Vitiligo types. Vitiligo disease: causes, symptoms and treatments. Diseases of the digestive system

One of the most unexplored diseases that are very difficult to treat is Vitiligo. It is represented by white spots that appear on the skin of people in different ages. White spots are the result of the absence of melanin (pigment) in the skin layers. This article will tell you in detail what are the symptoms, causes and treatments. folk remedies at home, vitiligo disease in children and adults, will demonstrate photos of patients and give useful advice.
vitiligo disease causes

Features of the disease

Vitiligo is found in different countries. The most unpleasant thing is that this disease has become increasingly common in people of all ages. The reason for this wide prevalence has not been determined.

Most often, women go to the hospital, as well as young people whose age is less than 20 years. The disease brings inconvenience to about 1% of the world's population.

Doctors believe that this pathology does not pose a danger to health. At the same time, white spots indicate the presence of any serious disorders in the body. Also, people are concerned about the aesthetic issue. The disease manifests itself in the form of white spots, which are an unpleasant cosmetic defect.

Vitiligo is a poorly understood dermatological disease. Specific discomfort, it does not cause discomfort, but psychological, aesthetic problems are guaranteed for the patient.

The pathology under consideration was included in the group of "skin dyschromia" (dyschromia cutis). Translating from the Greek violation of skin pigmentation: "dys" - difficulty, dysfunction, "chroma" - color, color.

In the normal state, skin color is provided by such pigments:

• Carotene (yellow);
• Melanin (brown);
• Recovered hemoglobin (blue);
• Hemoglobin oxygenated (red).

Affects the change in the color of the skin. The disease in question (vitiligo) is also popularly called “white spot disease”, “dog”, “leukopathy”, “piebald skin”. Translated from Latin, vitiligo means flaw, defect. This disease is considered to be an acquired primary skin dyschromia. But a third of cases are genetically transmitted.

This video tells about what vitiligo is:

Vitiligo stages

Doctors distinguish 4 stages in vitiligo:

• I. Initial. It is characterized by the formation of a single spot on the skin. Depending on the characteristics of its development, this stage flows into one of the following.
• II. Stationary. The patient has only one spot, which does not grow for a long period, it is in a stable condition. Additional neoplasms do not appear on the epithelium of the patient.
• III. Repigmentation. It is characteristic of those cases when depigmentation was provoked by therapeutic measures, taking medicines. This stage is very rare.
• IV. Progressive. It is characterized by an increase in the number, size of white spots for several months (2 - 3). Progression can occur slowly (new spots appear very slowly around the old formation), lightning fast (the number of spots throughout the body increases rapidly. In just a week, many new white spots appear).

Forms

Given such a feature as localization, the nature of distribution, in clinical practice It is customary to distinguish 3 forms of the disease:

1. Focal. Spots are formed on different parts of the body, in foci.
2. generalized. White spots appear all over the body.
3. Universal. Depigmentation is observed on almost the entire epidermis.

Focal has 3 varieties:

• Focal. The presence in one focus of one, several spots.
• Segmental. White spots are grouped in the area of ​​the plexus of nerves or localized in their direction.
• Mucous. Spots are formed only on the mucous membranes.

The generalized form also has its own varieties:

• Acrofascial. There is a lesion of the epithelium on the hands, feet, face.
• vulgar. Spots randomly cover the epidermis of the entire body.
• mixed. It is characterized by a mixture of individual varieties, for example, vulgar + acrofascial, segmental + vulgar, acrofascial + segmental.

Dermatologists have identified 2 types of the disease (A, B):

• And "non-segmental". It is characterized by the absence of a violation of the sympathetic nervous system. In such cases, the disease in question is associated with autoimmune diseases.
• In "segmental". Violation of pigmentation is localized in the direction of the nerves, their plexuses. It is associated with a violation of the sympathetic nervous system.

Causes

In rare cases, there is an influence of a genetic factor on the occurrence of vitiligo. But this disease is not congenital. Its occurrence depends on the influence of certain factors (external, internal). Specialists noted an increase in cases of the disease during periods of increased solar activity (summer, spring).

The disease develops in the presence of such factors:

• Genetic. The relationship between genetics and disease has been experimentally proven. R. Spitz (a scientist working in the state of Colorado) confirmed the presence of a family predisposition to the occurrence of this pathology. Owners brown eyes more at risk of developing vitiligo.
• The presence of autoimmune failures. When immune function is impaired, healthy cells of the body are affected by antibodies. These conclusions were made by doctors who noticed in practice that patients suffering from skin lesions often have a concomitant disease (lupus, rheumatoid arthritis, dysfunction of the thyroid gland).
• Taking medications.
• Violation of the functioning of the endocrine gland. Malfunctions in the work of this gland, a change in the level of hormones can cause the development of vitiligo.
• Violation of the ovaries, adrenal glands, pancreas, pituitary gland.
• Diseases of the gastrointestinal tract. Due to impaired absorption of enzymes in diseases such as malabsorption, dysbacteriosis, the necessary nutrients (magnesium, copper, zinc, manganese) enter the skin in insufficient quantities. Without these nutrients melanocytes (special cells) cannot produce enough melanin for pigmentation.
• Violation of the trophism of the epithelium. Typically, trophic disorders are the result of trauma to the epithelium (microtrauma, burns, scars).
• Tyrosinase enzyme deficiency.
• The action of chemicals. The skin can be affected by low-quality cosmetics, formaldehyde, phenol.
• Violation of the functioning of the autonomic nervous system.

Vitiligo occurs when the body is weakened by injuries, infections, intoxication.

Read about the signs and symptoms of vitiligo skin disease in children and adults below.

