Vitiligo - Causes, symptoms and treatment. MF.
If we talk about such a disease as vitiligo, then different authors about him can see a lot of different interpretations. This is because the disease is poorly understood and there are no precise approaches to its treatment. It is characterized by the appearance on the skin of white spots prone to increase( the second is called "white spot disease").In 50% of cases it starts from 10 to 30 years. There is no racial accessory, but in dark-skinned or tanned people, the spots are more noticeable. The incidence of the disease is 1%.
Causes of Vitiligo
Causes are unknown, but physicians tend to consider the disease as autoimmune. Probably, who will answer exactly this question, then such a person will be awarded a Nobel Prize. Vitiligo is characterized by the death or slowing down of the function of the cell - melanocytes, participating, due to the pigment melanin, in the color of the skin. They seem to become alien in their own organism. A hereditary factor was observed in 30% of patients( a severe family history, the presence of vitiligo in one of the parents).If at least one of them has "white spots", according to the authors, the probability of this pathology in a child is 10%.It is noted that in the process of pathogenesis, diseases of the visceral system are also important: the thyroid gland, diabetes mellitus, anemia, liver disease. Sometimes the first foci appear in the projection of the suffering organ.
Symptoms of vitiligo
There are three main forms of vitiligo:
1. Focal, small spot or group of spots on a small part of the body. I must say that they have a yellowish shade.
2. Segmental, with one spot or group of spots on one side of the body, that is more common.
3. Generalized when the rash is spread all over or almost the entire skin.
Symptoms of vitiligo - light spots on the skin
Among the accompanying symptoms, it should be noted depigmentation of hair( their graying).Stains can statically stay on the body for a long time, and may increase in size, new spots may appear.
Diagnosis of Vitiligo
A dermatologist will successfully perform differential diagnostics with such conditions as: lupus erythematosus, white lichen, albinism, drug leukoderma, post-inflammatory depigmentation. The diagnosis is put on the basis of the clinical picture.
Confirms the diagnosis of a histological examination of light areas of the skin, it shows the absence of melanocytes and pigmentation on the basal layer of the epidermis.
Treatment of vitiligo
Because the exact causes of the disease are not known, there is no specific treatment, it is mostly symptomatic.
Treatment is difficult and consists of several stages:
1. Check with other specialists for everything you can. After all, the skin is the "barometer" of the internal environment of the body.
2. Avoid the sun, and with it the rest in hot countries. In parallel with this, it is necessary to use photoprotective agents with a safety factor of more than 30( for example, DNA Intensive Shield SPF 30 from the Swiss brand Valmont.) In the sunny season.
3. Recovery of skin pigmentation: puva-therapy, application of helium-neon laser, vitamin therapy( B1, Vitamin C), drugs of copper, which is not enough for this disease.
4. Cosmetic means, masking pigmentation. The effect lasts up to 2 weeks, after which the procedure must be repeated.
5. Sometimes they resort to skin transplantation, but I have a negative attitude towards this technique, because the transplanted skin is uneven, bumpy and not a fact that it does not have new vitiligo foci.
In this case it is very important to choose a course of treatment. In this we are helped and folk remedies. For example, a tincture of Echinacea, increasing the number of T lymphocytes, reduced with vitiligo. Duckweed marsh, rich in a spectrum of vitamins, has perfectly proved itself with vitiligo, duckweed is used, as is St. John's wort inside and locally. Treatment with phytopreparations is long, not less than six months, in order to achieve a tangible result. You know, in this case, I'll repeat: "To each his own, his own drug and the treatment scheme chosen by the doctor."
Until recently, the disease was designated as incurable, however, to date, various very effective methods of treatment have been tested and used in practice.it is advisable to apply on time, with the first symptoms, otherwise a small, poorly noticeable for the surrounding focus can spread and lead to unpleasant cosmetic defects.
