the first spot over several months. Slow progression is considered a natural progression of the disease. However, there is also fulminant vitiligo. In this case, the patient has an increase in the number of spots throughout the body for several weeks.

  • The initial stage in which a single spot forms on the skin. Depending on the nature of the disease, this stage will later turn into a progressive, stable or repigmentation stage.

  • The stationary stage, which is characterized by the fact that the patient has one spot on the skin that is in a stable state. It does not grow for a long time period, new formations do not appear.

  • Repigmentation stage. Most often, this stage is observed with the spontaneous formation of a spot caused by therapeutic measures, for example, taking certain medications. Unfortunately, independent and complete repigmentation in this form of skin disease is extremely rare.

Vitiligo stages
Vitiligo stages

It is generally accepted that this disease does not pose a direct threat to human life or health. However, vitiligo itself is most often the result of any disorders in the body, which should not be left without attention.

Therefore, if a person has vitiligo, you should pay attention to:

  • Thyroid function.
  • Taking medications may not be suitable and require immediate replacement.
  • For the presence of other skin diseases, in particular, psoriasis, baldness, etc.
  • On malfunctions of the immune system and on the factors that provoke these disorders. In addition, there is information about the relationship between vitiligo and diabetes mellitus.
  • Frequent stress or mental instability.
  • The lack of nutrients in the body.
  • Vitiligo is often observed with pneumonia, progressive myopia.

Therefore, if, in addition to vitiligo, a person is worried about any other concomitant symptoms, this must be reported at the doctor's appointment. In addition, patients often require psychological assistance, since such a pronounced cosmetic defect can lead to psychological trauma, depression, the development of an inferiority complex about their own appearance, etc.

Is vitiligo transmitted?


Is vitiligo inherited?

The question of whether the disease is inherited has been repeatedly studied by various scientists. There is no consensus, but most studies indicate that there is a certain combination of genes that is responsible for the manifestation of vitiligo in members of the same family. Therefore, it is generally accepted that the risk of hereditary transmission varies from 15 to 40%.

But at the same time, spots are not formed without fail, but only under the influence of risk factors. Therefore, a child of parents who suffer from vitiligo can live their whole life without experiencing the symptoms of this disease. However, children with a family history of complications are at increased risk.

Scientists have investigated certain haplotypes that are most common in vitiligo patients. But their frequency of occurrence is constantly changing and depends on the specific surveyed population. Therefore, nevertheless, special attention should be paid to the factors that precede depigmentation.

Is vitiligo transmitted from mother to child?

Naturally, mothers with vitiligo wonder if there is a risk of transmission of skin pathology to a child. In this case, it is important not to be confused: a person who was born has not the disease itself, but a predisposition to its development.

Therefore, if the mother or other family members have vitiligo, it is necessary that the child is exposed to the trigger factors as little as possible. Among them are psychological and physical trauma, exposure to ultraviolet rays, the formation of burns, etc.

If the disease affects a woman during pregnancy, then this does not affect her course and does not pose a threat to the fetus. However, during the carrying of a child, the hormonal background is disrupted, which can lead to the early spread of the disease. Signs of vitiligo are extremely rare in newborn children, and even if the disease is inherited, it will usually first manifest itself after 9 years. Therefore, if a baby has white spots on the skin, then it would be more appropriate to suspect psoriasis, lichen white or colored lichen, as well as allergies. But unlike vitiligo, these formations will peel off.

Is vitiligo transmitted from person to person?

Since the disease is quite common and in the immediate environment you can often meet a person suffering from vitiligo, the question of the transmission of the disease by airborne droplets or in another way is quite natural.

The answer to this question is unequivocally negative. This disease is not infectious and the person suffering from it does not pose a danger to others in terms of infection. Therefore, you can fearlessly communicate with people who have spots of the corresponding origin on the skin.

How and how to treat vitiligo?

How and what to treat vitiligo
How and what to treat vitiligo

If one or more white spots appear on the skin, then you need to go to an appointment with a dermatologist. He will examine the skin with a specialized lamp and determine the nature of the depigmentation. If necessary, material will be taken to clarify the diagnosis. These procedures are important as it is necessary to be able to distinguish vitiligo from other skin diseases.

With regard to therapy, despite the existing cases in medicine of complete and spontaneous healing of vitiligo, there is a high risk that the disease will progress without appropriate treatment. Due to the fact that pathology is often accompanied by concomitant diseases, it is important to correctly use drugs of various groups.