Symptoms

The appearance of vitiligo is evidenced by the formation of white spots, perhaps initially only one such spot will appear. The depigmented spot has a milky white color, its size is small (diameter 0.2 - 0.3 cm). Over time, such a spot grows, similar neoplasms appear around it. Their shape can be oval, round, the boundaries of the depigmented area are clearly defined.

Scales do not form over white spots, the spot does not rise above the pigmented skin, it is located on a par with it. On the edge of the spot / focus of spots, an accumulation of pigment is visible. It turns out. That the spot is clearly outlined by a dark ring on the border with a healthy area of ​​​​the epidermis. Blotches of intense pigmentation can even be found inside the depigmented area.

From the primary spots, which are small in size, large foci are formed over time, which have an irregular shape. The edges of such a focus are also endowed with enhanced pigmentation.

Pigmentation often affects open areas of the body (neck, hands, feet, face, elbows, fingers, legs. Less commonly, the disease is localized in the near-anal region, groin area, on the scalp). In men, spots can form in the area of ​​​​the mustache, beard. Merging into foci, depigmented spots can spread to the entire abdomen, buttocks, and back.

The spread of the focus of the disease to the whole body is very rare.

Hair in the area of ​​depigmentation also loses color, becomes discolored. There was a violation of the functioning of the sweat glands. In the sun, the diseased areas do not sunbathe, but the area with hyperpigmentation surrounding the spot becomes darker, more saturated.

Vitiligo is sometimes accompanied by the following symptoms:

• lichen planus;
• alopecia nest form;
• psoriasis;
• chorioretinitis;
• diseases of the gastrointestinal tract with a chronic course.

Vitiligo symptoms

Diagnostics

For an accurate diagnosis, you need differential diagnosis. This disease is differentiated from the following:

• pityriasis versicolor;
• idiopathic guttate hypomelanosis;
• partial albinism;
• chemical, true, post-inflammatory leukoderma;
• leprosy;
• multi-colored lichen.

The patient needs to go comprehensive examination. It includes many studies:

• general blood analysis;
• examination of the epithelium with a Wood's lamp;
• examination with a video dermatoscope;
• to detect the complete / partial absence of melanocytes;
• blood for the Wasserman reaction.

Knowing the causes of vitiligo disease, consider its treatment.

Treatment

Vitiligo is considered an intractable disease. Until now, scientists have not been able to pinpoint the cause of depigmentation. Also, the mechanism of the development of the disease is not fully understood. In very rare cases, the disease goes away on its own, without any medical measures. Although modern medicine has given people the opportunity to use various medical therapeutic methods, it is possible to cure the disease completely only in some cases.

Therapeutic therapy is prescribed by the doctor after the examination. Treatment is selected taking into account such features:

• age;
• somatic status;
• stage of development of the disease;
• the size of the affected area;
• spot localization.

The video below will talk about the treatment of vitiligo:

Therapeutic way

Given the progress in the field of medicine, the treatment of vitiligo began to be performed various methods, among them we highlight:

• laser therapy;
• Phytotherapy.
• Macro-, microelement therapy.
• Therapy with glucocorticosteroids.
• Whitening of the epithelium;
• The use of the drug "Melagenin plus".

Specialists are busy developing a vaccine, the action of which is to eliminate the autoimmune reaction that often provokes the development of the disease.

According to medical practice, the maximum effect brings complex treatment. In this case, non-surgical methods of therapy are combined with surgical ones. Stopping the pathological process depends on the accuracy in detecting the factor (external, internal) that provoked the development of the disease.

In the treatment of vitiligo, UVB therapy is also used. The affected areas of the epidermis are exposed to ultraviolet radiation. For the best effect, it is worth using waves whose length is 310 nm. Narrow wave therapy is considered more effective than exposure to type A rays.

In a medical way

For the treatment of vitiligo, the following drugs are used:

• "Thiamin".
• "Riboflavin".
• "Vitamin C".
• Vitamins C, E, B 12.
• "Melagenin".
• VITISKIN Gel.
• Vitasan.
• "Ammifurin".

Operation

Surgical treatment, which involves melanocytic transplantation, autotransplantation. But doctors still do not guarantee a lasting, long-term effect from the operation.

We will deliberately not describe how to treat the skin disease of vitiligo in children and adults with folk remedies, since there is no sense in such treatment.

Disease prevention

Certain preventive measures experts have not found. But doctors recommend:

• less time to stay;
• carry out hardening procedures;
• take vitamins.

Complications

One of the significant complications is the formation of sun due to the loss of the skin's protective function.

Forecast

For those suffering from this disease, the prognosis will certainly seem unpleasant. Vitiligo is chronic.

It is almost impossible to cure it. Doctors can only stop the development of the disease.

In the video below, the girl shares her ways of treating vitiligo:

Vilitigo is not a fully understood dermatological disease, its most striking manifestation is a noticeable white skin color in the form of spots. Such fading is connected with the fact that melanin pigment begins to disappear from the skin. The disease is not fatal, but causes a lot of trouble.

Causes

At first, it was believed that vitiligo could be caused not only by a virus, but also by an infection. Penetrating under the skin, the virus begins to act on the subcutaneous layer, destroying melanin, from the lack of which the skin begins to lighten and vitiligo spots appear. Neuropsychic stress, severe emotional trauma and, especially, disease spinal cord can lead to such a disease. The most common causes of vitiligo are:

The most common place for the onset of vitiligo disease is skin areas that are regularly irritated, since tight shoes harm the foot, a heavy backpack tightens the skin on the shoulders, a tight belt frays the skin. In all these places, active infection can begin, the skin will become dryish, then it will begin to fade.

The infection is exclusively acquired by the carrier, it is not genetically transmitted, and vitiligo is very rare in children. The most vulnerable to it are middle-aged people, teenagers become infected infrequently. At the moment, cases of infection have decreased, but environmental harmful factors and frequent stress increase the risk of vitiligo. In the skin, the pigment melanin is responsible for the rich color of the skin and its healthy appearance, which is why vitiligo, destroying this pigment, immediately manifests itself in the form of spots.

