Vitiligo is a long-term skin condition characterized by patches of skin that lose its pigment. The affected skin becomes white and usually has a sharp margin. Hair from the skin can also be white. The inside of the mouth and nose may also be involved. Usually both sides of the body are affected. Often patches begin in areas of sun-exposed skin. This is more visible in people with dark skin. Vitiligo can lead to psychological stress and those affected may be stigmatized.
The exact cause of vitiligo is unknown. This is believed to be due to genetic susceptibility that is triggered by environmental factors so that autoimmune disease occurs. This results in the destruction of skin pigment cells. Risk factors include a family history of other autoimmune conditions or diseases, such as hyperthyroidism, alopecia areata, and pernicious anemia. It is not contagious. Vitiligo is classified into two main types: segmental and non-segmental. Most cases are non-segmental, which means they affect both sides; and in this case, the affected skin area usually develops over time. About 10% of cases are segmental, meaning they mostly involve one side of the body; and in this case, the affected skin area usually does not develop over time. Diagnosis can be confirmed by tissue biopsy.
There is no known cure for vitiligo. For those who have bright skin, sunscreen and makeup are all that is usually suggested. Other treatment options may include steroid or phototherapy creams to darken the light patch. Alternatively, efforts to relieve unaffected skin, such as hydroquinone, can be tried. A number of surgical options are available for those who do not improve with other measures. Combination treatments generally have better results. Counseling to provide emotional support can be useful.
Globally about 1% of people are exposed to vitiligo. Some populations have levels as high as 2-3%. Men and women are equally affected. About half showed abnormalities before the age of 20 and most developed before the age of 40. Vitiligo has been described since ancient history.
Video Vitiligo
Signs and symptoms
The only sign of vitiligo is the pale, pale area of ​​the depigmented skin that tends to occur in the extremities. Patches are small initially, but often grow and change shape. When skin lesions occur, they are most prominent on the face, hands and wrists. The loss of skin pigmentation is especially noticeable around the body's orifices, such as the mouth, eyes, nostrils, genitals and umbilicus. Some lesions have increased skin pigment around the edges. Those exposed to vitiligo are stigmatized because their condition may experience depression and similar mood disorders.
Maps Vitiligo
Cause
Although some hypotheses have been proposed as potential triggers that cause vitiligo, the study strongly implies that changes in the immune system are responsible for the condition. Vitiligo has been proposed to be a multifactorial disease with genetic susceptibility and environmental factors are both thought to play a role.
The TYR gene encodes a tyrosinase protein, which is not a component of the immune system, but is a melanocyte enzyme that catalyzes the biosynthesis of melanin, and the main autoantigen in general vitiligo. NIH states that sunburns can cause illness but there is no strong evidence to support this.
Early evidence shows the possible relationship with eating gluten.
Immune
Gene variations that are part of the immune system or part of the melanocytes are both associated with vitiligo. It is also thought to be caused by an immune system that attacks and destroys skin melanocytes. A genomewide association study found about 36 independent susceptibility loci for common vitiligo.
Autoimmun Association
Vitiligo is sometimes associated with autoimmune and inflammatory diseases such as Hashimoto's thyroiditis, scleroderma, rheumatoid arthritis, type 1 diabetes mellitus, psoriasis, Addison's disease, pernicious anemia, alopecia areata, systemic lupus erythematosus, and celiac disease.
Among the inflammatory products of NALP1 are caspase 1 and caspase 7, which activate inflammatory cytokines interleukin-1 ?. Interleukin-1? and interleukin-18 expressed at high levels in patients with vitiligo. In one of the mutations, the amino acid leucine in the NALP1 protein is replaced by histidine (Leu155- & gt; Nya). The proteins and their original sequences are highly sustainable in evolution, and are found in humans, chimpanzees, rhesus monkeys, and baby shrubs. Addison's disease (usually autoimmune destruction of the adrenal glands) can also be seen in individuals with vitiligo.
Diagnosis
Ultraviolet light can be used in the early phases of the disease for identification and to determine the effectiveness of treatment. Skin with vitiligo, when exposed to black light, will glow blue. Conversely, healthy skin will not react.
Classification
Classification attempts to measure vitiligo have been analyzed as somewhat inconsistent, while recent consensus has approved segmental systems of vitiligo (SV) and non-segmental vitiligo (NSV). NSV is the most common type of vitiligo.
Non-segmental
In non-segmental vitiligo (NSV), there is usually some form of symmetry at the depigmentation patch site. New patches also appear over time and can be generalized across most of the body or localized to a specific area. The extreme cases of vitiligo, to the extent that small pigmented skin remains, are referred to as vitiligo universalis . NSV can occur at any age (unlike segmental vitiligo, which is much more common in adolescence).
Non-segmental vitiligo classes include the following:
- Common vitiligo: the most common, widespread and randomly distributed pattern of depigmentation
- Vitiligo universal: depigmentation covers most of the body
- Focal vitiligo: one or more macules scattered in one area, most common in children
- Acrofacial vitiligo: fingers and periorificial areas
- vitiligo mucosa: depigmentation only mucous membrane
Segmental
Segmental vitiligo (SV) differs in appearance, cause, and frequency of related illnesses. Treatment is different from NSV. It tends to affect the skin area associated with dorsal roots of the spinal cord and most often unilateral. It's much more stable/static in the process and its association with autoimmune diseases seems to be weaker than common vitiligo. SV does not improve with topical therapy or UV light, but surgical treatments such as cell transplantation can be effective.
Differential diagnosis
Chemical leukoderma is a similar condition due to some chemical exposure. However Vitiligo is a risk factor. Triggers may include inflammatory skin conditions, burns, intralesional steroid injection and abrasions.