Corticosteroid therapy with
Topical treatment with corticosteroid ointments and creams containing calcineurin inhibitors: pimecrolimus and tacrolimus. With prolonged application, corticosteroids can be quite effective, but the side effects of steroid( atrophy of the skin, the formation of telangiectasias, and the treatment of large areas of the skin surface - oppression of adrenal function, diabetes, hypertension, osteoporosis) limit their use. Calcineurin( Pimecrolimus - Elidel) inhibitors do not have similar side effects, but are much less effective than steroids, and therefore are used only in combination with other methods for treating vitiligo.
Systemic use of corticosteroids, although it may have a very positive therapeutic effect, is not widely used due to the high probability of pronounced systemic side effects: diabetes, hypertension, osteoporosis, suppression of adrenal function).
Laser therapy of vitiligo
Laser therapy using an excimer laser is acceptable for the treatment of vitiligo with a small lesion area. The method is very expensive. The newest development is the excimer laser XTRAS( USA).
Phototherapy
Phototherapy - treatment with light of a certain wavelength - with vitiligo it is used in the form of selective phototherapy, PUVA therapy, narrow-wave UVB phototherapy at a wavelength of 311 nm. Selective phototherapy is the least effective, PUVA-therapy( taking psoralens photosensitizers inside with subsequent irradiation of the skin with UVA rays) is much more effective in comparison with selective phototherapy, however, toxic effects manifested by nausea, vomiting, headache, dizziness, and the risk of skin cancerlong-term use limit the use of PUVA therapy in the treatment of vitiligo. Narrow-wave 311 nm UVB phototherapy is comparable in effectiveness to PUVA therapy( restoration of pigmentation of more than 75% of the area of vitiligo foci in 70% of patients), but it has no toxic side effects and, moreover, it is permitted for use in the treatment of children. The most noticeable curative effect is observed in the presence of foci in the face, neck, trunk and proximal parts of the extremities. With the localization of the fingers and toes, the effect is less pronounced. In addition, the foci, which occurred no more than 2-5 years ago, respond better to treatment.
Phototherapy, namely narrow-wave 311 nm UVB-phototherapy, is considered at the moment one of the most accessible and effective methods of treatment of vitiligo. The method is quite safe, and this is important for long-term use. To achieve a good effect, 30 to 100 procedures are required, with a frequency of 2-3 times a week.
Depigmentation of
Removing residual pigmentation( depigmentation) by applying 20% monobenzone to pigmented skin is a very effective method for the treatment of vitiligo with a large area of skin damage, when it is better not to restore pigmentation to skin color, but to bleach the remaining islets of normal pigmented skin(the effectiveness of the method was clearly demonstrated to the world by Michael Jackson).It should be remembered that skin bleaching with monobenzone is irreversible. Means Dy-o-derm, Dermablend also discolour normal skin. I will clarify that the skin becomes especially vulnerable to sunlight and there is a need for constant use of sunscreen.
Placental therapy of vitiligo
The method is quite new and promising, at least showed better results than all other methods of treatment of vitiligo.
For the treatment of vitiligo, preparations based on the placenta extract are used, and it is also possible to add copper and zinc hyaluronates, medicinal plant extracts( parsnip, St. John's wort, walnut) to them.
The healing properties of the placenta extract have long and successfully been used by Cuban specialists who have created on their basis well-known preparations from Vitiligo Melagenin and Melagenin-Plus. The addition of the preparation of calcium chloride significantly increases its effectiveness, since the presence of calcium ions is necessary in the process of multiplication of melanocytes, as well as for the synthesis of melanin.
Among the active components of therapeutic agents used in dermatology, a special place is occupied by hyaluronic acid and its associates with biologically active metals, called hyaluronates. Hyaluronates are closely related to the processes of proliferation, migration and differentiation of skin cells. Thus, one of the most important functions of hyaluronas is the restoration of the skin after damage of any genesis.
Hyaluronate in the body interacts with intercellular matrix proteins and cell membranes. In many enzymatic reactions, together with hyaluronates, copper- and zinc-containing proteins are involved, responsible for the normal functioning of the skin, including in the processes of melanin synthesis, proliferation and migration of melanocytes. Contained in the skin of zinc provides an antioxidant, sunscreen effect on skin tissue. The antioxidant effect is manifested in the fact that zinc cations induce the synthesis of metallothione, a protein that binds free radicals and prevents the aging and death of skin cells. These properties of zinc led us to the conclusion that it is necessary to introduce it into the composition of a new therapeutic agent.
