Vitiligo is a disease characterized by the appearance of depigmentation areas (white spots) on the skin, their gradual growth and fusion. The hair on the affected areas is also devoid of pigment. The disease mainly causes cosmetic inconveniences. Aggravation of the disease and sunburn of depigmented areas with prolonged insolation are Disease begins with the appearance of one depigmented area, subsequently increasing in size. Diagnosis is based on visual examination, for differentiation from other dermatological diseases, a skin biopsy is possible. Treatment includes photo and hormone therapy, but it remains ineffective so far.
Vitiligo is a chronic skin disease from the class of dyschromia, which is characterized by the appearance of depigmented areas. With vitiligo, melantocytes partially or completely lose their functions, as a result of which the skin discolors. The incidence is about 3% of the population, the skin is most often affected; lesions of the retina, meninges and hair are less common. Basically, the disease begins to manifest itself at a young age, the incidence in people after 40 years is significantly lower.
The etiology of vitiligo has not yet revealed the main causes of its occurrence, but inheritance by dominant type indicates that genetic predisposition is one of the main factors. Dyschromia, which once arose due to disorders of the nervous system, metabolic processes and disorders in the work of the endocrine glands, is genetically fixed and manifests itself in subsequent generations. With neuropsychiatric injuries that are accompanied by neuroendocrine disorders, such as diabetes mellitus, vitiligo is diagnosed more often. Disorders of the thyroid gland, ovarian dysfunction and changes in the functional state of the pituitary-adrenal system are predisposing factors in the appearance of vitiligo. The combination of several factors increases the risk of getting sick.
Working in hazardous production, constant contact with aggressive chemicals such as formaldehyde, phenol, phenol-containing reagents and harsh detergents increases the risk of occupational vitiligo.
Infectious diseases, especially those that cause chronic disorders in the work of internal organs, depressive states, frequent physical injuries of the skin (for example, burns) and intestinal invasions are of great importance in the development of vitiligo. The constant wearing of clothes made of synthetic fabrics, disregard for personal hygiene rules and the use of cosmetics, which include chemically aggressive substances, can cause a violation of the functions of melanocytes and, as a result, provoke vitiligo.
Vitiligo debuts with a single depigmented ivory spot, which can be localized on any part of the skin. Disease differs from other dyschromias by the presence of a hyperpigmentation zone on the periphery of the lesion. In the hyperpigmentation zone, there is a thickening of the pigment. The primary spot of vitiligo has a tendency to peripheral growth, in the future the number of foci increases, they tend to merge with the formation of extensive areas of depigmented skin. Depending on the depth of the melantocyte dysfunction, vitiligo spots can be either ivory-colored or completely snow-white if the melantocytes completely lose their functions.
In vitiligo, the loss of melantocytes of their functions can be observed both gradually and immediately. The reasons why the disease progresses and is poorly treated have not been studied.
An important diagnostic sign is that vitiligo spots can be located on any parts of the skin and mucous membranes, but they are never localized on the palms and soles of the feet. Hair, including downy, discolored in areas of vitiligo, 30-40% of patients have premature gray hair. Pain and other subjective sensations are absent, but 10% of patients with vitiligo complain of itching. Itching is most likely secondary in nature due to exposure to the affected area of sunlight and any other aggressive factors, as the dermis with non-functioning melantocytes loses its protective functions.
The spots have rounded outlines and are located mainly on the flexor and extensor surfaces, in the armpits, in the wrists, on the face and on the buttocks. Posttraumatic form is localized along the surgical suture or scar. Often, constant traumatization of the skin, for example, with seams of clothing, also leads to post-traumatic vitiligo.
The acrocephalic form is characterized by areas of depigmentation on the face, scalp, ears and neck. With the universal form of vitiligo, there are islands of skin with normal pigmentation that have a concave sinking edge.
Most often, the spots are arranged symmetrically, which facilitates diagnosis. With atypical forms of vitiligo, flaky erythema may occur immediately before the appearance of depigmentation, which requires a differentiated diagnosis with pink lichen. Vitiligo reticulata occurs on the skin of the genitals and on the inner surface of the thighs. As a result of uneven loss of pigmentation, cells with healthy melanocytes form a grid of dots. With spot vitiligo, depigmentation areas are small, but the characteristic hyperpigmentation around the focus is more pronounced.
The duration of the formation of vitiligo spots is variable, from several years to several months. With a rapid form, vitiligo spots can appear in a few hours. One of the complications is sunburn of the affected areas, since due to the absence of melanocytes, the skin completely loses its protective functions from radiation.
Clinical manifestations and questioning of the patient help to make a diagnosis, and biopsies are resorted to to confirm it. Histological examination reveals a complete or partial absence of melanocytes and changes in collagen fibers characteristic.
There is a slight inflammatory reaction at the edges of the depigmented zone, a small number of lymphocytes and an increase in the number of melanocytes with hypertrophied melanosomes are observed in the late stages.
Vitiligo does not respond well to treatment, only in 5% of cases there is a spontaneous restoration of skin color. Adequate vitamin therapy with a mandatory content of copper and zinc in vitamin complexes helps to stop the progression of vitiligo. Irradiation of vitiligo-affected areas with narrow-wave UV rays and laser therapy for two years also reduce the likelihood of peripheral spot growth. Treatment of liver diseases and diseases that provoked vitiligo, in some cases, help restore normal skin pigmentation.
PUVA therapy and selective phototherapy are used in the treatment. To mask cosmetic defects, the use of tonal cosmetic products with a high level of UV protection is shown. The exclusion of direct solar radiation, except for medical ultraviolet and wearing clothes covering the affected skin, helps to avoid sunburn.
Lubricating the skin with corticosteroid ointments of moderate activity with a combination of photosensitizing drugs, for example, containing psoralen, have a good therapeutic effect, although 25% of patients have no positive dynamics during vitiligo at all.
Alternation of hormonal therapy of vitiligo and phototherapy in each case is prescribed individually, if necessary, corticosteroid drugs are prescribed orally.
The prognosis of the disease is always unfavorable.