Vitiligo - a kind of skin disease in which skin loses its natural pigmentation due to destruction of melanin.This results in discoloration of the skin and its diversity.Folksy Russian name of the disease sounds like "Pes" that most likely is connected with such a diversity of skin in vitiligo.
Another name for the disease - leucoderma, which translated from Latin means white skin.The name of the vitiligo can be derived from the Latin "vitilum" (error, defect) or "vitilus" (calf), associating with both disorders in skin color, and with the diversity of bovine hides.
Skin With this feature a person is not born, but becomes it under the influence of various external and internal factors.The highest incidence of the disease debuts occur within the first ten years of life, adolescence, as well as pregnancy and menopause in women.It is also noted the connection the first signs of the disease with periods of higher solar activity (spring and summer).
factors that trigger the appearance
in which the body's own antibodies appear to tissues, play an important role in the occurrence of vitiligo.This is confirmed by the fact that patients with vitiligo are often found, and other autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, destruction of the thyroid gland, for example, Hashimoto, type 1 diabetes, Addison's disease, alopecia baldness).
There is a genetic predisposition to vitiligo.This position is shown in experiments R.Sprittsa the University of Colorado.They have established not only the relationship with a family history of the disease, but also proved that people with light (gray or blue eyes) less likely to suffer from vitiligo than brown-eyed.Also, the frequency of the disease is higher in blacks.
This sharp fluctuations in hormone levels and stress, which can trigger the onset of disease.
This violation of nutrition of the skin and underlying tissues are associated with skin trauma (mechanical, chemical, radiation damage).So after the mechanical integrity of the skin disorders triggered inflammatory reaction with an autoimmune component, which leads to the destruction of cells that produce the pigment melanin.Frequent exposure to the sun is already available depigmetatsii process of skin quickly and significantly progresses.
drugs and certain chemicals can also cause the appearance of areas of skin depigmentation.
There vitiligo relationship with liver abnormalities (changes parnehimatoznymi and stagnation of bile), and worm infestation and Giardia.
At the tissue level associated with Vitiligo melanocytes dying off and cellular - with tyrosinase inhibition - the enzyme that is involved in pigmentation.
symptoms of vitiligo
The disease manifests itself in the appearance of the skin well-defined spots or foci of milky color.Typical places of their location are the areas around the mouth, ears, nose, eyes on the back of the hands and feet, the tips of fingers, armpits, elbows and knees, groin and perianal area.The boundaries of the centers of the clearer, the darker the skin of the patient.There may also be affected scalp or beard and mustache area in men.
There are several varieties of depigmented spots:
- Tricolor have pigmented circuit in place perhoda white skin healthy.
- have the additional four-strong pigmentiroannym border.
- Inflammatory restricted raised shaft.
- have appropriate Bluish color.
localized form - lesions in limited areas of the skin
- Focal disease - is often the individual single spots or lesions on any one or two areas of the skin.
- Segmental Vitiligo - sided foci within the dermatome (skin segment is supplied with a spinal or cranial nerves).
- mucous vitiligo - the defeat of the mucous membranes.
Generalized form is manifested by extensive skin changes
- vulgar vitiligo - the centers are scattered throughout the body.
- Akrofitsialnoe - struck by the face and limbs.Total
- form is also called universal, and is characterized by widespread vitiligo in many segments of the vast areas of depigmentation, occupying up to 80% of the skin.
addition to skin foci may experience other symptoms:
- lightening or graying of the hair on the affected areas,
- alopecia baldness,
- eye lesions chorioretinitis (inflammation of the posterior section of the choroid including retinal).
most patients without treatment of vitiligo is slowly but steadily progressing.Also, there are cases of depigmentation hopping or self-recovery of the pigment.
How to diagnose
Diagnostics is engaged in the dermatologist.To this end, it is based on the data of the skin examination, uses a special lamp of Wood, in the light of which the depigmentation areas have clear outlines and shining blue-white light flyuorestsuiruyuschim.If necessary, areas of the skin is taken for biopsy that confirms or refutes the diagnosis more accurate.
Not all the white spots on the skin caused by vitiligo, and to distinguish this disease accounts for a large number of pathological conditions.
Here are some of them: post-traumatic scars, hypopigmentation on the background of eczema or atopic dermatitis, chemical leukoderma, secondary syphilis, pityriasis versicolor, tuberous sclerosis, localized scleroderma.Selenium deficiency, pyachtnisty gipomelanoz, visceral leishmaniasis.Leprosy, atrophic lichen sclerosus.
Methods of treatment of vitiligo
Despite the fact that cases of spontaneous cure of the disease and self-recovery of the skin pigment are described in the medical literature without any treatment, the risks are high continuous progression of the process.Therefore, a reasonable tactic patsientadolzhna reduced to seeking medical help from a dermatologist.
Since the disease affects not only the skin but also immune.endocrine and nervous system, the treatment involves a complex approach and is divided into local and systemic use of drugs of different groups.
It is drugs that suppress inflammation (including autoimmune) and allergic reactions.
At the localized form of the disease is shown topically treated by hormonal ointments.
- first phase - an ointment with an average activity: hydrocortisone butyrate (Lokoid, Latikort), hydrocortisone butyrate (Lorinden, lokakortena) (flumethasone) ftorokort, Triakort (triamcinolone), Esperson (Dexamethasone) Alkometazon (Afloderm).Course duration - 3-4 months.
