The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: " Why not self-medicate?". Vitiligo is a skin disease in which the dermis loses its natural pigmentation due to the breakdown of melanin in the body. As a result of this process, pigment disappears in some areas of the skin and white spots form.
In medical practice, vitiligo is also referred to as leukoderma. From Latin, this name of the disease is translated as "white skin". According to statistics, the syndrome of "white skin" affects about 1% of the total population of the planet. The disease does not depend on the place of residence and race. 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 discovered that they had problems during this period.
Classification of the disease
Depending on the location of the spots, vitiligo can be classified into 3 main categories - generalized (throughout the body), localized (in certain areas) and universal (practical complete loss of pigmentation). Such types can be divided into peculiar subgroups.
There is also a classification of vitiligo according to the characteristics of the resulting patch. According to this feature, the division into a three-color, four-color, blue and inflamed spot is known. The disease also proceeds in several directions. It can have a progressive appearance with a permanent increase in areas of depigmentation, a stable appearance and an unstable appearance in which spots may 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 impaired. This type of vitiligo is commonly associated by specialists with various autoimmune diseases.
Non-segmental vitiligo is most often bilateral and symmetrical in distribution. When new areas with depigmented skin appear, the disease becomes unstable. Such vitiligo tends to regress or improve the clinical picture. A disease is considered stable, in which during the year there are no changes with previously formed spots.
Non-segmental vitiligo, in turn, can be subdivided into mucosal, focal, generalized, acrofacial, and universal subtypes.
Segmental type of vitiligo or subtype B implies a process of skin depigmentation that visually extends along the direction of nerves or nerve plexuses on the surface of the skin, by analogy with the incidence of herpes zoster. Segmental vitiligo is commonly associated by dermatologists with diseases of the sympathetic nervous system.
The segmental type of the disease is subdivided into unisegmental, bisegmental, multisegmental, mucoid, or focal subtypes. Most often, segmental vitiligo is manifested by one large white spot on the surface of the skin (in 90% of cases), but it can also appear in 2-3 affected segments. In this case, each of the segments in this case is located on one side of the body.
Segmental vitiligo is most common in young adults. After 1 year, the disease becomes stable, representing an example of mosaicism on the surface of human skin. The segment of the lesion usually extends along Blaschko's lines, less often it can take a dermatomal form following the location of the nerve fibers, a phylloid or leaf-like configuration, or be placed in a checkerboard pattern. Along the edge, the white spot is smooth or uneven. Sometimes there are cases of a genetic disease - leukotrichia (albinism).
In localized vitiligo, patchiness is located in certain places on the body. This type of disease can be represented by a focal subtype, when the spots are located on only 1-2 parts of the body, a segmental subtype, in which all the spots are strictly on one side of the body, and a mucous subtype, when the absence of melanin affects only the mucous membranes of the human body.
The most common form of the disease is the generalized type of the disease. With this type of vitiligo, depigmented spots are localized on the surface of the entire body. At the same time, there are certain subtypes of the generalized form. In particular, when placing white spots in the face and limbs, experts talk about acrofacial vitiligo, with symmetrical localization of spots throughout the body - about vulgar vitiligo, and with a combination of all types of spotting - about a mixed form.
All of the above types of disease represent almost 100% of all cases of manifestation of the disease under consideration in clinical practice. However, in very rare cases, vitiligo can appear in patients as almost 100% loss of skin pigmentation. This form of vitiligo is usually qualified as universal and considered the most rare.
People are not born with the disease in question. It occurs as a result of pathological processes and changes in the body. In childhood (up to 10 years), vitiligo develops very rarely. Sometimes experts talk about the relationship between the development of vitiligo and periods of increased solar activity in the spring and summer.
The most common causes of vitiligo are:
- Autoimmune processes in the body. They cause immune 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. Such conclusions about the relationship between vitiligo and autoimmune processes are based on the fact that patients with the pathology under consideration often have concomitant diseases - rheumatoid arthritis, systemic lupus, and thyroid pathology.
- Genetic predisposition. The American scientist R. Spitz experimentally proved that the family factor plays an important role in this pathology. Brown-eyed people are also more prone to vitiligo.
- Endocrine pathologies. Thyroid dysfunction and hormonal fluctuations can trigger the development of vitiligo. These factors are commonly referred to as the neuroendocrine causes of vitiligo. These may also include dysfunction of the ovaries, adrenal glands, pituitary gland, pancreas.
