What is Vitiligo?
At its core, vitiligo represents the disappearance of the melanin pigment from the skin.
Causes of Vitiligo
The basis of vitiligo, like most skin pigmentation disorders, according to many researchers, is a violation of the formation of normal melanin in the melanocytes of the skin. This, in turn, may be due to a number of reasons.
Previously, the infectious theory of the origin of pigment metabolism disorders was considered the most common and generally accepted. It was assumed that some kind of known or unknown viruses, penetrating into the skin, contributes to the further appearance of areas of excessive or, on the contrary, insufficient coloration on it. The defeat of the skin could occur as a result of any bacterial infection, under the action of harmful substances secreted by pathogenic bacteria. At present, this hypothesis has been rejected because it has not found adequate evidence. To date, it is considered that the following factors play the most important role in the development of the disease: neuropsychic experiences and stresses, some diseases of infectious origin, syringomyelia (a special hereditary disease of the spinal cord, as a result of which the innervation of the skin is violated) diseases of the helminthic nature, disturbances in the functioning of the endocrine glands (of the main importance are disorders of the functions of such glands as the pituitary gland, thyroid gland Lesa, gonads). Vitiligo can develop in those places where the skin is constantly exposed to mechanical stimuli, for example, while wearing bandages, corsets, dressings, gypsum. Not in the last place are various violations of metabolic processes in the body, for example, a deficiency of elements such as iron and copper, which are quite important in the mechanism of disease development.
Pathogenesis during Vitiligo
The disease is acquired, therefore, it is in no way associated with genetic disorders and almost never affects young children. Most often, the pathology occurs in adults, more rarely in adolescents and children of older age groups. Especially strongly vitiligo. Currently, the number of cases of pathology has somewhat decreased, however, due to the effect of a large number of unfavorable environmental factors, as well as the constant stress situation in society, it is still quite common.
Normally, the natural color of the skin is ensured by the specific melanocytes that contain the melanin pigment in its structure. Normal melanocytes must always contain a special set of enzymes, by which other substances, for example, the amino acid tyrosine, are converted into a specified pigment. Melanocytes in large quantities are located in the deeper layers of the skin, in the hair trunks. It is interesting to note that in people with different intensity of coloring of the skin, for example, a European and a Negro, the number of melanocytes contained in the skin does not differ at all. Excellent only the amount of pigment produced by them. Under normal conditions, a lot of different factors affect the intensity of skin and hair coloring: heredity, belonging to a particular race and nation, duration of exposure to the sun during the day, features of the body’s metabolism, nutrition, age.
Vitiligo is manifested by the fact that on the skin of the patient appear round or oval-shaped spots, devoid of melanin pigment, which are initially, as a rule, small in size – 0.2-0.3 cm in diameter. Initially, they can be more, in the future their sizes grow. Externally, the spots look white, milky or ivory, which is typical.
The boundary between lesions and healthy skin is clear. Characteristic signs are that scales never form on the surface of the spots, and the spots themselves never rise above the surface of healthy skin, which in the area of the spots is devoid of pigment. However, if you look closely, it may seem that the pigment seems to be moved to the edges of the lesions, since the skin here is intensely colored.
Sometimes in some patients, smaller spots of enhanced skin pigmentation appear inside the vitiligo spots themselves. As mentioned above, at the very beginning of its development, vitiligo spots are small. Then, at the edges, they begin to grow, become larger, sometimes as a result of growth they merge with nearby spots, forming larger foci of irregular outlines. At the same time on the edges of the focus remains the same characteristic feature – increased color of the skin. Often, the lesion takes on time simply gigantic proportions: it can occupy the entire area of the buttock, the entire stomach, the entire back. Sometimes a lesion captures the entire skin of the body, but this is extremely rare.
Defeat with the disease does not differ any favorite localization, it can be located in absolutely any place, including the eyebrows, on the genitals, on the scalp. Most often, foci are detected on the external genitalia, which are often mistaken for manifestations of sexually transmitted infections on the dorsum of the hands, in the folds between the buttocks. In some patients, the skin manifestations of vitilio-go look unique: small areas of depigmentation alternate with areas of normal skin, which generally gives it a motley appearance.
Hair in the affected area of the skin becomes discolored. At the same time, the patient does not feel any subjective sensations, does not make complaints, does not turn to medical institutions for help. Some researchers in recent years have found that the skin in the area of vitiligo spots is very sensitive to the action of sunlight, especially the ultraviolet spectrum.
In the affected area, the function of the sweat glands is significantly impaired, which leads to impaired sweating. When exposed to ultraviolet light, the skin in the area of vitiligo spots never gets a tan, while the surrounding spots of the hyperpigmentation darken even more. There are places where vitiligo never develops – these are mucous membranes, palms and soles. In some patients, the development of the disease occurs in a peculiar way: first, a reddening patch of skin appears in the area of the future focus, then the skin on this spot loses its color. Vitiligo often affects the patient’s skin not in isolation, but is combined with diseases such as scleroderma, porphyrin disease, nesting baldness, Satan’s nevus, white skin atrophy, etc. Specific signs are the absence of flaking and skin atrophy in the area of lesions at any time. form of the disease.
Vitiligo always proceeds chronically, it is quite difficult to give therapy. As already mentioned, the process begins with a small spot, and in most cases imperceptible on the skin. In the future, this speck grows in size. New foci of lesions appear in other areas of the body, and this process occurs slowly, gradually, and may last for months and even years. Sometimes the disease does not cease to develop until the very end of the patient’s life. The literature describes cases when the disease passed on its own, without appropriate therapy, but this happens extremely rarely, most often vitiligo stubbornly resists any treatment methods.