- In the absence of the effect of switching to highly ointment: mometasone furoate (Elokim), fluticasone (Kutiveyt) atseponat methylprednisolone (Advantan) Fluatsinolon (Sinalar, flutsinar) Clobetasol (Dermoveyt), Betamethasone (Celestoderm, Beloderm) course for two monthsrepeated courses of 1-4 months.
in generalized vitiligo resorted to the system receiving glucocorticoids in tablets.To reduce the side effects of this treatment (Cushing syndrome Itseno-diabetes) using pulse therapy or an alternating Pick-up Artist therapy with high doses of short, alternating certain interruptions in receiving funds.Prednisolone, methylprednisolone, dexamethasone, triamcinolone appointed in tablets.
They cause the skin to increase the sensitivity of melanocytes to UV radiation, which is under the influence of an active way of skin pigments.This group of drugs - vegetable furokumariny.
- Beroksan contains two furokumarinov parsnip (bergapten and ksantoksin).
- methoxsalen, Puvalen, Oksoralen, Lamadin contain only ksantoksin.
- Meladinin - isolated from Ami large (contains ksantoksin and imperatorin).
- Ammifurni - similar to beroksanu doplneniem izopimpinellina also isolated from Ami.
- psoralen selected from psoralen.
- Psoberan - fig.
UV lamp for treating
She irradiated skin after receiving fotosensebiliziruyuschih funds, it has a long wave radiation (320-420 nm).This method is called PUVA-treatment.It is contraindicated in pregnancy, in children under five years of age and persons over 60 years, cancer pathology, increased sensitivity to UV radiation, diseases of the blood, cardiovascular system, liver and kidneys.
more gentle way of UV irradiation areas of Vitiligo - Treatment lamp with an average wavelength (311 nm) without prior fotosensebilizatsii drugs.This method is called narrowband phototherapy.It is more gentle effect on the body, almost no side reactions, but is less effective.The treatment lasts from 1 to 5 minutes.Studies in California dermatologists argue that even long courses of ultraviolet radiation (up to 36 months) does not lead to skin cancer patients.
to deal with vitiligo, and used treatment for psoriasis and dermatitis -Elidel and Protopic.This external preparations, based anti-inflammatory drug makrolaktam ascomycin.Means suppresses T lymphocytes and inhibits the immune response, while providing anti-inflammatory activity like glucocorticoids.
Children applied 0.03% and 0.1% ointment in adults.The duration of three months to six months.The most pronounced results are achieved on the face.Worse therapy lends itself to the area of hands and feet.The preparation is used both alone and in combination with narrow-band ultraviolet radiation.The drug works only locally and is not absorbed into the bloodstream.
Systemic therapy also involves the use of the correction of hormonal disorders, the treatment of depression and neuropsychiatric diseases, which could lead to the development of vitiligo.Also appointed agents, reducing ascorbic acid deficiency, copper, immunomodulators and antioxidants.
This elimination areas of depigmentation highly directional radiation with a wavelength of 308 nm.This mechanism of action is almost similar to phototherapy.The highest efficiency is achieved in patients with localized forms of the disease and the duration of the pathological process is not more than five years.The duration of the emission of one session of a second.Other names for this method - an excimer laser or Ratokderm.
- whitening skin
This is an attempt to equalize the tone of the affected areas, and healthy skin.At present, the most popular means for this procedure - elokvina injection, hydroquinone (2-4%) and monobenzyl ether (Monobenzon) externally.All preparations are aggressive enough and have a lot of side effects, and therefore can not be considered a panacea in solving the problem of depigmentation.In addition, the price tags on them rather bite (elokvina injection costs about 50 thousand rubles), and the clarification of areas occurs, requiring almost constant use of drugs.
- Surgery or autograft skin
more effective for patients with small foci.This method is expensive, traumatic, can lead to postoperative suppurative complications or reactions of transplant rejection and, unfortunately, does not guarantee a stable effect.
- melanocyte transplantation
This entry pigment cells retrieved from the patient's own skin healthy portions of his problem skin.
- Melagenin plus
It is an alcoholic extract of human placenta, produced by Cuba.Entitled Melagenin drug appears on the market since 1998, the average efficiency is different with regard to localized forms of the disease.
- Creating vaccines
In 2013, scientists from the Medical School at the University of Chikagkskom in a series of experiments on mice, the tested vaccine protein that suppresses the autoimmune reaction leading to vitiligo.However, until today the completion of the information is not received the vaccine.
- drug Sceness
Australian drug Sceness, registered in Europe, for the treatment of erythropoietic protoporphyria, is also a term for elimination of depigmentation in vitiligo.
Treatment of vitiligo with folk remedies
- Immediately it should be noted that the uncontrolled use of plant resources fotosensebiliziruyuschih (St. John's wort, Ami, psoralen) can lead not cure vitiligo, and to sunburn.
- Such natural immmunomodulyatory like duckweed also do not give any positive effect.
- The treatment also includes herbal plants containing copper (series, arnica, yarrow) and adaptogens (Rhodiola rosea, Eleutherococcus, Aralia).
- of the interesting folk methods include acupuncture and Chinese medicines Chinese medicine and Syaodyanlin Xiaodan, who do not know whether to help someone other than the followers of these fields of medicine.
Summing up the prospects of the treatment of vitiligo, we have to admit that this process is laborious and time-consuming, resulting in the recovery of about 20% of cases in the spontaneous cure of about 5% of patients.