Vitiligo - violation of skin coloration, characterized by the appearance of bleached often symmetrically arranged spots of different sizes and shapes, milky-white color; stains show a tendency to increase the boundary.
Causes
- Diseases of internal organs and the endocrine glands (e.g. thyroid disease was observed in 30% of patients with vitiligo).
- Disorders of the immune system.
- Violation of the nervous system function, and emotional stress.
- Chronic inflammatory diseases.
- Poisoning.
- Sunburn.
symptoms
On healthy skin appear multiple or single discolored (ivory) spotty rash prone to edge growth. On the edge of the stain mark condensation pigment that contributes to a more dramatic contrast discolored lesions and healthy skin. Rash gradually spread, and in some patients with large areas of skin become pure white.
Vitiligo can be positioned on any areas of the skin (other than the skin of the palms and soles) and mucosal. The hair on the spots of vitiligo are also discolored; 35% of patients present with premature graying. Subjective feelings are usually absent, however, 10% of patients notice itching.
In 50% of cases the disease begins between the ages of 10-30 years. Children usually develop limited forms of vitiligo, often against the background of autoimmune and endocrine diseases (eg, diseases of the thyroid gland, rheumatoid arthritis and etc.). In elderly people the disease usually does not develop.
Photo: site of the Department of dermatology Tomsk Military Medical Institute
Diagnostics
In addition to the characteristic white spots on the skin, diagnosis is based on laboratory parameters.
For an accurate diagnosis it is recommended to pass the following tests for suspected vitiligo:
- general blood analysis (OAK)
- urinalysis (OAM)
- blood on biochemistry (glucose, Indicators of liver and kidney function)
- blood on Antibodies to thyroglobulin (AT-Tg) and thyroid peroxidase antibody (TPO).
Vitiligo is to be distinguished from the following diseases:
- variegated, Plain or white lichen
- Secondary leucoderma on the background of atopic dermatitis, syphilis or lupus.
* look The federal standard for diagnosis and treatment of vitiligo in 2013, according to which this article is written
vitiligo treatment
If the damaged area is not more than 20% of the body, especially topical glucocorticosteroid agents are assigned as creams and ointments.
- methylprednisolone aceponate (advantan and analogues)
- alklometezona dipropionate (Afloderm and analogues)
- betamethasone dipropionate (aktiderm and analogues)
There are several schemes for the application of these preparations, the physician selects an optimal scheme based on the analysis results, the area affected, the patient's age and other factors.
If the visible effect is observed within 4-6 months, prescribers second line - topical calcineurin inhibitors:
- tacrolimus ointment varying the degree of concentration
- pimecrolimus cream
It's worth noting that despite the success of the study (2013.), The diagnosis of vitiligo is still not officially part of the indications for use.
Non-pharmacological therapy
1. Narrowband ultraviolet therapy (course consists of 20-100 procedures).
2.Selektivnaya phototherapy (Broadband UV treatment) - is more efficient, reduces flow activity vitiligo. Procedures prescribed 2-3 times a week. Course duration - 20-100 procedures.
3. laser radiation treatment or monochromatic light - identical on the effectiveness of the procedure. The course lasts for 20-60 treatments. According to 2013 research., Is more effective than narrowband therapy.
4. In the treatment of vitiligo also used drugs that increase sensitivity to light, in combination with PUVA therapy (irradiation with UV light).
Drugs that increase sensitivity to light:
- methoxsalen (puvalen, oksoralen, lamadin and so on.)
PUVA therapy is conducted in courses for 15-25 procedures with an interval of 1-3 months.
Contraindications for PUVA therapy:
- pregnancy,
- malignant tumor,
- increased sensitivity to radiation
- diseases of the stomach, liver, kidney, cardiovascular system, blood,
- up to age 5 years and older than 60 years.
Note that PUVA therapy is most effective, but has the greatest number of side effects compared to other non-drug methods.
Surgical treatment of vitiligo
transplant donor skin areas, previously prepared by PUVA (which stimulates the synthesis of skin pigment and improves graft prizhivlyaemost) It is a fast method of treatment achieves a uniform color of the skin and is effective in the treatment of patients who are not helped conservative methods therapy.
Patients with vitiligo recommend avoiding direct sun exposure, use sunscreen.
Diet therapy in vitiligo:
The main goal of diet - restoration of normal metabolism, increase in the body of copper, zinc, iodine, iron and vitamins, as a possible cause of the disease in the absence of explicit source or as an additional reinforcing means during treatment.
Products containing copper: cod liver, fish, seafood, mushrooms, pineapple, bananas, cherry, raspberries, buckwheat, parsley, celery, figs, apricots, pears, blackberries, raspberries, cherries, walnuts, melons, legumes (peas, beans, lentils).
Prevention and prognosis of the treatment
In order not to exacerbate vitiligo patients is not recommended for prolonged sun exposure, undesirable skin trauma in the affected areas.
Vitiligo Treatment long and effective treatment selection takes 6 months to a year.
In 20% of patients treated vitiligo completely ineffective, especially with long duration of disease.
Separate recovery occurs in 5% of cases.
Forums for the diagnosis and treatment of vitiligo are written in accordance with the Federal treatment guidelines year 2013.
