[Reprint from The Alienist and Neurologist, April, 1886.] 
The Role of the Nervous System in the 
Causation of Vitiligo.* 
Professor of Dermatology and of Syphilology in the St. Louis College of Physicians 
and Surgeons. 
By A. H. Ohmann-Dumesnil, A. M., M. D., 
IN disease we find generally that nutrition is, in some 
degree, more or less perverted; that the normal equili- 
brium between waste and repair has been destroyed. 
And the agency which tends to preserve this equilibrium, 
which acts as the normal regulator of the various func- 
tions of the body, resides in the nervous system. So that 
it may be asserted that nutrition and the perturbations 
it undergoes are almost always directly dependent upon 
normal or perverted nerve action, whatever its remote 
cause may be. And when the great nerve centres or 
the centres in direct communication with them suffer, 
there is a corresponding change in the general process of 
nutrition. 
Vitiligo or acquired leucoderma is generally classified 
by dermatologists as a disease characterized by an 
atrophy and hypertrophy of the pigment of the skin, the 
former being central and the later peripheral. If we ex- 
amine its clinical characteristics we will find that the 
appearance which it presents is that of a macule or 
spot of varying size or shape, more generally roundish 
or ovalish, of a milky white color. This whitish ap- 
pearance is made much more prominent from the fact 
that at its periphery there is an increased height of color 
manifested in a yellowish or brownish discoloration. This 
latter is sharply defined against the white spot, and 
gradually fades into the normal skin. The spot itself in- 
creases peripherally, slowly or rapidly. It is apparent, 
♦Read before the St. Louis Medical Society, Feb. 6th, 1886, 
1 2 
A. H. Ohmann-Dumesnil. 
then, that it really consists in a displacement of pigment 
which is certrifugal, and that the want of coloring matter 
in the central portion is balanced by its excess in the 
peripheral part. 
We know furthermore that there is, perhaps, no other 
single organ having such a great extent as the skin and 
the richness with which it is supplied with glands, blood- 
vessels, lymphatics and nerves can be very easily demon- 
strated. We also know that a great many of the diseases 
of the skin are due directly to nervous influence, organic, 
functional or reflex; and there is no reason to doubt that 
impaired or perverted innervation or organic nerve changes 
may be the cause of a perversion of the nutrition of the 
skin, and manifested by an improper or perverted distri- 
bution of pigment. 
Besides we have an analogous condition in the case 
of discoloration of the skin, due to liver troubles or to 
uterine diseases, where an excessive development of pig- 
ment takes place through reflex action springing from 
some irritation of a nerve centre. 
Cases of vitiligo have been observed from time to time 
which seemed to point very definitely to a nervous origin. 
The two following cases, occurring in my own practice, I 
wish to allude to briefly, as being very pertinent to the 
subject: 
Case i. W. G , aged thirty-five, is of a spare build, 
but has always been in apparent good health. Is of a 
“nervous temperament” and was considerably troubled 
by two spots which appeared sometime before consult- 
ing me. He was solicitous concerning them because 
they were increasing in size. At the time he sought my 
advice the spots were about the size of a silver dime, 
round and situated on each side of the chin, equidistant 
from the mesial line. The beard was white at the site 
of the vitiligo. He was advised to make use of an 
ascending galvanic current, which he did. He informed 
me a few months later that the spot on the right side 
had almost disappeared, and that on the left was consid- 
erably improved. At the same time he confessed that 
he had been negligent in attending to it. This is the The Nervous System in Vitiligo. 
3 
more easy to understand when it is known that he is a 
physician. 
Case 2. C. M , aged twenty-eight, is of powerful 
build, but unfortunately the possessor of what he calls 
“ weak ” nerves. There is an instability of the nervous 
system which is sometimes very distressing in its results 
to the patient. When first seen, the vitiligo involved a 
part of the chin, of the neck, of the pre-auricular space, 
of the eyebrow and of the scalp of the right side. On 
the chin and scalp, as well as the front part of the neck, 
the trouble could be seen to be abruptly defined at the 
median line, being entirely limited to the right half of 
the face and head. The hair on these different patches 
was perfectly white. He was given ascending galvanic 
electrization and local stimulants to apply to the spots. 
