Vitiligo: treatment, causes, symptoms

Update: October 2018

Vitiligo is a type of skin disease in which the skin loses
its natural pigmentation as a result of the destruction of melanin.
The result is a discoloration of skin areas and its
variegation. The common Russian name of this disease sounds like
“Song”, which is most likely due to such diversity
skin cover with vitiligo.

Another name for the disease is leucoderma, which is translated from
Latin means white skin. Onзвание же витилиго может происходить
from the Latin “vitilum” (mistake, defect) or “vitilus” (calf),
associating with both skin color impairment and variegation
calfskin

Causes of Vitiligo

With this feature of the skin, a person is not born, but acquires
its under the influence of various external and internal factors.
Onибольшая частота дебютов болезни приходится на первые десять лет
life, puberty, as well as pregnancy and menopause
among women. Also noted is the connection of the first signs of the disease.
with periods of greater solar activity (spring and summer).

The factors that trigger the onset of the disease are very
varied.

Autoimmune processes

Under which antibodies appear in the body to its own
tissues play an important role in the occurrence of vitiligo. it
confirmed by the fact that patients with vitiligo are often found
and other autoimmune diseases (systemic lupus, rheumatoid
arthritis, thyroid lesions, for example, Hashimoto’s goiter,
type 1 diabetes mellitus, Addison’s disease, alopecia baldness).

Genetic predisposition

There is a genetic predisposition to vitiligo. it
position proved in the experiments of R. Spritz from the University
Colorado. They have established not only the relationship with family
predisposition to the disease, but it is also proved that people with bright
(gray or blue eyes) are less likely to suffer from vitiligo than
brown-eyed. Also, the incidence of the disease is higher in the Negroid race.

Neuroendocrine causes

it резкие колебания уровня гормонов и стрессовые состояния,
которые могут инициировать начало diseases.

Trophic disorders

it нарушения питания кожи и подлежащих тканей связаны с
skin injuries (mechanical, chemical, radiation damage).
So after mechanical violation of the integrity of the skin
an inflammatory reaction is initiated with an autoimmune component that
leads to the destruction of the cells producing the pigment melanin. With
frequent exposure to the sun already existing skin depigmetisation process
progresses rapidly and noticeably.

Medicines

The effects of drugs and certain chemicals can also
cause the appearance of skin depigmentation sites.

Liver diseases

There is an interrelation of vitiligo with hepatic pathologies.
(pairchymatous changes and stagnation of bile), as well as helminthic
invasions and giardiasis.

On тканевом уровне витилиго связано с отмиранием меланоцитов, а
on cellular – with inhibition of tyrosinase – an enzyme that
participates in pigmentation.

Symptoms of Vitiligo

The disease is manifested in the appearance of clearly defined spots on the skin.
or foci of milk-white color. Characteristic places of their
locations become areas around the mouth, ears, nose, eyes, on
back of the hands and feet, fingertips, armpits,
elbows and knees, groin and nearanal area. The boundaries of the hot spots
clearer the darker the patient’s skin. May also be affected
scalp or beard and mustache area in men.

There are several types of depigmented spots:

  • Tricolor have pigmented contour in the place of transition white
    skin to healthy.
  • Four-colored possess additional strongly pigmented
    border
  • Inflammatory is limited to a raised shaft.
  • Bluish have a corresponding color.

Localized form – lesions on limited skin areas.

  • A focal form of the disease – these are individual, often single spots.
    or foci on one or two skin areas.
  • Segmental vitiligo – unilateral foci within
    dermatome (segment of the skin supplied by a single spinal or
    cranial nerve).
  • Vitiligo mucosa – lesions of the mucous membranes.

Generalized form manifests extensive skin.
changes

  • Vulgar vitiligo – foci scattered throughout the body.
  • Acrofessional – affected face and limbs.
  • The total form is also called universal vitiligo and
    characterized by widespread in many segments
    depigmentation areas, occupying up to 80% of the skin.