Among copper-containing enzymes involved in the normal synthesis of melanin and the functioning of melanocytes, it is necessary to isolate tyrosinase, which provides the production of melanin( skin pigment).With a lack of tyrosinase, the pigmentation and protective properties of the skin are reduced under the influence of ultraviolet rays.
Such important functions of hyaluronic acid, copper and zinc for the normal functioning of melanocytes have led specialists to develop a drug for the treatment of vitiligo containing copper and zinc hyaluronate.
Note that inorganic preparations of copper and zinc, used to treat vitiligo, irritate the skin and in large doses are toxic to the body, inactivating the enzymatic activity of proteins. These deficiencies are smoothened in associates of hyaluronic acid with copper and zinc, since metal ions form chemical bonds with acid, losing their toxicity. Hyaluronic acid, binding metal cations, prolongs their action, slowly giving them to tissues, that is, it fulfills the depositing and transport function, while it itself participates in biochemical processes.
Preparations containing associates of hyaluronic acid with copper and zinc have a synergistic( mutually reinforcing) effect, including the beneficial properties of hyaluronic acid and biologically active metals, copper and zinc. Those.this is not a sum of organic and inorganic components, but completely new biologically active complexes.
The development of vitiligo is often associated with autoimmune processes leading to the death of melanocytes, and copper and zinc hyaluronates have an immunomodulating effect, not only activating non-specific immunity but also affecting cells participating in specific immunity reactions. Consequently, these compounds are able to normalize the immunological balance of the skin, especially if it has been disturbed. With local application, it contributes to the enhancement of natural skin protection, which is especially necessary for the depigmented area.
The extract of parsnip seeds, St. John's Wort herb and walnut peel contains the sum of various furocoumarins, and is a part of the preparation as a photosensitizing agent.
Thus, the composition containing associates of hyaluronic acid with copper and zinc, placenta extract, calcium chloride and medicinal herbs has the following effect: it has a direct effect on the enzymatic activity in melanocytes, their multiplication, differentiation and migration, has immunomodulating and antioxidant properties,protecting the skin from external and internal factors, improves metabolic processes in the skin.
Food for vitiligo
Food should contain foods rich in copper: cod liver, seafood, cabbage, tomatoes, lamb, apples, as well as containing zinc: rice, oats, corn.
Prevention of Vitiligo
After treatment, avoid contact with sunlight, even with a favorable result. Clear prevention of the disease does not exist. The only thing I will note is a moderate stay in the sun and treatment of internal diseases.
Consultation of a doctor for vitiligo
Question: Are vitiligo contagious?
Answer: Not at all.
Question: Is the risk of skin cancer high with vitiligo?
Answer: No. Same as in his absence.
Question: Is it itchy, painful?
Answer: No.
Doctor of the dermatologist Mansurov A.S.
News on Vitiligo:
Scientists have created a genetically modified protein that heals vitiligo in mice. Previous studies have shown that a key role in the disease of vitiligo is played by HSP70i, a stress-inducible protein of heat shock( activation of its synthesis occurs when the temperature rises).
The HSP70i consists of 641 amino acids. Researchers from the University of Loyola in New Orleans replaced one of these amino acids, obtaining a genetically modified version of the HSP70i. A new modified protein displaces its normal predecessor and stops the development of an autoimmune reaction.
Scientists have introduced modified HSP70i to experimental mice suffering from vitiligo and having a color "salt with pepper".After a while, the coat of mice acquired a normal black color. Similar effects were obtained in experiments on the culture of human skin cells.
Experimenters hope that research on humans will confirm the effectiveness of the new method and finally will allow to find a cure for vitiligo. True, the experiments were conducted back in 2013, and nothing more was heard of them. Perhaps the experiments stopped because of the insecurity of genetically modified development.