He came to my office rather irregularly for some time 
and distinct improvement declared itself. After about 
three months of this irregular treatment, the spots were 
commencing to regain their normal color, the hair having, 
to a great extent, ceased to be white. The patient be- 
came tired, probably, and ceased coming. 
From a limited survey of the literature of the subject, 
it will be found that but few have recognized a nervous 
origin for this disease. Cazenave and Schedel* say that 
the cause is one which cannot be determined. E. Les- 
ser f says that we still lack any explanation, and he is 
not disposed to attribute any case to nerve action, pre- 
ferring rather to suppose that symmetrical parts of the 
skin are equally affected by any morbid process affecting 
the integument. Dr. A. Harvey Reed | considers the 
disease a purely nervous affection under protest until 
elucidated more. He has used electricity without success, 
but fails to state what sort of a current he has employed 
and in what manner. Morris|| does not discuss the 
etiology of vitiligo, simply stating that no remedies have 
been found to remove the patches. Neumann § whilst 
* L'raite abrege des Maladies de la Peau, 1828. 
tZiemssen's Cyclopedia, (Wood & Co.), 1885. 
tTrans. Ohio State Med. Soc. 1885. 
||Skin Diseases, 1880. 
§Hand Book of Skin Diseases. Trans, by Bulkley, 1879. 4 
A. H. Ohmann-Dumesnil. 
acknowledging that very innervating diseases, such as 
typhoid, may cause partial discoloration, laments that in 
the majority of cases we do not know the cause; Robin- 
son * speaks about in the same strain. Hyde f regards 
its etiology as obscure “ unless the strong probabilities 
in favor of its occurrence under the influence of perturbed 
innervation be accepted as conclusive.” Piffard J thinks 
that most of the speculations regarding the cause of 
vitiligo are not provided with a sufficient basis of fact to 
even render them probable, and yet theoretical considera- 
tions would lead him to suggest the use of the galvanic 
current. Kaposi || says simply that we are not able to 
cure vitiligo by any of the means at our disposal. 
Liveing§ states that well-marked unilateral leucoderma is 
almost unknown in England. Wilson says that the dis- 
ease is generally symmetrical. Tilbury Fox** has seen 
cases where the sensation was blunted, or, at least, we 
are led to infer this from what he says. He says, further- 
more, that he “cannot but think exposure to the sun’s 
rays has much to do with its production, deranging the 
pigment formation in the skin.” Hilliertt makes no com- 
ments, whatever, on this disease. Thomas F. WoodJJ in 
describing a case, where almost exact symmetry existed, 
states that “ to say it is due to faulty innervation scarcely 
brings us to a nearer solution.” 
On the other hand we find some authors who are not 
only advocates of the nervous element in the causation 
of this disease, but unwilling witnesses have placed them- 
selves upon record. Bulkley |||] says “ I have seen marked 
benefit from the use of phosphide of zinc and nux vomica.” 
Duhring§§ in his excellent work when speaking of the 
•Manual of Dermatology, 1884. 
t Diseases of the Skin, 1883. 
JMateria Medica and Therapeutics of the Skin, 1881. 
||Hebra and Kaposi. Lehrbuch der Hautkrankheiten, 11.1875. 
§ Diagnosis of Skin Diseases, 1879. 
IT Diseases of the Skin, 1867. 
••Skin Diseases, 1881. 
tfHand-book of Skin Diseases, 1870. 
JJNotes on Leucoderma. Jour. Cut. and Ven. Dis. I. 
IHIManual of Diseases of the Skin, 1884. 
§§ Diseases of the Skin, 1881. The Nervous System in Vitiligo. 
5 
etiology states that “while, as a rule, no satisfactory 
cause can be offered for its development, it seems to 
be due to some disturbance of innervation.” Leloir 
and Chabrier * have noted changes in the peripheral 
nerves in a case of vitiligo and Dejerinef has also made 
the alterations of the nerves of the skin in a case of 
vitiligo the subject of a paper. 