In addition to skin lesions, other symptoms may occur:

  • lightening or graying hair in areas of lesions,
  • leucoderma,
  • soothing baldness
  • eye lesions with chorioretinitis (inflammation of the posterior part
    choroid, including the retina).

In most patients without treatment, vitiligo is slow but
steadily progressing. There are also cases of hopping
depigmentation or self-restoration of the pigment.

How to diagnose

Diagnosis involved a dermatologist. For that he
based on skin inspection data uses a special lamp
Woods, in the rays of which depigmentation areas have clear outlines
and glow with white and blue fluorescent light. If necessary
skin areas are taken for biopsy, which confirms or
refutes the diagnosis most accurately.

Not all white spots on the skin are caused by vitiligo, and to distinguish
this disease comes from a large number of pathological
states.

Here are just a few of them: post-traumatic scars,
hypopigmentation on the background of eczema or atopic dermatitis,
chemical leucoderma, secondary syphilis, pityriasis versicolor,
tuberous sclerosis, focal scleroderma. Selenium deficiency,
pyalous hypomelanosis, visceral leishmaniasis. Leprosy,
sclerotic atrophic lichen.

Vitiligo Treatment Methods

Despite the fact that the medical literature describes cases
spontaneous cure of the disease and self
Restoration of skin pigment without any treatment, the risks are high
constant progression of the process. Therefore, a reasonable tactic
the patient should be reduced to seeking medical help from
dermatologist.

Since the disease affects not only the skin, but also immune.
endocrine and nervous systems, the treatment involves a complex
approach and is divided into the use of local and systemic drugs
different groups.

Glucocorticoids

These are anti-inflammatory drugs (including
autoimmune) and allergic reactions.

In the localized form of the disease, local treatment is indicated.
hormonal ointments.

  • The first stage – an ointment with medium activity: Butyrate
    hydrocortisone (Lokoid, Latikort), hydrocortisone butyrate
    (Lorinden, Lokakorten), (Flumetazon) Fluorocort, Triacort
    (Triamcinolone), Esperson (Dexamethasone), Alcomethasone (Afloderm).
    Course duration – 3-4 months.
  • In the absence of effect, switch to highly active ointment:
    Mometasone fuorat (Elokom), Fluticasone (Kutiveyt), Apononat
    methylprednisolone (Advantan), Fluacinolone (Sinalar, Flucinar),
    Clobetasol (Dermoveit), Betamethasone (Celestoderm, Beloderm) course
    for two months with repeated courses in 1-4 months.

With generalized vitiligo resort to systemic reception
glucocorticoid tablets. To reduce the side effects of
such treatment (Itseno-Cushing syndrome, diabetes)
use pulse therapy or alternating therapy with
in short, high doses, alternating at intervals
receiving funds. Prednisolone, Methylprednisolone, Dexamethasone,
Triamcinolone is prescribed in pills.

Photosensitizing drugs

They cause the skin to increase the sensitivity of melanocytes to
exposure to ultraviolet radiation, under the action of which
skin pigments are actively formed. This group of drugs –
vegetable furocoumarins.

  • Beroksan contains two furocoumarin pasternak (bergapten and
    xanthoxin).
  • Methoxalen, Puwalen, Ocoralen, Lamadin contain only
    xanthoxin.
  • Meladinin – isolated from the large amia (contains xanthoxin and
    imperatorin).
  • Ammifourney is similar to beroxane with the addition of isopimpinellin,
    also isolated from amia.
  • Psoralen isolated from psoralea.
  • Psoberan – from figs.

UV lamp for treatment

Ей  облучают кожу после приема фотосенсебилизирующих
means, has a long wave of radiation (320-420 nm). Such a method
called PUVA therapy. It is contraindicated in pregnancy,
children under five years old and those over 60 years old, with cancer pathologies,
hypersensitivity to ultraviolet radiation, blood diseases,
cardiovascular system, liver, kidneys.

