Vitiligo is a skin disease in which the dermis loses its natural pigmentation due to the destruction of melanin in the body. As a result of this process, pigment disappears in some areas of the skin and white spots are formed.
In medical practice, vitiligo is also referred to as leukoderma. From Latin, the name of the disease translates as "white skin". According to statistics, "white skin" syndrome affects 1% of the total population of the planet. Depending on the population, place of residence and race, the disease does not. Purely visually, such spots are more noticeable in dark-skinned people for obvious reasons. The onset of the disease most often occurs at the age of 10-30 years - in half of the registered cases of the disease, patients found themselves having problems during this period.
Depending on the localization of spots, vitiligo can be classified into 3 main categories - generalized (throughout the body), localized (in certain zones) and universal (almost complete loss of pigmentation) varieties. Such types can be divided into peculiar subgroups.
There is also a classification of vitiligo with respect to the types of blot that occur. On this basis, the division into a three-colored, four-colored, blue and inflamed spot is known. The disease also proceeds in several directions. It can have a progressive appearance with a constant increase in depigmentation zones, a stable look and an unstable look, at which spots can appear, disappear and be replaced by other spots.
Non-segmental vitiligo or type A classification includes any form of the disease in which the activity of the sympathetic nervous system is not disturbed. This type of vitiligo is usually associated with various autoimmune diseases by specialists.
Non-segmental vitiligo, most often, bilateral and symmetrical in the distribution zone. With the emergence of new areas with depigmented skin, the disease becomes an unstable type. Such vitiligo is prone to regress or improve the clinical picture. A disease is considered to be stable, during which there is no change during the year with the previously formed spots.
Non-segmental vitiligo, in turn, can be subdivided into mucous, focal, generalized, acrofacial and universal subspecies.
The segmental type of vitiligo or subtype B implies such a process of depigmentation of the skin, which visually spreads along the direction of the nerves or nerve plexuses on the surface of the skin, by analogy with the incidence of shingles. Segmental vitiligo is usually associated in medical circles with diseases of the sympathetic nervous system.
The segmental type of the disease is subdivided into single-segment, bisegmental, multi-segment, mucous or focal subtypes. Most often, segmental vitiligo is manifested by one large white spot on the skin surface (in 90% of cases), however, 2-3 affected segments may also appear. In this case, each of the segments in this case is located on one side of the body.
Most often, segmental vitiligo is characteristic of young people. After 1 year, the disease becomes stable, representing an example of mosaicism on the surface of human skin. The lesion segment usually spreads along the lines of Blashko, less often it may take a dermatomic form following the location of the nerve fibers, phylloid or leaf-like configuration, or be placed in a checkerboard pattern. On the edge of the white spot is smooth or uneven. Sometimes there are cases of congenital settlement - leukotrichia.
When localized vitiligo spotting is located in certain places on the body. This type of disease can be represented by a focal subtype when the spots are located only 1-2 areas of the body, a segmental subtype in which all spots are strictly on one side of the brow, and a mucous subtype when the absence of melanin affects the mucous membranes of the human body only.
The most common form of the disease is a generalized type of disease. With this type of vitiligo, depigmented spots are localized on the surface of the whole body. At the same time, there are certain subtypes of the generalized form. In particular, when placing white spots in the face and extremities, experts talk about acrofacial vitiligo, with symmetric localization of spots throughout the body - about vulgar vitiligo, and when combining all varieties of spotting - about a mixed form.
All of the above types of the disease describe almost 100% of all cases of manifestation of the disease being encountered in medical practice. However, in very rare cases, vitiligo can look like in patients as almost 100% loss of pigmentation on the skin. This form of vitiligo is usually called universal in medicine and considered the most rare.
With the disease in question, people are not born. It arises from pathological processes and changes in the human body. In childhood (up to 10 years) vitiligo develops very rarely. Sometimes experts talk about the relationship of the development of vitiligo with periods of increased solar activity in the spring and summer.
The most common causes of vitiligo, which experts call in their practice, are:
- Autoimmune processes in the body. They cause immunity dysfunction, which is why antibodies designed to destroy foreign microorganisms begin to fight their own healthy cells, causing a complex of pathological conditions, including vitiligo. Similar conclusions about the relationship of vitiligo and autoimmune processes are based on the fact that in patients with the pathology in question, associated diseases are very often detected - rheumatoid arthritis, systemic lupus, and thyroid pathology.