Other conditions with similar symptoms include the following:
- Pityriasis alba
- Tuberculoid leprosy
- Postinflammatory hypergigmentation
- Tinea versicolor
- Albinism
- Piebaldism
- Idiopathic guttate hypomelanosis
- Progressive macular hy- communelanosis
- Primary adrenal insufficiency
Treatment
There is no cure for vitiligo but some treatment options are available. The best evidence is for the applied steroids and the combination of ultraviolet light combined with the cream. Due to the higher risk of skin cancer, the National Health Service of the United Kingdom suggests phototherapy is only used if primary care is not effective. Lesions in the hands, feet and joints are the most difficult to reproduce; the easiest face to return to the natural skin color because the skin is thinner in nature.
Immune mediator
Topical preparations of immune suppressants including glucocorticoids (such as 0.05% clobetasol or 0.10% betamethasone) and calcineurin inhibitors (such as tacrolimus or pimecrolimus) are considered first-line treatment of vitiligo.
Phototherapy
Phototherapy is considered a second-line treatment for vitiligo. Exposing skin to light from UVB lamps is the most common treatment for vitiligo. Treatment can be done at home with UVB lights or in the clinic. The exposure time is set so that the skin does not undergo overexposure. Treatment can take several weeks if the spots are on the neck and face and if there is no more than 3 years. If the spots are on hands and feet and have been there for more than 3 years, it could take several months. Phototherapy sessions are performed 2-3 times a week. Spots in large areas of the body may require full body care at the clinic or hospital. Broadband and narrowband UVB lights can be used, but the selected ultraviolet narrowband about 311 NM is the choice. It has been reported constitutively that a combination of UVB phototherapy with other topical treatments enhances re-pigmentation. However, some patients with vitiligo may not see changes in the skin or re-pigmentation that occurs. Serious potential side effects involve a risk of developing skin cancer, a risk equal to excessive exposure to natural sunlight.
Ultraviolet light treatment (UVA) is usually performed in a hospital clinic. Psoralen and ultraviolet Light treatment (PUVA) involves taking drugs that increase skin sensitivity to ultraviolet light, then exposing skin to high-dose UVA rays. Treatment is required twice a week for 6-12 months or longer. Due to high doses of UVA and psoralen, PUVA can cause side effects such as sunburn or freckling of the skin.
Ultraviolet B (NBUVB) phototherapy has no side effects caused by psoralen and is as effective as PUVA. Like PUVA, treatment is done twice a week in the clinic or every day at home, and no need to use psoralen.
Camouflage skin
In mild cases, vitiligo patches can be concealed with makeup or other cosmetic camouflage solutions. If a person is pale, patches can be made less noticeable by avoiding unaffected tannery.
De-pigmenting
In the case of vitiligo a wide choice to remove skin pigments unaffected by topical medications such as monobenzone, mequinol, or hydroquinone can be considered to make the skin the same color. The removal of all skin pigments with monobenzone is permanent and strong. Sun safety must be obeyed for life to avoid sunburn and severe melanoma. Depigmentation takes about a year to complete.
History
The description of a disease believed to be vitiligo dates back to a section in Ebers Papirus medical texts about 1500 BC in ancient Egypt. The term whiteness of the skin was also present around 1400 BC in the sacred texts of India such as Atharvaveda and shinto prayer in East Asia around 1200 BC. The Hebrew word "Tzaraath" from the Old Testament book of Leviticus which dates back to 1280 BC (or 1312 BC) describes a group of skin diseases associated with white spots, and subsequent translations into Greek led to their continuous merger with vitiligo with leprosy and spiritual impurity.
Medical sources in the ancient world such as Hippocrates often do not distinguish between vitiligo and leprosy, often grouping these diseases together. In Arabic literature, the word "alabras" has been associated with vitiligo, with this word found in the Qur'an. The name "vitiligo" was first used by Roman physician Aulus Cornelius Celsus in his classic medical text De Medicina .
Etymology
The etymology of the term "vitiligo" is believed to be derived from "vitium", meaning "defective" or "defective".
Research
Afamelanotide in Phase II and III clinical trials for vitiligo and other skin diseases.
The drug for rheumatoid arthritis, tofacitinib, has been tested for the treatment of vitiligo.
In October 1992, a scientific report was published about the successful transplantation of melanocytes to areas affected by vitiligo, effectively rejuvenating the region. This procedure involves taking a thin layer of pigmented skin from the patient's gluteal area. The melanocytes are then separated into cellular suspensions that are expanded in culture. The area to be treated is then rubbed with dermabrader and melanocytes graft applied. Between 70 and 85 percent of patients have almost complete skin repigmentation. The longevity of repigmentation differs from person to person. To date, several transplantation techniques have been developed, including transplantation of melanocyte precursors derived from hair follicles. Transplant procedures are often used to treat segmental vitiligo that is less responsive to other types of treatments. In vitiligo non-segmental, success is achieved when treating patches that are not developed (called vitiligo stable).
Society and culture
Changes in appearance caused by vitiligo can affect a person's emotional and psychological well-being and can create difficulties in getting or keeping a job. People with this disorder may experience emotional stress, especially if vitiligo develops in visible areas of the body, such as the face, hands, arms, legs, or on the genitals. Participating in vitiligo support groups can improve social coping skills and emotional fortitude.
See also
References
External links
- Vitiligo in Curlie (based on DMOZ)
- Questions and Answers about Vitiligo - US National Institute of Arthritis and Musculoskeletal and Skin Diseases
Source of the article : Wikipedia
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