Treatment with glucocorticoids (agents aimed at suppressing autoimmune processes and allergic reactions) is indicated for:

  • Localized form of the disease. In this case, it is advisable to use ointments. For a start, agents with average activity are prescribed. Among them are hydrocortisone butyrate, Esperson, Alcometasone, Ftorocort, Triacort and others. The course must last at least 3 months. If the effect is not observed, then ointments with higher activity are shown. Among them are Elokom, Kutiveit, Sinalar, Dermovate, Beloderm and others. These funds cannot be used without interruption for more than 8 weeks. The course will need to be repeated after 1 to 4 months.

  • Generalized form of the disease. However, in this case, the use of drugs in tablet form is shown. Since when taking glucocorticoids inside, there is a high risk of developing diabetes mellitus and Itseno-Cushing's syndrome, it is necessary to use pulse therapy in parallel, and the drugs themselves should be taken intermittently. Among this group of drugs used for the treatment of generalized forms of vitiligo, Triamcinolone, Dexamethasone, Prednisolone, Methylprednisolone can be distinguished.

Since an ultraviolet lamp is often used to treat vitiligo, doctors prescribe photosensitizing agents to patients. They increase the sensitivity of melanocytes to ultraviolet radiation.

Among the plant furocoumarins are:

  • Bergapten and Xanthoxin containing Beroxan;
  • Containing one xanthoxin Puvalan, Oxoralen, Lamadin, Metoksalen;
  • Containing imptonin and xanthoxin Meladinin;
  • Ammifurin containing xanthoxin, bergapten and isopimpinelline;
  • Extracted from Psoberan figs;
  • Isolated from Psoralei Psoralen.

In addition, there are means such as Elidel and Protopic. They are most often prescribed for the treatment of psoriasis and various dermatitis. But in some cases, they are effective in the fight against vitiligo. They are used externally and have an anti-inflammatory effect, suppressing T-lymphacytes and inhibiting the body's immune response. Their action is somewhat similar to the effect that can be achieved using glucocorticoids.

Elidel and Protopic can be used both in adults and children. However, the concentration of the active substance in ointments will vary (for children - 0.03%, for adults - 0.1%). Treatment should be course and, depending on the stage and form of the disease, it can last from three to six months. The advantage of these funds is that they are not absorbed into the bloodstream, providing a local effect.

Systemic therapy is aimed at eliminating hormonal disorders, at removing patients from depression, at eliminating mental and other diseases of the nervous system, which are often triggers in the development of vitiligo. It is important that the patient compensates for the deficiency of trace elements and vitamins. Therefore, he is shown the appointment of complexes containing ascorbic acid and copper. Also, a doctor may prescribe antioxidants and immunomodulators.

Medicine does not stand still and methods for treating vitiligo are constantly being improved. New ways to fight the disease include:

  • Treatment using a laser or laser therapy. In this case, the affected areas of the skin are exposed to radiation having a certain wavelength. This method is similar to phototherapy. The greatest effect can be achieved in the treatment of local forms of the disease (for patients with segmental, focal and vulgar forms), when the patient suffers from vitiligo for no more than five years. You will not have to spend a long time under the laser, the initial procedures take only a few seconds.

  • The skin whitening procedure helps to make blemishes less visible. In this case, its tone is aligned. For this purpose, various injections are used, the most popular are Eloquin, Monobenzone and Hydroquinone. But before deciding on such procedures, it is worthwhile to learn more about the presence of contraindications, since each of these funds is very aggressive and has certain side effects. In addition, the drugs are expensive and will need to be administered regularly.

  • Surgical intervention (melanocytic transplantation). If vitiligo has not affected large areas of the skin, then you can turn to surgery and auto transplant. But this method is fraught with complications in the form of rejection and suppuration of the transplanted area. In addition, no doctor is able to guarantee a stable and long-term effect.

  • Transfer of a person's own pigment cells (melanocytes) from intact skin areas to the problem area.

  • Using Melagenin plus - an alcoholic extract isolated from the human placenta. The drug is most effective if the patient suffers from a localized form of the disease.

  • Sceness drug. In the future, a drug developed in Austria called Sceness can be used to treat vitiligo. It is currently used to treat erythropoietic protoporphyria.