- Genetic predisposition. The American scientist R. Spitz experimentally proved that the family factor in this pathology plays an important role. Brown-eyed people are also more prone to vitiligo.
- Endocrine pathology. Malfunctions of the thyroid gland and hormonal fluctuations can trigger the development of vitiligo. These factors are called neuroendocrine causes of vitiligo. These may also include malfunctions of the ovaries, adrenal glands, pituitary, pancreas.
- Trophic skin disorders. The resulting skin problems due to injuries, burns can provoke the formation of vitiligo foci. The cells responsible for the production of melanin are destroyed, an autoimmune process is triggered in the inflamed layers of the skin, and the depigmentation of the skin begins to progress under the influence of ultraviolet radiation. So there are trophic disorders.
- Taking medications sometimes also causes the pathology in question.
- Pathological liver processes with biliary congestion, gastrointestinal diseases (malabsorption, dysbacteriosis) interfere with the absorption of enzymes and deprive the skin of part of the necessary nutrients (zinc, copper, manganese) that are necessary for the healthy formation of melanin.
- The effect of chemicals on the skin. Under the influence of poor-quality household chemicals and cosmetics, reagents and phenol, formaldehyde, and agents containing it, the destruction of melanin in skin cells can also be provoked.
Experts pay attention to the fact that vitiligo in the body is only the tip of the iceberg, demonstrating pathological processes that may have an infectious traumatic, intoxication nature. For example, more than 10% of all patients suffering from the pathology under consideration have thyroid problems.
Among the main endocrine pathologies that can cause the disease in question, doctors call:
- goiter 1 and 2 degrees, in which the thyroid function is not changed, is observed in 86% of patients with vitiligo;
- hyperthyroidism - diagnosed in 12% of human patients;
- hypothyroidism is a more rare concomitant vitiligo pathology, it occurs only in 2% of patients.
Thus, the relationship between the clinical picture of vitiligo and endocrine diseases can be traced very easily. That is why doctors pay special attention to the diagnosis of various parallel diseases, if the patient turns to them with diseases of the skin.
Symptoms of the disease
The first sign of the onset of vitiligo can be considered the disappearance of pigmentation on any part of the skin. The lesion will necessarily be symmetrical, most often it first appears on the face, near the eyes and mouth, or on the palms, feet, and genitals.
Sometimes around the bleached skin spots on a healthy skin, an intensely colored rim appears. If vitiligo begins to appear on the scalp, the hair may also become discolored. If vitiligo has already appeared, then new spots may appear in those places where some injuries, cuts, bruises, sunburn were observed recently. By the way, if a person already has at least a small manifestation of vitiligo, you should not get involved in sunbathing, otherwise there is a risk of spreading the clinical picture through the body.
Vitiligo spreads very rapidly, the skin is rapidly losing melanin, and for this reason pigmentation in the affected areas of the body. At some point, this process may slow down, but at any opportunity (exacerbation of a chronic disease, flu, etc.), vitiligo can gain momentum again. The development cycles of the disease can be repeated many times, while it is absolutely impossible to predict or explain their occurrence, which prevents effective treatment of the disease.
In the zone where the skin has already faded, the activity of the sweat glands is disrupted. When exposed to sunlight on the skin with white spots, a tan never forms, although the epidermis will darken in non-affected areas. Each case of vitiligo is unique, sometimes the process of skin discoloration can begin with redness, which will gradually lose pigment and become white.
Often, along with vitiligo, patients develop diseases such as porphyrin disease, alopecia alopecia, white skin atrophy, scleroderma, and others. The main distinguishing feature of vitiligo is the complete absence of desquamation upon lesion. The chronic nature of vitiligo interferes with its quick and complete recovery. Even the smallest imperceptible spot may eventually grow and discolor the rest of the skin.
The spread of vitiligo is usually slow, from a small speck to noticeable manifestations may take several years, and sometimes the development takes the whole life of the patient. There are cases in medicine when the clinical picture of vitiligo suddenly disappeared on its own without any therapy, but this is not so common. To date, an effective and reliable means for the treatment of the disease in question has not been found in science.