Symptoms

When a disease occurs, melanin begins to disappear from the skin, so specific spots form: oval or more oblong shapes, as the disease develops, the spots grow. Vitiligo on the face can be seen very clearly: the skin becomes thinner and more tender. As a rule, such spots have a bright white color, they are noticeable even on fair skin, the border of the formation is clearly visible.

The stages of vitiligo characterize the width of the spots and their distribution. The spots do not protrude above the skin, to the touch they are practically indistinguishable from healthy areas, there are no scaly formations. Rarely there are spots inside the spots. The lesion expands and may merge with other spots into long oblong lines. In rare cases, if left untreated, the patches cover most of the skin.

Spots can appear on any part of the skin, even on the eyebrows and exposed areas of the head, are often found on the genitals, can appear between the buttocks or on the outside of the genitals, so they can be mistaken for a sexually transmitted disease. If the disease affects areas of the skin covered with hair, then they first lighten, and then fade completely. Sunburn will not help hide such spots. The skin on the infected areas does not change color. For large stains, this can affect the release of perspiration. Other skin conditions can also develop in the affected areas of vitiligo, such as:

• porphyrin disease;
• scleroderma;
• white skin atrophy;
• nest baldness.

The disease of vitiligo proceeds chronically, at first practically imperceptible spots appear, which spread more and more over time. Therapy does not affect them much, the disease can develop both for months and years. Scrapings taken from the site of the focus indicate the absence of melanin, while the edges of the focus contain them in excess. The body perceives the disease as an allergy and begins to produce the necessary antibodies, but they do not act on the disease.

How to Diagnose

In the hospital, a doctor can easily diagnose vitiligo, but it is better, of course, to donate blood and scrapings for analysis. The focus of the lesion does not contain melanin pigment, it focuses on its border, within the limits above the norm. Some diseases can also be manifested by similar spots:

• similar spots can cause venereal diseases especially during syphilis. Often they give additional symptoms, itching in the anus and irritation of the mucous membrane;
• versicolor versicolor can also leave characteristic spots that disappear with time. At the site of the formation of such spots, vitiligo can develop, then the skin will quickly lighten;
• leprosy forms light patches, not as light as vitiligo, but can spread widely. An important feature of leprosy is that the places of its defeat are devoid of sensitivity: with strong pressure, the skin does not react.

For clarification, it is necessary to pass the appropriate tests to the laboratory and consult with a dermatologist.

A photo

The photo of vitiligo clearly shows how the disease is expressed.

Photos of celebrities

Spots are clearly visible in the photo of vitiligo. Vitiligo is also found in celebrities. They hurt like famous people like Michael Jackson and Lee Thomas, and Chanel Brown Young is a model with vitiligo, although the disease did not interfere with her career.

How to cure

There is no ideal method of treatment, it works for every organism different way. Very rare cases where the spots simply disappeared over time. Treatment of vitiligo is a long process that requires constant monitoring, otherwise you can return to the initial stage of the disease. It is not always possible to completely get rid of the disease, you can stop the spread of spots and make them smaller. Most effective options how to cure vitiligo:

• the most important thing is to resume the normal metabolism of the patient, for this they apply various drugs that improve the metabolic process. Preparations containing melanin pigment are prescribed;
• the affected areas are treated with alcohol;
• most effectively, together with the procedures, carry out ultraviolet irradiation of the affected tissues, before that they are treated with a special preparation;
• PUVA therapy with the help of ultraviolet light introduces various drugs, hormones and medicines under the skin. They provide fast local treatment;
• if local treatment is used, it is impossible to lubricate the eye area and eyelids with special solutions.

Children under the age of 5 years are more difficult to treat, most drugs are contraindicated for them. People with weak immunity and complex chronic diseases, as well as old age, most drugs can harm. The first course of therapy is a month, then the doctor prescribes repetitions of courses. They can be carried out throughout life or until the disease is cured.

Hormonal drugs have positive influence on the body, paired with vitamins E and A. But only a doctor can prescribe hormones and only after passing the tests. How to treat vitiligo and how, only a specialist determines. A group of hormones for the adrenal cortex most actively slows down the spread of the disease. People who have the following diseases, this group is contraindicated:

• hypertension, as well as heart disease;
• diseases skin;
• diabetes;
• osteoporosis;
• tuberculosis;
• diseases manifested by purulent formation;
• diseases associated with the stomach.

Since a group of hormones is prohibited, alternative drugs can be used.

Therapy in the treatment of vitiligo is being improved and new drugs are being tested, but the most effective treatment of all types of illness, there is always a timely visit to the doctor. While the disease is just beginning to develop, it is much easier to cure. To eliminate a cosmetic defect, a vitiligo cream is used. It doesn't completely hide stains, but it's very effective. The ointment will help the skin to smooth out a little and breathe again. You can also treat folk remedies, but it helps very rarely, they mainly use decoctions and ointments, but they, like other drugs, only slow down the disease. The photo before and after the treatment of vitiligo shows the use of ointments and creams after courses of therapy, but not everyone can be completely cured by such means.

Photos of treatment before and after

See photos before and after treatment.