In addition, scientists are still trying to develop a vaccine that can eliminate the autoimmune reaction that leads to the development of the disease.

In addition, more and more data indicate that combined treatment is most effective, when surgical treatment is complemented by several non-surgical methods of exposure.

Also, in rare cases, the doctor manages to detect the connection between vitiligo and an external or internal factor. By eliminating them, you can stop the pathological process. In particular, saving the patient from helminthic invasion or stopping contact with a certain chemical.

With regard to recommendations regarding the patient's nutrition, he needs to include in his diet foods fortified with copper. Among those: seafood, apples, tomatoes, cabbage. In addition, it is worth including in the diet rice, oats and corn, as they contain zinc.

There are no specific preventive measures to prevent the development of the disease. However, persons with a history of the disease are advised to stay in the sun as little as possible and promptly treat diseases that are provocateurs of this skin pathology.


[Video] Dr. Berg - 3 natural remedies for vitiligo:

Ultraviolet lamp for vitiligo treatment (UVB therapy)

UV lamp
UV lamp

At the moment, an ultraviolet lamp is increasingly used in the treatment of vitiligo. This method is very effective and is based on exposure of the affected skin to ultraviolet radiation. It is a mistake to use the term PUVA to name all types of ultraviolet exposure, because they have some differences.

Thus, when the skin is irradiated with type A waves with the use of drugs, both herbal and synthetic origin (psoralens), there are a number of serious contraindications and complications. Among them, the risk of developing cataracts and skin carcinoma. In addition, this procedure should not be carried out by pregnant women, the elderly, over 60 years old, children, patients with cancer, with pathologies of the kidneys, liver, heart and blood vessels. Side effects that often occur during the procedure are erythema, nausea and burning sensation.

Therefore, in recent years, more and more patients with vitiligo are prescribed ultraviolet radiation, which has a narrower spectrum of action, when the wavelength is 310 nm. In this case, the patient experiences fewer side effects, the risk of developing malignant skin formations decreases.

Narrow-wave therapy does not require the indispensable reception of photosensitizers, while its effectiveness is higher than irradiation with waves of type A. There are much fewer contraindications to carrying out such a procedure, these are: cataract and the absence of a lens, the presence of melanoma, and autoimmune diseases.

The risk of side effects when using narrow wavelength therapy is significantly reduced. As a rule, the patient complains of mild itching and dry skin. Burns can only occur if the dosage has been exceeded.

As for the procedure, the time of exposure to the lamp on places with thin skin (in particular, the facial area) should not be more than 2 minutes. The feet, hands and elbows can be irradiated for 5 minutes. You should not wait for an instant effect; after the first procedure, you will not be able to get rid of vitiligo. The sessions are most often held three times a week. At the same time, the doctor can recommend up to 200 procedures, for which a patient with vitiligo must be prepared. To achieve the effect, a course effect is required. If the skin turns red after irradiation, then it is necessary to apply any cream used for burns. During irradiation, it is important to use special glasses that will protect the lens and retina.

What vitamins to take for vitiligo?

Scientific studies have shown that the intake of certain vitamins (for example, E, C, alpha-lipoic acid) has an effect on the course of the disease and can enhance the therapeutic effect. Therefore, doctors often prescribe certain drugs to patients with this skin disease. Among the most popular are thiamine, ascorbic acid, pantothenic acid and riboflavin.

Role of folic acid

In Sweden, studies have been carried out on the effects of folic acid and vitamin B12 on vitiligo. The study involved 100 vitiligo patients, all of them took 5 mg of folic acid 2 times a day and 1 mg vitamin B12 once a day. A prerequisite was daily exposure to the skin with ultraviolet rays. Exactly 3 months later, the results were summed up. More than half of all participants achieved positive results, and several patients were completely cured by 100%.

On the subject: 10 most effective folk remedies in the treatment of vitiligo

Some drugs used for vitiligo



Melangenin is used as a topical treatment for vitiligo. It is able to restore the pigmentation of the skin, by enhancing its ability to absorb ultraviolet rays.

Currently, the drug Melagenin Plus is actively used, which acts in the same way as melagenin, but its effect is enhanced by the calcium chloride and alcoholic extract of the human placenta included in the composition. This allows cells to multiply more actively and synthesize melanin with a higher bioavailability.

The remedy is used even in the most severe cases of vitiligo. At the same time, reviews indicate that the depigmentation process does not return, and normal skin is not damaged.