- Trophic skin disorders. Emerging 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 under the influence of ultraviolet light, depigmentation of the skin begins to progress. This is how trophic disorders occur.
- The use of drugs sometimes also causes the pathology in question.
- Pathological processes of the liver with biliary stasis, diseases of the gastrointestinal tract (malabsorption, dysbacteriosis) disrupt the absorption of trace elements and deprive the skin of part of the nutrients it needs ( zinc, copper, manganese ), which are needed for the formation of melanin.
- The effect of chemicals on the skin. Under the influence of low-quality household chemicals and cosmetics, chemical reagents such as phenol, formaldehyde, and compounds containing them, the destruction of melanin in skin cells can also be provoked.
Specialists draw attention to the fact that vitiligo in the body is just the tip of the iceberg, demonstrating pathological processes that can have an infectious, traumatic, intoxication etiology. For example, problems with the thyroid gland are observed in more than 10% of all patients suffering from the pathology in question.
Among the main endocrine pathologies that can cause the disease in question, doctors name:
- changed, observed in 86% of patients with vitiligo;
- hyperthyroidism - diagnosed in 12% of patients;
- Hypothyroidism is a rarer comorbidity of vitiligo, occurring in only 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 concomitant 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 in any part of the skin. The lesion will necessarily be symmetrical, most often it first occurs on the face near the eyes and mouth or on the palms, feet and genitals.
Sometimes an intensely colored border appears around discolored skin spots on healthy skin. If vitiligo begins to appear on the scalp, then the hair may also become discolored. When vitiligo is detected, new spots may appear in places where some injuries, cuts, bruises, and sunburn have recently been observed. Therefore, if there is a manifestation of vitiligo in the form of small spots, you should not get involved in sunbathing, otherwise there is a risk of their spread throughout the body.
Vitiligo spreads quite quickly, the skin rapidly loses melanin and, for this reason, pigmentation in the affected areas of the body. At a certain point, this process may slow down, but at any opportunity (exacerbation of a chronic disease, influenza, etc.), the prevalence of vitiligo may again expand. The cycles of the development of the disease can be repeated many times, while predicting or explaining their occurrence is completely impossible, which makes it difficult to effectively treat the disease.
In the area of the discolored area of the skin, the activity of the sweat glands is disturbed. When exposed to sunlight, areas of the skin with white spots never form a tan, although the epidermis will darken in unaffected areas. Each case of vitiligo is unique, sometimes the process of skin discoloration can begin with redness, which will gradually lose pigment and turn white.
Often, along with vitiligo, patients develop diseases such as porphyrin disease, alopecia areata, white skin atrophy, scleroderma, and others. The main distinguishing feature of vitiligo is the complete absence of peeling in the lesion. The chronic nature of vitiligo prevents its rapid and complete cure. Even the smallest imperceptible speck over time can begin to grow and discolor on the rest of the skin.
The spread of vitiligo is usually slow, from a small speck to noticeable manifestations can take several years, and sometimes the development takes the entire life of the patient. There are cases in medicine when the clinical picture of vitiligo disappeared on its own without any therapy, but this is extremely rare. To date, no effective and reliable means for the treatment of the disease in question have been found.
Difference from other diseases
A feature of the manifestation of vitiligo is a clear contrast in the color of the spots in relation to healthy skin. The smooth surface of milky-white or snow-white spots with pityriasis-like edges does not have redness or signs of inflammation. It is easy to distinguish vitiligo from birthmarks - all spots with this disease are exactly the same in color.
In most dermatological diseases, the surface of the skin begins to peel off, itch, the person sleeps poorly and constantly combs the damaged areas. With vitiligo, such problems do not exist, spots do not declare themselves in any way, except for visual perception. Their only "living" manifestation is a periodic increase in the size of the white zones. Therefore, it is very easy to distinguish vitiligo from any skin problems, it is almost impossible to confuse the symptoms, it is characteristic only of the problem under consideration.
Do spots itch with vitiligo
The patient does not feel any subjective sensations when vitiligo occurs. This applies to soreness, itching, swelling of the skin at the sites of lesions. However, very rarely, some patients complain of itching spots with vitiligo. This is evidence of a secondary lesion of the skin, the influence of the sun, cosmetics, and other aggressive influences on it, but not vitiligo. The dermis, which has lost melanin, loses its own protective functions along with it, which means it becomes sensitive to any very weak impact.