Treatment with folk remedies

Treatment of vitiligo with folk methods is quite possible, tinctures and creams on a natural basis are used. The following methods are most effective, although they do not guarantee 100% results:

• St. John's wort oil. St. John's wort is dried, then it needs to be crushed and put in a jar, pour vegetable-based oil. The remedy should be infused for at least two weeks. Such a tincture has a weak effect due to its low concentration, but it is still worth a try;
• strongly concentrated St. John's wort oil. Only St. John's wort flowers are taken, without stem and foliage. The jar is filled with them tightly and to the top, leaving a couple of centimeters to close the lid. Next, oil is poured, you can use not only sunflower oil, but also, for example, sea buckthorn. The mixture should be infused in the sun or in a warm place for two weeks. The tincture gives a more significant effect due to its high concentration;
• black cumin oil. This oil can be rubbed as a ready-made tincture, it has good properties, it is useful not only for the skin, but also relieves fatigue. Black cumin oil can be found in pharmacies or cosmetic stores;
• marsh duckweed tincture. Marsh duckweed has a number healing properties, it contains iodine and bromine salt, which have a positive effect on the body. To prepare such a tincture, you need to use the duckweed itself and vodka. First, the duckweed is washed under the tap and placed in a jar. For one teaspoon of duckweed, you need to take 50 gr. vodka, you can use alcohol, but a little diluted. After pouring, the tincture stands for a week in a dark place. Then the product must be filtered through cheesecloth. No more than 20 drops of tincture are used per glass of water and it is used every day;
• black pepper. Ground black pepper has not only taste, but also healing properties. Scientists have proven that pepper can be used to treat vitiligo, thanks to piperine, which is part of it, it has positive effect on the skin. Ground pepper is applied to damaged dry skin and rubbed a little. After 20 minutes of being on the skin, it can be washed off;
• ointment for vitiligo from sulsen. You can find sulsen ointment in a pharmacy or cosmetic store, it is used as an alternative and sulsen paste. It is best to buy a 2% ointment, the agent is applied to problem areas for half an hour, after which it is carefully wiped off;
• ground sesame. Sesame works well on the skin, but you need to take it inside. Sesame seeds are ground through a blender or coffee grinder, in the morning and evening you need to eat a teaspoon of ground sesame powder. The effect will become noticeable when yellow shades appear on the spots. Within a month, you can cure vitiligo completely, after which you should stop using sesame seeds;
• onion and garlic. Effective in use against vitiligo spots are garlic and onions, which are cut into two parts and rub the spots with them for five minutes, several times a day. You need to alternate onions and garlic, one day rub one, the other the other.

You can use several methods at once, the main thing is to find out what works best and apply them only after consulting a doctor.

Their reviews on the treatment of vitiligo in various medical forums were left by people who have undergone treatment, and those who have just started. Such a practice is very important: those who have been fighting the disease for years tell what helped them most effectively, and what is just a waste of time. Not so long ago, it is very informative and useful for those who have become ill to read such reviews. If we talk about such a disease as vitiligo, the history of recovery of each is very important for people who are just starting to deal with the disease.

Vitiligo is a disease that is accompanied by discoloration of some parts of the body due to the destruction of the melanin pigment. Doctors from all over the world are constantly studying the nature of its occurrence and the nature of its development. Treatment of vitiligo is carried out in a complex manner, taking into account the factors that led to the manifestation of specific symptoms.

Description of the disease

Vitiligo is a disease in which discolored patches of skin form on the body. different localization and size against the background of the destruction of melanin (natural skin pigment). Pathology has a chronic nature of the course, it is difficult to treat. Most often it is found in people under the age of 30 years (more than 50% of cases). The disease is equally likely to affect both men and women. Also, the frequency of its development does not depend on the race of a person. But in dark-skinned people, white spots on the skin are more noticeable.

According to recent studies, vitiligo occurs in 1% of the world's population.

In medical practice, other names for the disease are also used - leukoderma, leukoderma. Pathology is one of the understudied, so the selection proper treatment is not always efficient.

Symptoms

This disease begins with the appearance on the skin of clearly defined spots of light white or milky color. The occurrence of vitiligo foci is typical for such areas of the body as the face (around the lips, eyes, on the nose, near auricles), limbs (back of the hands and feet, fingers). Very often, discolored spots appear under the armpits, in the groin, near the genitals and on other intimate places, on the elbows and knees. The foci of the disease are more visible in people with dark skin. Quite often, colorless spots form on the head or in the place where the beard grows in men.

The main symptoms of vitiligo include:

Varieties of vitiligo

There are several criteria on the basis of which the classification of vitiligo is carried out.

Classification according to the course of the disease

Depending on the stage of development of vitiligo, there are:

• Initial. On the body, one discolored spot is detected, which has a rounded shape.
• stage of stability. The resulting spot gradually increases in size. No other changes are observed.
• Progress. It is characterized by an increase in the size of the old spot, while other depigmented areas appear.
• Repigmentation. Sometimes it happens that the discolored areas of the body begin to be painted over again.

Types of vitiligo depending on localization

The localized type of vitiligo, the symptom of which is the appearance of one depigmented area of ​​the skin, is divided into the following types:

• Focal leukoderma. One or more spots are observed on the body of a sick person, which are in close proximity to each other.
• Segmental. The appearance of light spots occurs on a part of the body along the nerve fibers.
• Mucous leukoderma. The problem manifests itself exclusively on the surface of the mucous membranes.
• The generalized form of the disease is characterized by the appearance of light spots throughout the body. It is divided into several types:
  • Vulgar. It is distinguished by the formation of discolored spots that are randomly scattered throughout the body.
  • Acrofascial. The appearance of spots usually occurs on the surface of the hands, on the face, lower extremities.
  • Mixed. It is characterized by the presence of signs different types vitiligo.
  • Universal. The negative process develops throughout the body and occupies 80% of the area of ​​the skin.

Causes

Vitiligo usually starts when exposed to certain external and internal factors that affect the human body. This disease is never born, it is considered an acquired pathology. Most people notice the development of vitiligo in the first ten years of life, during puberty. Women may experience such a pathology during pregnancy or during menopause.