Difference from other diseases
A feature of the manifestation of vitiligo is a clear contrast of the color of the spots in relation to healthy skin. The smooth surface of milky-white or snow-white spots with scaly edges does not have redness or signs of inflammation. It is easy to distinguish vitiligo from birthmarks - all spots with this disease are absolutely the same in color.
In most dermatological diseases, the surface of the skin begins to peel off, itch, a person does not sleep well and constantly comb the areas of damage. When vitiligo such problems do not exist, the spots do not assert themselves, except for visual perception. Their only "living" manifestation is the periodic increase in the size of white areas. Therefore, it is very easy to distinguish vitiligo from any skin problems, it is almost impossible to confuse symptoms, it is characteristic only of the problem under consideration.
Does vitiligo stains scratch
The patient does not feel any subjective feelings when vitiligo occurs. This applies to pain, itching, swelling of the skin in places of lesions. However, very rarely, some patients may say that vitiligo spots they itch. This is evidence of a secondary lesion of the skin, the influence of the sun, cosmetics, other aggressive effects on it, but not vitiligo. The dermis, which has lost melanin, loses with it its own defense functions, and therefore becomes sensitive to any of the weakest effects.
Stage of the disease
Start of development
The debut of the disease begins with the appearance of one small white speck, localized in any part of the body. Other dyschromies on the skin differ from vitiligo by the absence of peripheral hyperpigmentation along the contour of the spot. This means thickening of the pigment in a healthy area of the skin around the white area in the form of a peculiar contour. Primary patches of vitiligo tend to grow, increase the number of foci, in the future they can come to a merger and form extensive depigmented areas.
Depending on the degree of malfunction of the melanocytes, vitiligo can manifest itself as milky and snow-white spots. At the same time, the loss of melanocytes can occur gradually and initially the milk spots may eventually become completely white. The reasons for this process has not yet been established.
Stable and unstable development
The development of vitiligo can be stable and unstable. Stable development means such a course of the disease in which over the course of several years the previously occurring stains do not undergo modifications. In the case of an unstable course, the originally created spots may disappear, but instead of them, new areas will form in other parts of the body, or existing spots may change their shape and size both downwards and upwards.
Experts speak about the stage of progression in vitiligo in the case when the existing spots increase significantly over 3 months, the old depigmented zones grow and new ones appear. A slow progression is observed if, in a few months, a new one appears next to the already formed depigmented zone. Such a progression is considered natural in the course of this pathology, but lightning vitiligo, in which in a matter of weeks the spots grow in both quantity and size, is an anomaly.
Over time, all spots of vitiligo usually increase in size, merge, new manifestations arise, which is evidence of the classic progression of pathology. Before the appearance of a new spot in its place, a slight burning sensation, goose bumps, may be felt shortly before it. Given the diversity of manifestations and not established causes, the disease in question is poorly curable. If the treatment is effectively started in the early stages, then melanin recovery and repigmentation of the skin can be achieved.However, this happens more often in children under 4 years of age. If it is impossible to restore the pigment in the affected area, the specialists move to combat the spread of the disease and seek to achieve remission, that is, to stop the growth of spots.
However, having achieved remission, one should not think that the disease has stopped. Psychogenic and immune influencing factors may well cause re-growth of vitiligo at any point in time. That's why vitiligo is vital to monitor your health and nutrition.
Diagnosis of the disease
In diagnostic procedures, specialists necessarily take into account the appearance of skin blemishes, which are very specific for vitiligo and are not similar to the manifestations of other diseases.
For more information about the course of the disease, the specialist will refer the patient to a series of tests. Sometimes it is important to know at what period vitiligo began to appear, how long it lasts, whether there is a tendency to increase pathology, whether there is a hereditary predisposition to a similar disease in a patient.
In the diagnosis of vitiligo, it is important to understand whether only one of some factors caused the onset of the disease, or a combination of specific conditions of the body led to such consequences. This will play a role in prescribing treatment and in preventing future disease recurrence.
If white spots appear on the skin, a visit to a dermatologist should not be postponed. Only a doctor with the help of a special examination with a lamp will be able to determine the nature of the disease and its cause. Sometimes to confirm the diagnosis requires the delivery of biomaterial for analysis.
Therapy of confirmed vitiligo consists in prescribing drugs from various pharmacological groups, depending on the reasons that caused this pathology.