More gentle way of ultraviolet irradiation plots
vitiligo – treatment lamp with an average wavelength (311 nm) without
preliminary photosensitization drugs. This method is named
narrowband phototherapy. It acts more gently on the body
almost no side reactions, but less effective. Duration
procedures from 1 to 5 minutes. Californian Studies
dermatologists claim that even long courses
ultraviolet radiation (up to 36 months) does not lead to skin cancer
in patients.

Other means

Means of treatment are used to fight vitiligo.
psoriasis and dermatitis are Elide and Protopic. These are preparations for
external use, based on anti-inflammatory
drug macrolactam ascomycin. The agent inhibits T lymphocytes and
inhibits the body’s immune response while simultaneously
anti-inflammatory effect similar to glucocorticoids.

In children, 0.03% is used, and in adults, 0.1% ointment.
Course duration from three months to six months. Most
pronounced results are achieved on the face. Worse therapy lends itself
hand and foot area. The drug is used both in isolation and in
combined with narrow-band ultraviolet radiation. A drug
It works only locally and is not absorbed into the blood.

Systemic therapy

Systemic therapy также предполагает применение коррекции
hormonal disorders, treatment of depression and neuropsychiatric
diseases that could lead to the development of vitiligo.
Also appointed funds, restoring the deficit of ascorbic
acids, copper, immunomodulators, antioxidants.

New in treatment

  • Laser therapy

This elimination of depigmentation sites is narrowly focused.
radiation with a wavelength of 308 nm. At the same time, the mechanism of action is almost
similar to phototherapy. At the same time the greatest efficiency
is achieved in individuals with local forms of the disease and duration
pathological process no more than five years. Duration
the action of radiation in one session is seconds. Other
The names of this method are Excimer Laser or Ratokderm. More about
contraindications and indications of laser therapy.

  • Skin whitening

This is an attempt to equalize the tone of the affected areas and healthy skin. On
Today, the most popular means for this procedure are injections.
Eloquin, hydroquinone (2-4%) and its monobenzyl ether (Monobenzon)
outwardly. All drugs are quite aggressive and have a lot of adverse
effects, therefore, cannot be considered a panacea in solving problems
depigmentation. In addition, the price tags on them very bite (injection
Eloquin costs about 50 thousand rubles), and clarification occurs
plots, so almost constant use is required
drugs.

  • Surgical treatment or auto graft

More effective for patients with small lesions. The
way expensive, traumatic, can lead to postoperative
purulent complications or graft rejection reactions and, to
Unfortunately, does not guarantee a lasting effect.

  • Melanocyte transplantation

This is the introduction of pigment cells collected from healthy areas.
the skin of the patient himself in his problem skin.

  • Melagenin plus

This is an alcohol extract from human placenta, produced by Cuba.
The drug called Melagenin has been on the market since 1998,
characterized by moderate efficacy against localized forms
diseases.

  • Vaccine creation

In 2013, scientists from the medical school at Chicago
University in a series of experiments on mice tested protein
vaccine that suppresses the autoimmune reaction, leading to vitiligo.
However, to this day, the completion of the vaccine information
have been reported.

  • A drug Sceness

Australian drug Sceness, registered in Europe, for
treatment of erythropoietic protoporphyria, also represents
perspective to eliminate depigmentation in vitiligo.

Treatment of vitiligo folk remedies

  • Immediately it should be noted that the uncontrolled use
    plant photosensitizing agents (Hypericum, Amia,
    psoraleas) can lead not to a cure for vitiligo, but to solar
    burns
  • Such natural immunomodulators as duckweed also do not give
    any positive effect.
  • Herbal treatments also include plants containing copper.
    (series, arnica, yarrow) and adaptogens (Rhodiola rosea,
    Eleutherococcus, Aralia).
  • The interesting folk methods include Chinese
    acupuncture and chinese medicine drugs xiaodan and
    Xiaodianlin, who do not know if they help anyone except
    followers of these areas of medicine.

Summing up the prospects for the treatment of vitiligo,
recognize that this process is laborious and laborious, leading to
recovery in about 20% of cases with spontaneous healing
approximately 5% of patients.

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