The drug should not be used while carrying a baby and while breastfeeding. It can be applied independently without additional exposure to an infrared lamp.


Ammifurin is a photosensitizing drug that is prescribed to patients with vitiligo when exposed to ultraviolet rays. Available in the form of tablets and solution for external use, it stimulates the production of melanin.

If used in the form of a solution, then the agent should be applied before the start of irradiation in advance, one hour before the procedure. If oral use is indicated, then it is worth taking the tablets after meals and drinking milk, but 2 hours before ultraviolet irradiation.

The drug is prohibited for use during pregnancy and breastfeeding, in the presence of hypersensitivity to the active substance, with stomach ulcers, pancreatitis, cirrhosis, hepatitis, diabetes, cachexia, nephritis, tuberculosis, cataracts, nevi, tumors, high blood pressure and thyrotoxicosis.

It is important to use glasses with dark glasses to protect the eyes while taking the drug during the sunny time of the day. As for the effectiveness, the best results in the treatment of vitiligo were recorded in young people with a short duration of the disease, as well as in brunettes and patients prone to sunburn.

The product cannot be used independently, without strict medical supervision.


Vitasan is produced in the form of a cream and consists exclusively of natural ingredients. It is able to have a complex effect: it regulates immune processes, has a sensitizing effect, and stimulates the production of melanocytes.

The composition of the tool includes such components as:

  • St. John's wort extract, which enhances the sensitization effect and increases the sensitivity of the skin to ultraviolet radiation;
  • Walnut extract, which saturates the skin with vitamins and microelements necessary for vitiligo - copper, zinc, ascorbic acid, etc.;
  • A series of extract, which enhances the reaction of the formation of the pigment necessary for vitiligo;
  • Calendula extract containing vitamins PP, C and B;
  • Fir oil, which is able to dilate blood vessels, stimulate blood supply, cell division and growth, and the development of local immunity;
  • Cedar nut oil, which contains vitamin E.

Suffering from vitiligo, it is necessary to apply the product twice in knocks, rubbing thoroughly. To achieve the maximum effect, you should use the cream in advance, before the onset of periods of maximum solar activity, that is, in winter.

Among the contraindications, one can single out only individual intolerance to the components that make up the cream. If you experience side effects in the form of itching, redness and burning, you should wash off the product and consult a doctor.

It is important to use the cream not as a single treatment, but as part of a complex therapy.

How to mask vitiligo spots?

How to mask vitiligo spots
How to mask vitiligo spots

The desire to hide white spots on the face and body is a completely natural desire of people suffering from vitiligo. Therefore, while treatment is being carried out, you can use the following methods:

  • The use of cosmetics. This is the most affordable and easiest way to make stains less visible. At the same time, apply foundation and other matting agents correctly. First, the skin must be smoothed to its natural color, and only after that it is necessary to start matting. In addition, you can use a permanent tattoo, which will be more resistant and will not wear off when in contact with clothing or water.

  • Using a self-tanner. If you perform this procedure in a salon, the color will turn out to be more even and it will last longer. In addition, it can be problematic to independently choose a shade and apply it to the body. Unlike cosmetic products, self-tanning is convenient to use on hands and feet, as it does not stain clothes.

  • Using green walnut peels. To do this, grind it with a blender and leave for 2 hours. After that, the mixture should turn brown. The juice from the peel must be squeezed out and applied with a cotton pad to the spots, which will contribute to their staining. One of the advantages of this product is that it does not leave marks on clothes.

  • A method such as dermabrasion can help mask vitiligo. In this case, the skin is processed in layers, and the depth of penetration depends on the form of the disease, the age of the spots, etc.

However, when using these products, it is important not to forget about the rules for caring for the affected skin. Do not injure her again or expose her to allergens. It is important not to wear too tight clothes and shoes, avoid rubbing stains, if there is a need to use a razor, then you should be as careful as possible. Jewelry should not leave visible marks on the neck and fingers. It is necessary to limit the time spent both in the sun and in the cold. After all, tanning most often provokes the formation of new spots.

Vitiligo is not a death sentence, and treatment is successful in most cases. It is important not to despair if one of the methods is ineffective, it is possible that another method will help in the fight against the disease. Even when it is not possible to get rid of vitiligo completely, it is quite possible to make the spots less noticeable using modern methods of therapy.


The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist

Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).

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