For example, glucocorticoids (agents that suppress autoimmune changes and allergies) are prescribed for vitiligo in the case of:
- localized form of the disease in the form of ointments, creams with an average degree of activity of active agents (Esperson, Elok, Sinalar, Dermoveit) for course use;
- generalized form of pathology in pill form (Prednisolone, Dexamethasone, Methylprednisolone).
Since vitiligo therapy rarely does without the use of ultraviolet radiation, patients are also shown to take photosensitizing drugs that increase the sensitivity of melanocytes to ultraviolet light. Among the means of such action with the plant nature today stand out are Beroxan, Oksoralen, Meladinin, Ammifurin, Psoberan and Psoralen. For parallel suppression of T-lymphocytes and inhibition of the immune response of the body using Protopic and Elidel, used at any age, starting with an early child. All therapy with the above drugs should have a course basis.
Systemic therapy, in addition to the main tasks, should solve the problems of removing patients from depressive states, eliminate hormonal disruptions, and have a positive effect on the pathologies of the nervous system. Multivitamin complexes with copper and ascorbic acid, various immunomodulators and antioxidant drugs are prescribed to all patients with vitiligo.
Among the newest methods of treatment of vitiligo today are laser therapy, skin whitening procedure, melanocytic transplantation, the transfer of their own pigment cells, the use of placental preparations. Laser therapy affects the affected skin with radiation of a specific wavelength.
The laser is best treated with local manifestations of the disease in the early stages.
With the help of skin whitening procedures, the tone of the entire surface of the epidermis is leveled, the areas no longer contrast with each other. For skin whitening, various injection preparations are used, such as Monobenzone or Eloquin, which have a number of significant contraindications and high price.
It is proposed to carry out melanocytic transplantation in small areas of the affected skin. This is a method of surgical transplantation of your own healthy skin to the affected areas. It is important to understand that the skin often does not survive, the transplantation sites may fester and the doctors do not give any guarantee that this will stop the pathological process in the body.
Experts seek to develop an effective vaccine, the action of which will be aimed at eliminating the autoimmune reaction of the body, leading to the occurrence of vitiligo. To date, the most effective is the combined treatment of the disease, including both surgical techniques and drugs.
It is also customary to attribute a diet to the complex of treatment of vitiligo, since to improve the course of the disease it is important that a sufficient amount of copper is introduced into the diet. Foods rich in copper, for example, apples, seafood, cabbage, and tomatoes are also capable of preventing the onset of pathology to some extent. It is important to use for vitiligo and rice, corn and oats, which include a lot of zinc needed by the body.
The best means of traditional medicine, directed against the manifestations and causes of vitiligo, are black cumin oil, St. John's wort, duckweed, black ground pepper. These funds are able to restore the production of melanin in the skin cells, eliminate foci of pathology, stimulate local immunity.
For the preparation of concentrated oil on the basis of Hypericum, which will help cure the manifestations of vitiligo, you need to collect the flowers of this plant and tamp them tightly in a glass jar, not getting enough of them to the upper border of the container. Then pour the flowers with refined vegetable oil, any, which is pleasant and suitable - sunflower, olive, almond, sea buckthorn. A jar of butter and hunter is placed in the sun for 14 days and shaken occasionally. Then the oil is well wrung out and new Hypericum flowers are placed in it for the same period. The procedure with oil extraction and color renewal should be repeated at least 5-6 times to enhance the effectiveness of the product. Ready butter from Hypericum should be taken orally with a teaspoon before each meal or smear white spots on the outside to restore pigmentation.
For more than 3,000 years, black cumin is considered among healers and doctors to be an effective means to help cure many diseases. It is sold in health food stores and is used externally for vitiligo. First, the white spots are wiped with a cloth moistened with vinegar, and then this oil is applied to them for half an hour. When the oil is on the skin, it is highly desirable that the sun's rays also get there, then the effect will be more rapid and pronounced.
The marsh marsh rich in iodine and bromine salts is also used for the treatment of vitiligo in traditional medicine. For the preparation of an effective composition based on duckweed, it is required to chop the grass in a meat grinder, mix it with an equal amount of honey and take it three times a day before meals for several years.
Scientists from the UK have found out experimentally that the substance piperine, which is very abundant in black pepper, actively stimulates the production of melanin in skin cells. To use black pepper against vitiligo, folk healers recommend mixing an equal amount of it with the same amount of baking soda, and then rubbing the mixture into bleached spots on the skin until the pigment is formed.