Doctors have found that the development of light spots on the skin is largely due to the peaks of solar activity, which occur in the spring and summer.

The causes of vitiligo are not fully known. But there are a number of adverse factors that directly affect the development of this disease.

Autoimmune processes

Autoimmune refers to such processes in the body, which are accompanied by the production of antibodies to their own tissues. In this case, the patient's immune system attacks the cells responsible for the production of the skin pigment melanin.

Quite often, doctors find other autoimmune diseases in people with vitiligo:

• systemic lupus;
• rheumatoid arthritis;
• goiter Hashimoto;
• Addison's disease and others.

genetic predisposition

Scientists have established a hereditary factor in the development of vitiligo. Parents with this pathology will almost certainly have children with the same problem. It has been found that people with fair skin and blue eyes the disease is much less common than in brown-eyed.

Neuroendocrine causes

A sharp change in the hormonal background, provoked by diseases or natural causes (due to pregnancy, menopause, puberty), leads to the appearance of light spots on the skin. Also, provoking factors include stressful conditions that adversely affect the work of all organs and systems.

Trophic disorders

Under trophic disorders imply malnutrition of the skin associated with its traumatization. They are provoked by mechanical, chemical influences or the influence of radiation. After violation of the integrity of the skin develops inflammatory process, which has an autoimmune component that provokes the destruction of melanin. And with prolonged exposure to the sun, the existing pathological process aggravated.

The action of drugs

Some medications can trigger the development of a disease such as vitiligo. The exact list of drugs and the effect of the duration of the period of their intake has not been finally established.

Presence of liver disease

In adults and children, the development of vitiligo is associated with the following diseases:

• parenchymal changes in the liver;
• stagnation of bile;
• helminthic invasions (including giardiasis).

Diagnostics

The diagnosis of "vitiligo" is made by a dermatologist on the basis of the examination and study of the course of the disease. Modern medical practice involves performing such manipulations to determine skin pathology:

• Examination of the skin using a Wood's lamp. This diagnostic method is considered one of the most effective. During the examination, depigmented areas of the skin glow white-blue and acquire a clear outline.
• Biopsy of modified tissues. Helps to accurately diagnose and distinguish vitiligo from other skin diseases.
• General and biochemical analysis of blood. Helps to determine the presence of concomitant pathologies.

Principles of treatment

It is extremely difficult to recover from vitiligo, since the appearance of spots is often associated with a malfunction immune system, liver and other organs. The lack of adequate therapy leads to aggravation of unpleasant symptoms and the spread of the pathological process over a large area. Although there are cases of spontaneous recovery.

To quickly restore the natural color of the skin, patients must undergo a comprehensive examination of the body and be constantly monitored by a dermatologist (if necessary, an immunologist, an endocrinologist).

List of drugs used

Based on the results of the analyzes, drugs of local and systemic mode of action are prescribed.

Glucocorticoids

Vitiligo can be cured with hormonal drugs- glucocorticoids. These drugs act directly on the immune system, which helps stop autoimmune processes.

With a localized form of the disease, glucocorticoids are used in the form of ointments:

In the generalized form of the disease, glucocorticoids are used in the form of tablets. They produce a systemic effect on the body, so they should be used strictly under medical supervision. It regulates the dosage of drugs, which avoids many side effects.

Photosensitizing agents

Many doctors prefer to treat vitiligo with photosensitizing agents. They act on melanocytes, as a result of which they become more sensitive to ultraviolet radiation. As a result, skin cells begin to produce pigments, which leads to the disappearance of depigmentation zones. These drugs are also called herbal furocoumarins, they include:

Other drugs

In the fight against vitiligo, other means are also used, the most popular of which are:

Application of ultraviolet lamp

Therapy consists in exposing the changed areas of the skin to ultraviolet radiation.

If type A rays are used during treatment, a course of photosensitizing agents is prescribed beforehand for all patients. This method is different high risk the development of side effects and complications - nausea, burning, cataracts, the appearance of carcinoma. Therefore, this method of treatment is prescribed less and less.

An excellent alternative is the use of ultraviolet radiation with a wavelength of 310 nm. When using this method of therapy, it is not necessary to take photosensitizing agents. The risk of developing malignant tumors and other complications is minimal.

When using each of the methods of therapy, there is a risk of burns, the skin may become red and irritated. To eliminate such complications, special creams are used.

Laser therapy

Vitiligo is treated with a laser that has a specific wavelength. The therapy technique is effective only for a localized form of the disease, the development of which began no later than 5 years ago.

Whitening

To hide a skin defect, special agents are introduced into problem areas of the body. They help even out skin tone. The most popular drugs in this group are called Monobenzone, Hydroquinone.

Because of a large number side effects such drugs are used strictly under the supervision of a physician.

Skin graft

Vitiligo can be treated with surgery. Melanocytes responsible for the production of melanin are transferred from healthy areas to pathological ones. They can also transplant the skin itself, but the method is fraught with various complications.

Photochemotherapy

Can be used as local or systemic therapy. In the first case, special preparations are applied to the skin, after which it is exposed to ultraviolet light. Systemic therapy is used when 20% of the skin is affected. In this case, the patient takes a special drug, after which he is exposed to UVA.

Folk remedies

Treatment of vitiligo can occur at home with the use of some folk remedies.

Other Methods

Other folk methods vitiligo treatment:

Treatment prognosis

The prognosis for vitiligo treatment is usually poor. The use of even the most modern methods of therapy is not able to completely get rid of light spots on the skin.. They only stop the pathological process and prevent its progression.

You can prevent flare-ups of discolored spots by following a special diet, which involves following the principles healthy eating. The diet of the patient should fill the body's need for all vitamins and minerals. Reception allowed alternative means(Protopic, Elidel).