Stages of the disease
Onset of development
The development of the disease begins with the appearance of one small white spot localized in any part of the body. Other dyschromias on the skin differ from vitiligo in the absence of peripheral hyperpigmentation along the contour of the spot. This means a thickening of the pigment on a healthy area of \u200b\u200bthe skin around the white zone in the form of a kind of contour. Primary spots of vitiligo tend to grow, increase the number of foci, in the future they can merge and form extensive depigmented areas.
Depending on the degree of melanocyte dysfunction, vitiligo can appear as milky or snow-white patches. In this case, the loss of melanocytes can occur gradually, and initially milk spots can become completely white over time. The reasons for this process have not yet been established.
Stable and unstable development
The development of vitiligo can be stable or unstable. Under stable development is meant such a course of the disease, in which for several years the previously occurring spots do not undergo changes. With an unstable flow, the spots that originally appeared may disappear, but instead of them, new ones will form in other parts of the body, or existing spots may change their shape and size both in the direction of decrease and increase.
Experts speak of the progression stage in vitiligo when, within 3 months, existing spots increase significantly in already depigmented areas and new ones appear. A slow progression is observed if a new one appears next to the already formed depigmented zone in a few months. Such a progression is considered natural in the course of this pathology, but fulminant vitiligo, in which spots grow in number and size in a matter of weeks, is an anomaly.
Over time, all vitiligo patches usually increase in size, merge, and new manifestations appear, which is evidence of the classical progression of pathology. Before the appearance of a new spot in its place, shortly before this, a slight burning sensation, a feeling of goosebumps, may be felt. Given the diversity of manifestations and the unknown etiology, the disease in question is difficult to completely cure. If treatment is effectively started in the first stages, then it is possible to achieve restoration of melanin production and repigmentation of the skin. However, it is more common in children under 4 years of age. If it is impossible to restore pigmentation in the affected area, specialists move on to combat the spread of the process and strive to achieve remission, that is, the cessation of the growth of spots.
However, remission does not indicate a cure for the disease. Psychogenic and immune factors may well cause the re-growth of vitiligo at any time. That's why vitiligo patients need to monitor their health and nutrition.
Diagnosis of the disease
During diagnostic procedures, specialists must take into account the appearance of the resulting spots on the skin, which are very specific to vitiligo and do not resemble manifestations of other diseases.
To obtain additional information about the course of the disease, the specialist refers the patient to a series of tests. Sometimes it is important to know in what period vitiligo began to appear, how long it lasts, whether there is a tendency for the lesion to spread, whether the patient has a hereditary predisposition to such a disease.
When diagnosing vitiligo, it is important to understand whether only one factor caused the onset of the disease, or a combination of specific body conditions led to such consequences. This will play a role in prescribing treatment and preventing future recurrence of the disease.
Treatment of vitiligo
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 a laboratory study of the biomaterial is required to confirm the diagnosis.
Therapy for confirmed vitiligo consists in prescribing drugs from various pharmacological groups, depending on the causes that caused this pathology.
For example, glucocorticoids (drugs 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, Elocom, Sinalar, Dermovate) for course use;
- generalized form of pathology in tablet form (Prednisolone, Dexamethasone, Methylprednisolone).
Since vitiligo is rarely treated without the use of ultraviolet radiation, photosensitizing drugs that increase the sensitivity of melanocytes to ultraviolet radiation are also indicated for patients. Among the means of similar action with plant nature, Beroxan, Oxoralen, Meladinin, Ammifurin, Psoberan and Psoralen stand out today. For parallel suppression of T-lymphocytes and inhibition of the body's immune response, Protopic and Elidel are used, used at any age, starting from early childhood. All therapy with the above drugs should be administered in courses.
Systemic therapy, in addition to the main tasks, should solve the problem of getting patients out of depressive states, eliminate hormonal disruptions, and positively influence the pathologies of the nervous system. All patients with vitiligo are prescribed multivitamin complexes with copper and ascorbic acid, various immunomodulators and antioxidant drugs.
Among the newest methods for the treatment of vitiligo, today there are laser therapy, skin whitening procedure, melanocyte transplantation, transfer of own pigment cells, and the use of placental drugs. Laser therapy affects the affected areas of the skin using radiation of a certain wavelength.
Local manifestations of the disease in the early stages are best treated with laser.
With the help of skin whitening procedures, the tone of the entire surface of the epidermis is evened out, the areas cease to contrast with each other. For skin whitening, various injectable preparations are used, such as Monobenzone or Elokvin, which have a number of significant contraindications and a high price.