Contraindications for Vitiligo
Can I do tattoos
Dermopigmentation or medicinal tattooing of vitiligo is a technique for filling the affected areas of the epidermis with special compositions for smoothing the skin tone. However, tattooing for vitiligo can be performed only after the consent of the attending physician, since only he can determine the presence of indications for tattooing and eliminate the likelihood of risks, including allergic ones, from such actions.
To maximize the effect of the tattoo, the master selects a certain technique of drawing and follows the previously developed algorithm of actions. If all procedures are followed, and the qualification of a specialist is at an appropriate level, then the masking of the skin defect looks very natural and natural.
After dermopigmentation is very important to carry out competent subsequent skin care. Restoration of the skin after such a tattoo will not happen in the same way as it happens after ordinary permanent makeup (tattoo). Effective skin healing becomes possible only with the use of certain ointments or gels, as well as sunscreens in cosmetics.
With painless healing of the skin, the procedure of cosmetic medical tattooing is required to be repeated. One month after the initial procedure, a planned correction of the work performed is carried out. If required, adjustments can be made not once, but several, which ultimately leads to the final result only after 3-4 months. If you follow the rules of care, medical tattooing for vitiligo stays on the skin for up to 5 years.
Sea and tan
Sun baths with vitiligo are shown for medicinal purposes, however, it is necessary to sunbathe with the maximum amount of accuracy, because discolored skin is very sensitive to ultraviolet rays and can be easily burned. When treating with special ointments, the treated areas of the epidermis are specifically required to be placed under ultraviolet to achieve the effect of darkening of the skin. Also, ultraviolet light on the skin with vitiligo falls during physiotherapy treatment under an ultraviolet lamp.
A visit to a tanning salon with vitiligo can be dangerous, but a natural tan in the sun during the period of minimal activity of the latter can even become useful. Going out in the sun should be early in the morning and in the evening before sunset. It is also important to remember that burns are much more painful than white spots. And on unburned skin, the latter are less noticeable than on dark skin.
Is there a danger
Manifestations of vitiligo are only painless white spots on the skin of the body, rarely you can change the color of the iris or fall in visual acuity. Other effects of this disease are not known to medicine, but most likely they are not, because vitiligo is just an indicator of some processes inside the body, and not the cause of the disease.
The danger for the development of vitiligo can be hidden in various domestic situations. For example, to start skin discoloration, a person may encounter enough chemicals, for example, phenols contained in hair dye, household chemicals and other similar products.
Also can be dangerous individually and how to treat a disease. For example, during pregnancy, women with vitiligo should not use ultraviolet radiation to awaken melanin in the skin.
Also, with diagnosed vitiligo, work stresses should be avoided. As a preventive measure, it is impossible to choose work related to rubbing of some skin areas on an ongoing basis, since this may provoke a disease in the future.
It is important to know exactly how the disease on the skin reacts to the flow of ultraviolet radiation. In some cases, vitiligo without a sunscreen cosmetics a person can not leave the house even in winter, in others - you can even be irradiated specifically without the use of protection. However, this question needs to be clarified before the skin is permanently damaged. With regard to the risk of developing skin cancer in vitiligo, most experts are inclined to believe that it does not exist.
Army service with vitiligo
Vitiligo disease is the reason for the release of a draftee from an urgent military service. However, such an exemption can be obtained only if it has multiple spots throughout the body in an amount of from 3 pieces with a size of 10 centimeters, or has at least two spots in the face area with a diameter of 3 centimeters each. In such cases, the conscript is credited to the medical commission as part of the stock for health reasons.
In case of non-observance of at least one of the above points, the young man is taken to the service. However, when changes in the skin color of conscripts are detected, they are examined for the presence of severe endocrine or nervous disorders. If in the course of additional diagnostics other pathologies emerge in a conscript, he is released from military service and enters the account in a medical institution, where he will be observed by an endocrinologist or a neurologist.
Specialty: pediatrician, infectious diseases specialist, allergist-immunologist.
Total experience: 7 years.
Education: 2010, SSMU, pediatric, pediatrics.
Experience infectious diseases more than 3 years.
He has a patent on the topic “A method for predicting a high risk of the formation of a chronic pathology of the adeno-tonsillar system in frequently ill children”. As well as the author of publications in the journals of the Higher Attestation Commission.