How to cover up spots

There are several ways to mask spots on the skin:

• The use of special cosmetics. An experienced cosmetologist will help you choose a foundation and a foundation for makeup.
• Self-tanning. If you need to mask spots and not stain the skin, it is recommended to use this method.
• Dermabrasion. The skin is polished, which helps to even out its tone.

Vitiligo is not a contagious disease. Contact with the sick will not bring any harm. Despite this, the pathology is accompanied by significant psychological discomfort, so its treatment should not be postponed.

Vitiligo- a chronic disease in which white spots appear on the skin, prone to growth and fusion. In addition to the skin, the hair, retina and meninges can be affected. Patients do not experience pain, itching or other unpleasant sensations, however, appearance defects significantly disrupt the psychological state.

In limited areas of the skin, the production of melanin, the pigment responsible for the color of the skin and hair, stops. As a result, milky white spots appear in this place. Pigment loss can occur quickly over several hours or slowly over several months.

Causes of vitiligo. The development of the disease is associated with a deficiency of zinc and copper in the body, exposure to heavy metals and other toxins, infectious diseases, injuries, neurosis, depression, hormonal imbalance (diabetes mellitus, pathologies thyroid gland). But heredity plays a leading role. For example, singer Michael Jackson, who suffered from vitiligo, passed the disease on to his eldest son.

Statistics. Vitiligo is a common skin disease. The number of patients reaches 0.5-8% of the world's population, which is about 40 million people. Vitiligo often appears at a young age: 50% of patients are people 10-30 years old. The onset of the disease in people older than 40 years is rare. The rise in incidence is noted in the spring-summer months, when the skin is more exposed to sun rays.

In general, men and women are equally affected. But women are more likely to turn to European doctors for skin depigmentation, and men to Asian doctors.

Story. From the Latin "vitiligo" is translated as "vicious disease". Ancient healers mistakenly associated its appearance with syphilis and other sexually transmitted infections. In the Middle Ages, white spots on the skin were considered a manifestation of the most dangerous infectious disease- leprosy (leprosy). And only in the middle of the nineteenth century, vitiligo was identified as a separate disease and proved that it is not contagious.

There is no effective method of treatment that guarantees getting rid of vitiligo. Approximately 20% of people fail to achieve lasting improvement with the help of drugs. However, 7% of patients spontaneously heal.

What determines skin color?

Skin structure

• Epidermis- the outer layer, which is formed by stratified keratinized epithelium. In it, in turn, there are 2 main functional layers:
  • Growth (basal) layer - active processes of cell division take place in it, ensuring the regeneration and renewal of the epidermis. Melanocytes are located precisely in the basal layer.
  • The stratum corneum - consists of dead keratinized cells. Performs a protective function.
• Dermis- the skin itself, separated from the epidermis by a basement membrane. Functions: provides support and nutrition to the epidermis, provides local immunity. There are 2 layers in the dermis:
  • Papillary - represented by loose fibrous connective tissue, which contains immune cells (basophils, macrophages and T-lymphocytes) and capillary loops.
  • Reticulated - consists of dense fibrous connective tissue, which performs the support function.

• Keratinocytes or epitheliocytes (85%) - cells that form the basis of the epithelium of the skin.
• Langerhans cells(10-15%) - cells that receive information about antigens (viruses, bacteria). They interact with lymphocytes and other immune cells, activating local skin immunity.
• Merkel cells(2-3%) - are responsible for the sensitivity of the skin, provide touch.
• melanocytes(up to 10%) - cells with large dark nuclei and a large number of processes located in the thickness of the basal layer. Skin pigment - melanin is produced and matures in special organelles - melanosomes.

Melanin production process

Melanin formed in melanocytes from the amino acid tyrosine, which enters the body with food and is synthesized in the liver from phenylalanine. This process occurs with the participation of a copper-containing enzyme - tyrosinase, a substance that converts tyrosine into melanin, as well as zinc and oxygen.

The formation of melanin occurs in several stages:

1. Melanocytes receive chemical signals from surrounding cells and produce the enzyme tyrosinase.
2. Under the action of the enzyme, tyrosine is converted into melanin. Pigment grains mature in rounded "capacities" of melanosomes.
3. Through the processes of melanocytes, melanin is transported to surrounding cells and absorbed by them. The degree of saturation of keratinocytes with pigment depends on the race, the individual characteristics of the organism, the degree of sunlight.

Causes of Vitiligo

Possible mechanisms for the development of vitiligo:

• Theory of self-destruction after infections or as a result of exposure to toxins, melanocytes are reborn. They produce toxic products that damage cell walls.


• autoimmune theory- due to a defect in immunity, melanin is destroyed by immune cells. They perceive the pigment as a foreign organism and attack it.


• Biochemical disorders– free radicals (hydrogen peroxide) accumulate in the skin. In this regard, the production of an enzyme - catalase, designed to neutralize them, decreases. Free radicals damage melanocytes and lead to skin discoloration.


• genetic theory. In 2007, British scientists were able to identify the NALP1 gene for vitiligo, which is inherited. People who have this gene get vitiligo.

