Vitiligo is a poorly studied dermatological disease that gives a lot of aesthetic and psychological inconvenience to its owner, who lives in a modern, intolerant and timid society. However, you can try to figure out the possible causes and existing methods of treatment for this disease.
Let’s start by determining the place of vitiligo in the system of dermatological diseases. Pathology belongs to the group dyschromia cutis (skin dyschromia). The name is translated from Greek as a violation of skin pigmentation (the prefix dys- means “impaired function”, “deviation from the norm”, “difficulty”, + chroma – color, color).
Skin color in the normal state of the human body is determined by four pigments:
Melanin – responsible for the brown color.
Carotene – provides a yellow tint.
Hemoglobin, oxygenated, is found in the capillaries and has a red color.
Reconstituted hemoglobin – found in venules and has a blue color.
Most often, a change in skin pigmentation is associated with an excess or lack of melanin.
It is interesting!
While doctors are looking for the causes of vitiligo and a means to combat this disease, a cosmetological approach to the problem offers a solution in the form of tattooing. Paint is driven into the depigmented areas of the skin using a special apparatus, which allows masking white spots. There are two drawbacks to this approach: applicability only for small areas of vitiligo and the lack of treatment as such.
Thus, vitiligo refers to acquired primary dyschromia of the skin, although it has been established that in about a third of cases it is transmitted genetically. The term “vitiligo” has synonyms, including outdated ones, such as “dog”, “piebald skin”, “white spot disease”, “leukopathy”. The very word “vitiligo” (vitiligo) comes from the Latin vitium, which means “flaw”, “vice” or “lack”.
Symptoms and diagnosis of vitiligo
Vitiligo is a dermatosis caused by a dysfunction of the processes of pigmentation of the skin with the formation of depigmented spots. This disease can occur at any age, but it occurs primarily in people under the age of 20 years – in the range from 10 to 30 years, half of all cases of vitiligo develop. Vitiligo has no race, on average, its prevalence is about 1% of the world’s population, while women are more “vulnerable” to this disease
- Vitiligo is not a contagious disease.
- Vitiligo does not increase the likelihood of skin cancer.
- Vitiligo does not cause itching and soreness, in general it is safe for health.
The hair in the lesion often changes color – it bleaches, fat and sweating, vasomotor and muscle-hair reflexes are weakened. With this disease, there is a significant risk of developing the so-called solar dermatitis.
Vitiligo is accompanied by the appearance of depigmented spots of various diameters, outlines, outlined by a zone of increased pigmentation, smoothly turning into the usual color of the skin, but predisposed to peripheral growth. Occasionally, milky white spots (macula) can be observed, which are framed by a clear, towering border around the perimeter. Vitiliginous spots have a tendency to overgrow and “merge” with each other, thereby creating significant areas of localization of the disease.
Melanocytes are not found in long-formed foci of depigmentation, however, in recent formations it is possible to find a small number of them, but with obvious signs of destruction, plus the same number of melanin granules in the basal layer of the epidermis – that is, very small.
A slight expansion of capillaries and an uncritical accumulation of basophils, histiocytes, fibroblasts around them, noncritical death of some hair follicles, and inhibition of the functions of sweat and sebaceous glands are typical for vitiligo foci.
Diagnosis is usually not difficult, which cannot be said about the treatment of this type of dermatosis. To clarify the diagnosis, it is differentially compared with pityriasis versicolor, true, chemical and post-inflammatory leukoderma and some other skin diseases: idiopathic drop-shaped hypomelanosis, tuberous sclerosis, partial albinism, thereby excluding their presence.
From the point of view of the localization of vitiligo and the nature of its distribution and development, several clinical forms can be distinguished, namely:
Focal (local) form, having in its composition 3 varieties:
Focal when one or several spots are present in one focus.
Segmental, when the spots are located in the direction of the nerves or their plexuses.
Mucous when exclusively mucous membranes are affected.
Generalized form, which also includes 3 varieties:
Acrofascial, when the distal parts of the hands, feet and face are affected.
Vulgar when there is a random spread of spots throughout the body.
Mixed when the acrophascial and vulgar, or segmental and acrofascial and / or vulgar varieties are mixed.
The universal form, when there is almost complete depigmentation of the entire skin.
Dermatologists also distinguish 2 types of vitiligo:
Type A (non-segmented), which reserves all the remaining forms and varieties of vitiligo, where the sympathetic nervous system is not disturbed. Vitiligo of this type is often associated with autoimmune diseases.
Type B (segmental) implies depigmented spots distributed in the direction of the nerves or their plexuses, as in the case of shingles, and associated with impaired function of the sympathetic nervous system.