Melanocytic transplantation is proposed for small areas of affected skin. This is a technique of surgical transplantation of one's own healthy skin to the affected areas. At the same time, it is important to understand that the skin often does not take root, the transplant sites can fester, and doctors do not give any guarantee that this will stop the pathological process in the body.
Experts are striving to develop an effective vaccine that will target the body's autoimmune response that causes vitiligo. To date, the most effective is the combined treatment of the disease, including both a surgical technique and drugs.
It is also customary to include diet in the treatment of vitiligo, since it is important that a sufficient amount of copper is introduced into the diet to improve the course of the disease. Foods rich in copper, such as apples, seafood, cabbage, tomatoes, can also prevent the onset of pathology to some extent. It is important to use rice, corn and oats for vitiligo, which contain a lot of zinc necessary for the body.
Contraindications for vitiligo
Is it possible to get tattoos
Dermopigmentation or therapeutic tattooing of vitiligo is a technique for filling the affected areas of the epidermis with special compositions for smoothing skin tones. However, tattooing for vitiligo can be performed only after agreement with the attending physician, since only he can determine the presence of indications for tattooing and exclude the possibility of risks, including allergic ones, from such actions.
To maximize the effect of the tattoo, the master selects a specific drawing technique and follows a previously developed algorithm of actions. If all the procedures are followed, and the qualification of the specialist is at the proper level, then the masking of the skin defect looks very natural and natural.
After dermapigmentation, it is very important to carry out competent subsequent skin care. Restoration of the skin after such a tattoo will occur in a completely different way, as it happens after an ordinary permanent make-up (tattoo). Effective skin healing becomes possible only with the use of certain ointments or gels, as well as sunscreens in cosmetics.
If the skin heals painlessly, the cosmetic medical tattooing procedure must be repeated. A month after the initial procedure, a planned correction of the work performed is carried out. If necessary, adjustments can be made not once, but several times, which ultimately leads to the final result only after 3-4 months. If you correctly follow the rules of care, medical tattooing with vitiligo stays on the skin for up to 5 years.
Sea and sunbathing
Sunbathing for vitiligo is indicated for medicinal purposes, but sunbathing must be done with the utmost care, since discolored skin is very sensitive to ultraviolet rays and burns. When treating with special ointments, special ultraviolet irradiation is required on the treated areas of the epidermis to achieve the effect of darkening the skin. Also, ultraviolet on the skin with vitiligo gets during physiotherapy treatment under an ultraviolet lamp.
A tanning bed for vitiligo can be dangerous, but natural sun tanning during a period of minimal activity can even be beneficial. You should go out into the sun 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 non-tanned skin, the latter are less noticeable than on dark skin.
Is there a danger?
Vitiligo symptoms are only painless white spots on the skin of the body, rarely there is a change in the color of the iris or a decrease in visual acuity. Other consequences of this disease are not known to medicine, but most likely they are not, because vitiligo is just an indicator of the totality of processes inside the body, and not the cause of the disease.
The danger for the development of vitiligo can be hidden in various everyday situations. For example, to trigger skin discoloration, it may be enough for a person to encounter chemicals, such as phenols contained in hair dye, household chemicals and other similar products.
Treatments for disease can also be dangerous on an individual basis. For example, during pregnancy, women with vitiligo should not use ultraviolet radiation to activate melanin in the skin.
Stress should also be avoided if vitiligo is diagnosed. As a preventive measure, you can not choose the type of activity associated with permanent injury to skin areas, since this can provoke the development of the disease in the future.
It is important to know exactly how skin disease responds to UV exposure. In some cases of vitiligo, without sunscreen cosmetics, a person cannot leave the house even in winter, in others, one can even be irradiated specially without using protection. However, this issue must be clarified before the skin is permanently damaged. As for the increased risk of developing skin cancer in vitiligo, most experts tend to believe that it does not exist.
Serving in the military with vitiligo
Vitiligo disease is a reason for exempting a conscript from compulsory military service. However, he will be able to receive such an exemption only if he has multiple spots all over his body in an amount of 3 or more spots in size from 10 centimeters or has at least two spots in the face area with a diameter of 3 centimeters or more each. In such cases, the conscript is enrolled on the medical board as part of the reserve for health reasons.
If at least one of the above points is not observed, the young man is taken to the service. However, when changes in the color of the skin are detected, recruits are examined for the presence of severe endocrine or nervous disorders. If during additional diagnostics other pathologies are revealed in a conscript, he is released from military service and gets registered in a medical institution, where he will be observed by an endocrinologist or a neurologist.