• genetic predisposition. Vitiligo is passed from parents to children dominant trait. This means that if one of the parents is sick, then the probability that the children will develop the same pathology is 50%. Even if vitiligo has arisen under the influence of injuries or other causes, the disease is fixed at the genetic level and is subsequently transmitted to descendants.
• Disorders of the endocrine glands:
  • thyroid gland
  • liver
  • pancreas
  • ovaries
  • pituitary-adrenal system
  Failure of the endocrine glands leads to disruption of the formation of enzymes in melanocytes.
• Disorders of the nervous system:
  • strong emotional upheavals
  After mental trauma neuro-endocrine changes occur and the innervation of certain areas of the skin is disturbed. Melanocytes do not receive neurochemical commands to produce melanin.
• Skin damage
  • burns, including solar;
  • scars formed after injuries;
  • microtraumas that occur when rubbing with seams of clothing, jewelry.
  When the skin is damaged, the basal layer of the epidermis, in which melanocytes are located, is injured. In some cases, the cells do not regenerate. In immune pathology, damaged melanocytes can be attacked and destroyed by immune cells.
• Diseases gastrointestinal tract
  • intestinal invasions;
  • malsorption syndrome.
  Diseases of the digestive system cause changes chemical composition blood and deficiency of enzymes in cells. Malabsorption leads to a lack of magnesium, manganese, copper and zinc, which are necessary for the formation of pigment.
• Exposure to chemicals on the skin
  • low-quality cosmetics;
  • formaldehyde;
  • phenol and phenol-containing reagents used in the production of paints, rubber, cables;
  • other chemically aggressive substances.
  Work in hazardous production is one of the most common causes appearance of vitiligo. Chemical substances affect the cells of the epidermis and disrupt their functioning. In this case, a change of job can lead to spontaneous self-healing.
• Decreased immunity
  • operations;
  • excessive exercise and sports.

Symptoms of vitiligo (photo)

Symptom	Origin mechanism	Manifestations	A photo
The onset of the disease is a single spot	In melanocytes, the synthesis of melanin decreases or completely stops.	The first symptom is a spot on the surface of the skin or mucous membranes. It can be rounded or with "torn" edges. The stain fades gradually or over several hours.
Hyperpigmentation around the lesion	An inflammatory process develops around the focus, which is accompanied by increased synthesis of melanin.	The spot is surrounded by a rim darker than healthy skin. This feature distinguishes vitiligo from other skin discoloration conditions.
The tendency of spots to grow and merge	Peripheral growth of foci is associated with the involvement of new melanocytes in the process.	White spots increase in size and merge with each other. The growth rate of foci depends on the individual characteristics of the organism.
Localization - any area of ​​\u200b\u200bthe skin or mucous membranes, except for the feet and soles	The skin on the palms and feet does not contain melanin, so spots do not appear in these areas.	Mostly spots are formed on the flexion and extensor surfaces of the limbs, on the face, in the armpits on the buttocks, around scars and in places of constant skin trauma.
Symmetrical lesion	For unknown reasons, the spots are arranged symmetrically on the body.	In most cases, the spots on the right and left sides of the body are identical.
Hair discoloration in the affected area.	On the affected area hair follicles lose melanin.	Inside the focus, vellus hair and the scalp on the head become discolored. In 30% of patients, early gray hair is found.
Reticular vitiligo	Many small foci of depigmentation are formed, located close to each other.	On the skin of the genital organs, the inner surface of the thighs and on the chest, dotted foci of discoloration appear, located in a gray area.

Diagnosis of the Cause of Vitiligo

Poll. During the collection of an anamnesis, the doctor finds out:

• whether any of the relatives have the same clinical symptoms, whether there is a hereditary predisposition to vitiligo;
• Does the patient suffer from autoimmune diseases that often accompany vitiligo (especially Hashimoto's thyroiditis);
• when did the onset of the disease occur and how quickly did it progress;
• whether there was an exacerbation over the past 6 months - growth and the appearance of new foci;
• features of the acquisition of sunburn. This information is necessary when prescribing phototherapy.

• Symmetrical arrangement of spots. Only in 10% of cases one side of the body is affected. Rashes can be located along the nerve or its plexuses.
• The foci are round, in 10-15% they may have an irregular shape or be punctate.
• Rashes can be represented by single small spots or lead to complete depigmentation of the skin.
• The skin on the lesions does not peel off, is not covered with crusts or erosions. The exception is cases when a secondary infection joins.
• Hair located on the spots lose their color, discolor.
• There are spots around moles.
• The lesions are surrounded by a ring of hyperpigmentation. The dark rim is clearly visible after exposure to medical ultraviolet or sun exposure.
• In the universal form, when a large surface area of ​​the body is affected, areas of healthy skin have a sinking edge.
• Often, depigmented areas appear in places of constant friction with a shirt collar, watch, belt.

A Wood's lamp or black light lamp emits ultraviolet A rays and is used to diagnose skin conditions. The lamp is made of dark glass and has a weak glow.

Wood's lamp is used to detect foci of depigmentation in areas of the skin where the sun's rays do not fall: under the hair, in the armpits, on the genitals. The light of the lamp is brightly reflected from the spots, which makes it possible to consider their number, shape and color transitions. The foci of the disease have a bluish-white color.

Skin biopsy

Research is rarely done. A scalpel scrapes off a layer of the epidermis in the center of the focus and on the periphery. Microscopic examination of a sample in patients with vitiligo reveals:

• complete or partial absence of melanocytes
• altered collagen fibers
• a large number of melanosomes in the rim surrounding the focus

Vitiligo treatment

It is believed that vitiligo cannot be cured with one drug or method - an integrated approach is needed.