Thus it is seen that a hasty and superficial glance at 
a part of the literature of the subject shows quite a 
diversity of opinion, but it also shows that those who 
have paid the most attention to the subject and those 
who have studied this disease, seem to be pretty well 
agreed that the nervous system has quite a considerable 
part to play in its production. And to more clearly 
establish this conclusion, as a legitimate deduction from 
certain premises, I will recapitulate the arguments upon 
which it is based : 
1. There are analogous cases where pigment loss or 
disturbance is known to depend upon some functional or 
organic trouble of the nervous system. Take for exam- 
ple the blanching of hair through mental emotion and 
the loss of pigment of anaesthetic spots in leprosy. We 
have here conditions where the relations of cause and 
effect are very clear. 
2. Another somewhat analogous action is where there 
is an excess of pigment due to nervous influence. This 
we find well illustrated in chloasma, which is almost 
always caused by reflex nervous action. In fact there is 
no other plausible cause given for it. In both these dis- 
turbances of pigment, we merely have variations from a 
certain type of which vitiligo is another variation, the 
three being types of loss, increase and displacement of 
the cutaneous pigment. Besides pigmentation may be 
induced by local irritation, such as cantharides, etc., which 
act upon the terminal nerves. 
3. The distribution of the disease is another very 
•Comptea Kendus de P Academic des Sciences, 1879. 
tNote Sur les Alterations des Nerfs de la Peau dang un cas de Vitiligo. Progrds 
Medical, 1881. 6 
A. H. Ohntann-Dumesnil. 
strong presumption in favor of its nervous origin in a 
considerable number of cases. It is, as a rule, symmet- 
rical and quite often unilateral. I have given marked 
examples of these two in my cases which, to my mind, 
are very conclusive upon this point. 
4. The concomitant nervous phenomena also seem to 
corroborate the idea that the cause of vitiligo in many 
cases is directly traceable to a neurotic origin. We find 
that the majority of patients having the dermatic 
affection are either the subjects of some nervous 
malady or are the possessors of what they themselves 
term “ weak ” nerves, and are persons predisposed to, 
and who easily acquire nervous diseases, besides, the 
family history generally contains a pretty fair record of 
nervous troubles. 
5. The effects of nervines have been quite marked in 
some cases. They have never been given a sufficient 
trial to derive a legitimate conclusion, but all means used 
to tone the nervous system have always been followed by 
benefit, more or less marked in the general system and in 
the skin disease. 
6. The use of the galvanic current has been one at- 
tended by more than satisfactory results in my hands, 
and I shall continue to use it in the treatment of vitiligo 
until I am pretty well satisfied that it is useless. Of 
course, a few cases cannot determine a therapeutical 
question; yet, the marked good effects of galvanism, in 
a few cases, have made me think that the cause of the 
vitiligo was probably nervous. 
7. The nerve alterations found in this disease are marked 
in some cases. There have been few, if any, investiga- 
tions, in this direction, and it seemed as if those who were 
to write upon the subject had agreed to ignore or entirely 
taboo any possible neurotic origin, and rather ignored 
this important part of the pathology of the disease. 
The few points given above together with a close ob- 
servance of cases will show that the role of the nervous 
system in the causation of vitiligo is a considerable one, The Nervous System in Vitiligo. 
7 
and, moreover, that it is more often active than is gen- 
erally supposed. This is of some importance as it may 
contribute to an effort on the part of all who see this 
disease to treat it, and not merely turn away patients 
with the assurance that nothing can be done for their 
disease. A new era is dawning upon us. We are learning 
that, through a better knowledge of etiology and of path- 
ology, a number of diseases, hitherto regarded as incur- 
able, are now entering the domain of the curable. May 
vitiligo soon be counted with these. At any rate, I 
would recommend in every case a careful search for a 
nervous origin and a treatment combining internal nerve 
tonics with external nerve stimulation, such as the ascend- 
ing galvanic current, as success or failure will aid, to a 
great degree, in determining how far the nervous sys- 
tem exerts its influence in vitiligo.