If we look at scrapings taken from the lesion site under a microscope, it turns out that melanin is completely absent in such skin. At the same time, in the material taken from the edges of the focus, the content of the melanocytes themselves and the pigment in them is found in very large, excessive amounts. At the same time in all layers of the skin in the area of the focus can be identified inflammatory phenomena, which, apparently, are mainly due to allergic reactions.
Diagnosis of Vitiligo
The diagnosis in the clinic is made easily when the skin shows characteristic lesions in vitiligo, which are white spots without pigment of melanin, in the area of which the formation of scales or atrophy is never detected. Often it is necessary to distinguish the disease from the so-called leukoderma of syphilitic origin. It develops in the secondary period of syphilis and is a pattern of a grid on the neck, which is formed due to a large number of spots that are devoid of pigment. The important point is that when syphilis, in contrast to vitiligo, there are other signs, such as peculiar lesions on the mucous membranes, in the anus, so-called polysclerosis. Also in the conditions of modern clinics it is easy to set up some simple laboratory reactions that can confirm the presence of syphilis in the patient, and not other pathology.
When leprosy (leprosy), spots may appear that are very similar to those of vitiligo. The difference is that with leprosy in the area of the lesions there is no sensitivity at all, which is easy to identify with the help of the application of irritations with an ordinary needle. In the spotted form of leprosy, on the contrary, the patient is worried about the constant pain in the area of pathological lesions, which are caused by irritation of the nerve endings. For additional analysis, a patient can take scrapings or smears from skin spots and mucus from the nasal cavity from the patient. In the study of this material under a microscope, microbes of leprosy are detected in it. Of great importance when a patient is diagnosed is his detailed inquiry as to after which factors the disease developed, how it started, how it went on later, what feelings the patient himself experienced.
Another disease capable of forming spots on the skin, similar to those of vitiligo, is versicolor versicolor. But the foci of affection at the same time have a light, but slightly different color from a milky white with vitiligo. In addition, on the body of the patient, in addition to white, foci of a different color and character may appear: pink and dark colors, with scaling on the surface. When scraping stains with pink lichen, a sign of the so-called “shavings” is determined. When smeared with iodine tincture, the spots take on a darker color, which is never observed in vitiligo.
With multi-colored lichen, spots resembling those of vitiligo occur most often in the early stages after recovery, when the patient is subsequently exposed to the sun for a long time. At the same time, discolored spots appear on the sites of the former centers of multi-colored lichen. They exist only for some time, and then spontaneously disappear, which is never the case with vitiligo. In any case, if even the slightest difficulty arises in making a diagnosis of vitiligo, then such a patient should consult a neuropathologist and an endocrinologist to assess the state of the nervous system, the system of endocrine glands, and metabolic processes in the body. This is important in the future, in terms of proper selection of therapy. In all cases, the patient’s blood is taken for the formulation of the Wasserman reaction (a specific laboratory reaction to detect syphilis).
The patient is assigned substances that improve metabolic processes, especially in the skin, drugs that directly affect the metabolism of melanin pigment. Local skin therapy is carried out with alcohol solutions of various drugs.
Most often, such therapy is combined with physiotherapeutic measures, especially by irradiating lesions with ultraviolet light. At the beginning, the skin is treated with an appropriate preparation, and then irradiation is performed. This combination contributes to a significant increase in the positive effect. Currently, such a perfect technique has been developed, such as PUVA therapy, the essence of which is that various medications, preparations of hormones of the adrenal cortex, are injected directly into the skin with the help of ultraviolet rays.
When applying local skin therapy, do not lubricate with medicinal solutions, creams and ointments the area of the eyelids and the skin around the eyeballs. With the majority of currently used techniques, the total duration of one course of therapy is on average about 1 month. In the future, such courses should be repeated to the patient with a certain frequency all his life. Of particular difficulty is the treatment of children with vitiligo, under the age of 5 years and younger, since many of the drugs used in adults are contraindicated. Also, contraindications to the main variety of drugs prescribed for vitiligo include diseases such as acute intestinal infections, irritable bowel syndrome, hepatitis, inflammatory processes in the kidneys, diabetes, hypertension, tuberculosis, pregnancy, general depletion of the body to a large extent, the age of the patient. over 50 years old.
Very often, with vitiligo, a good effect can be obtained when a patient is prescribed various hormonal drugs, vitamin medicines, especially A and E. It should only be remembered that hormone drugs can never be prescribed without first consulting the patient by an endocrinologist, as with their illiterate use developing complications may exceed the manifestations of the disease itself by the degree of harm to the patient’s body.
The most widely used group of hormonal drugs for vitiligo are adrenal hormones. However, as mentioned above, their appointment requires some caution. This is especially true for young children. Contraindications to the use of drugs in this group are: hypertension, heart defects in children and adults, diabetes mellitus, tuberculosis, purulent skin diseases, osteoporosis, gastric ulcer and duodenal ulcer, malignant tumors, especially skin. During adrenal gland hormone therapy, a necessary condition is to monitor the patient’s condition, which consists in measuring blood pressure at least three times a day (in the morning, at lunch and in the evening), periodically examining the patient’s urine, blood (special attention is paid to its clotting, sugar content) . With comorbidities from the internal organs, they control their functions, especially the nervous system and the system of endocrine glands.
Forecast. In relation to the recovery of the patient is unfavorable. Modern methods of therapy, which are constantly being improved, at the moment can only suspend an already evolving process, but rarely lead to the full recovery of the patient. The consolation is that vitiligo does not affect the ability to work and daily life, causing only cosmetic inconvenience. For the correction of spots in the most visible places, you can use a variety of foundation creams.
It consists mainly of hardening, restorative measures, taking vitamin preparations.