Therefore, the treatment of vitiligo includes several areas:

• topical treatments (ointments, creams and lotions)
• general treatment systemic drugs
• physiotherapy procedures
• treatment of diseases of the gastrointestinal tract and other pathologies that provoke vitiligo
• taking vitamin preparations (A, E, B1, B2, C, PP, D), taking minerals, especially copper and zinc
• elimination of provoking factors (friction, pollution)

Ointments and creams for the treatment of vitiligo

Drug group	Representatives	Mechanism of therapeutic action	Mode of application
Corticosteroids	Prednisolone Betamethasone Diprospan	Hormone therapy reduces the immune attack and promotes pigment restoration.	The funds are applied to depigmented areas with a thin layer 1-3 times a day for 3 months. The use of corticosteroids around the eyes is not recommended.
Calcineurin inhibitors	Protopic Elidel	Suppress the attack of the immune system on melanocytes. Reduces signs of inflammation and allergies.	Apply a thin layer to the affected areas of the skin 1-2 times a day. Ointments are gently rubbed until completely absorbed. The duration of treatment is not more than 6 weeks.
Photosensitizing agents	Melaginin Melaginin Plus Psoralen	Enhance skin absorption of ultraviolet rays, restore skin pigmentation.	The preparations are applied to the foci of the disease and gently rubbed 1-3 times a day. After application, it is desirable to expose the skin to low-power irradiation (solar or UV lamp). The course of treatment is 3 months.
An integrated approach to the treatment and care of skin with vitiligo	Vitix gel	Restores the balance of free radicals. Stops the development of the disease and causes repigmentation of the skin.
	Vitix tablets	A food supplement that increases the effectiveness of Vitix gel therapy in the treatment and care of skin affected by vitiligo.
	Gel corrector Viticolor	Camouflages depigmented skin areas.

Signs of improvement with topical treatment of vitiligo become noticeable after 2-6 weeks:

• spots are reduced in size. At the same time, their edges become uneven, scalloped
• the foci change their color, evenly darken
• dark blotches appear inside the spots - foci of melanin production around hair follicles

Cosmetics for vitiligo helps to make the manifestations of the disease less noticeable.

• Artificial tanning products- milk, lotion, cream based on dihydroxyacetone. The product is gently rubbed in a circular motion into clean, dry skin. It contains dyes that allow you to achieve the effect of tanned skin.
• Whitening lotions eliminate excessive pigmentation around the foci of the disease. Some companies (Covermark, Dermablend) have developed products specifically for the skin of people with vitiligo.
• Photoprotection with a protection index UPF 15-25 protect depigmented skin from direct sunlight and prevent burns on the affected areas. They must be applied to exposed areas of the body immediately before going outside.

Systemic therapy for vitiligo

• systemic corticosteroids: Prednisolone, Betamethasone, Diprospan;
• immunosuppressants: Levamisole, Cyclosporine A, Cyclophosphamide, Isoprinosine.

Physiotherapy for the treatment of vitiligo.

For the treatment of vitiligo, ultraviolet type B is used - medium wavelengths. Irradiation is carried out according to the general (whole body) or local method, when they act exclusively on the affected areas. Sometimes, to enhance the effect, photosensitizing agents are applied to the skin: Melaginin, Psoralen.

Sessions are carried out 2 times a week for 5-10 minutes. The course of treatment takes about a year.

PUVA therapy

PUVA therapy is a treatment method that includes long-spectrum ultraviolet irradiation in the A range, together with photosensitizers. These drugs increase the sensitivity of the skin to ultraviolet radiation, and therefore improve the production of melanin. In PUVA therapy, the following are used: Methoxaralen, Trioxaralen, Ammoidin, Meladinin, Lamadin, Puvalen, Oxoralen. Medicines take with food 2-3 hours before the procedure.

The entire body or affected areas are irradiated for 5-30 minutes. The procedure is carried out every other day. To achieve significant results, 100-200 sessions are needed.

Laser therapy

The laser affects the remaining melanocytes and activates their work. Laser therapy improves metabolic processes in the skin and promotes the production of enzymes responsible for the formation of melanin. Irradiation is carried out with two types of lasers:

• red wavelength 0.67 µm
• infrared - wavelength 0.89 µm

The procedure is carried out in biofeedback mode. The radiation is modulated by the patient's pulse and respiration rate. The duration of one procedure is up to 30 minutes. The full course includes 15-20 sessions. A noticeable improvement occurs after the 6th exposure.

Proper treatment of vitiligo can slow the progression of the disease and cause the lesions to grow back. However, 60% of successfully treated patients relapse after some time (months, years).

Surgical treatment of vitiligo

After the operation, new melanocytes are formed in the deep layers of the epidermis. The process of restoring pigmentation takes several months.

There are several methods surgical treatment vitiligo

• Epidermal transplant. The affected areas of the skin are excised. In their place, an autograft prepared by the PUVA method (a flap of the epidermis from a healthy part of the body) is placed.
• Minitransplants. Areas of healthy skin less than 1 mm in size are transplanted into depigmented foci.
• Transplantation of cultured or non-cultured melanocytes. Individual cells that produce pigment are implanted into the skin.

• The foci are located on open areas of the body (face, neck, décolleté, hands). They are a significant cosmetic defect and violate the psychological status of the patient.
• Lack of results from local and systemic therapy for 12 months.
• The disease is in remission. For 1-2 years, new spots do not appear, and existing ones do not grow.

• tendency to scarring
• intolerance to UV and laser therapy

• scarring
• uneven pigmentation
• rejection of transplanted areas of the epidermis

Prevention of vitiligo.

Preventive measures for vitiligo:

• A balanced, wholesome diet rich in vitamins, zinc and copper. Nutritionists recommend regularly consuming:
  • milk products
  • sea ​​fish, squid and shrimp
  • liver, meat of rabbits and chickens
  • buckwheat and beans
  • bran, seeds, nuts
  • citrus fruits, apples, figs
  • parsley, spinach, celery.
• Phytotherapeutic agents help to normalize the activity of melanocytes. Among them:
  • mountain arnica tincture
  • rosehip berry decoction
  • decoction of nettle leaves.
• Avoid prolonged exposure to the sun and tanning beds. Use before going out sunscreen.
• Avoid rubbing the skin with clothes, jewelry, washcloths, chair backs, exercise equipment.
• Use hypoallergenic cosmetics for sensitive skin.
• Avoid skin contact with chemical active substances.
• If possible, avoid stressful situations, hypothermia, infectious diseases and other factors that reduce immunity.