Causes of Vitiligo
The causes and mechanism of the occurrence of vitiligo are still a secret from medical science, no matter how regrettable it may be, however, there are a number of scientific hypotheses that offer certain methods of treatment. It is possible that some of them will actually be successful, after numerous clinical trials. We can list a number of scientific hypotheses about the occurrence of vitiligo, but we should not forget that the hypothesis is an unproven theory, which means that the probability of error and risk is especially high. But in the absence of other effective methods of treatment, it remains to try hypotheses in practice – only if there are volunteers and their fair knowledge of the experiment: in any case, everyone who decides to treat vitiligo is already a participant in a certain experiment, since it is not known in advance whether the prescribed scheme will help him therapy. One day, a scientific hypothesis will turn into a proven theory and someone will rightly receive a Nobel Prize for revealing the mechanism of formation and treatment of vitiligo.
Various researchers offer their own version of the etiology and pathogenesis of vitiligo – while all of them are quite vague from the point of view of evidence-based medicine, but have the right to exist, and therefore we list the main alleged reasons:
Neuroendocrine disorders, such as dysfunction of the thyroid gland, adrenal gland, pituitary gland, and gonads.
Disorders of the autonomic nervous system with a predominance of sympathicotonia, in which melancholic depression, mydriasis (dilated pupils), tachycardia, hypertension, dry mucous membranes, pallor of the face and skin as a whole, frequent constipation can be observed.
Autoimmune causes when antibodies are produced and T-killers multiply in relation to their own healthy cells and body tissues.
Family history, inheritance of the disease and the influence of trigger factors on the development of the disease; It is noteworthy that the study of vitiligo together with the main organ and tissue compatibility genes – histocompatibility (HLA system) – gave such results as the detection of HLA haplotypes: DR4, Dw7, DR7, B13, Cw6, CD6, CD53 and A19. Moreover, all this has not yet been convincingly proven.
Enzymatic deficiency of tyrosinase, an enzyme that is responsible for the oxidation of tyrosines and the synthesis of melanin in humans.
This article does not address vitiligo, the cause of which, for example, was the chemical effect (tert-butylphenol, butylpyroxatechin, polyacrylate), since in this case dermatological disease should be attributed to secondary and eventually passing leukoderma.
Methods and treatment for vitiligo
In general, based on statistics, the prognosis of treatment for vitiligo cannot be called positive. However, there are people who have completely got rid of this ailment, therefore one cannot relate to existing methods of therapy “through the sleeves”. Medicine and laboratory and hardware diagnostics do not stand in one place, but are constantly evolving.
So what should be done:
The PUVA therapy method, in which the affected parts of the body are irradiated with ultraviolet radiation of a certain intensity and wavelength. It implies the use of orally or externally photosensitizing agents that improve the perception of ultraviolet radiation – 8-methoxypsoralene (8-MOS), 5-methoxypsoralen (5-MOS) or trimethylpeorapen (TMP), psoberan, ammifurin or beroxane – after which a few hours later local or general UV radiation on special equipment. With a good combination of circumstances, after several sessions, the resumption of pigmentation on the affected areas of skin vitiligo.
Helium Neon Laser.
Glucocorticosteroid therapy – external and general: applications with creams, chipping foci, ingestion of drugs.
Vitamin therapy with Group B drugs (thiamine bromide or chloride, cocarboxylase hydrochloride, pyridoxine, cyancobalamin, nicotinic acid and others), vitamins A (including chipping of the affected areas), C.
Micro- and macronutrient therapy, primarily 0.5–1% copper sulfate, including ingestion and electrophoresis (with vitiligo, people usually have a deficiency of copper in the body), zinc, sulfur, and iron.
Diet therapy, which includes without fail such a set of products as seafood, cod liver, lamb, cabbage, tomatoes, apples, rice, oats, corn.
Herbal medicine, which involves the balanced use of, for example, duckweed, St. John’s wort (externally and inward in the form of tinctures and decoctions), echinacea, which has the ability to increase the number of T-lymphocytes, which are traditionally not enough for vitiligo. The result of herbal medicine can be noticeable no earlier than six months later.
Cosmetology in the form of such means as UV protective agents during sunny days with a degree of protection of more than 30, masking compounds: dihydrooxyacetone, Debrosan, Vitaday and others.
We warn you that in no case can you self-medicate, the tactics and strategy of therapy can only be compiled and justified by a doctor. The main thing is not to delay a visit to a dermatologist in order to prevent the spread of the disease to various parts of the skin in time.
We do not consider surgical treatment, which involves the transplantation of skin patches, as we consider this a counterproductive measure.