Vitiligo – Ala Disease
Vitiligo comes from the Latin word “vitelius”. Vitelius means veal in Turkish. The disease has been likened to spots on the back of this animal. There are melanocyte cells in our skin that produce pigment and give our skin its color. As a result of damage to these melanocytes, pigment cannot be produced. As a result of pigment deficiency, scattered and patchy white spots and spots occur on the skin. The spots are obviously as white as milk. These spots can vary in size; It can be as large as a point to cover the entire face. Sometimes the loss of melanin pigment is partial and may not be a complete white patch. Not every white spot means vitiligo. Rarely, there may be color loss in the hairs. It is also known as mother-of-pearl ala, baras, ebreş in the middle of the public. In our society, vitiligo is confused with psoraisis disease, which is characterized by white dandruff-red sores on the skin. But these two diseases are completely different from each other.
What is the course of vitiligo disease?
Vitiligo disease is a long-term, repetitive disease that can last a long time, with periods of exacerbation and remission from time to time. The disease shows a different and individual course in each patient. In other words, every patient’s vitiligo is different. In some patients, a small number of plaques form and never increase. In some individuals, the disease may be so widespread that there is almost no normal skin-colored area of the patient.
What are the incidence and characteristics of vitiligo?
Although vitiligo varies relatively in the society, it is seen at a rate of 1-2%. There is no gender-related difference in the incidence. Approximately 30% of patients have a family history of vitiligo events. The disease itself is not hereditary, but genetic predisposition is a matter of speech. It is common in blacks, Moroccan and Yemenite Jews. Although vitiligo can appear from birth to old age, the age of onset is most common between the ages of 10 and 30. It is very rare in older ages and infants. The increased interest in the appearance of the skin in women makes it possible to detect vitiligo earlier than in men.
What are the initial symptoms and features of complaints in vitiligo?
In early-period vitiligo, the white areas are not obvious and may be itchy. Initially, vitiligo progresses without symptoms. Vitiligo appears as sharp-ended and cosmetically irritating white patches that become more evident when the skin is sunburned. Further prominence of the lesion can be prevented by sun protection.
Are there clinical types of vitiligo? What are these?
At first there are only a few small, sharply demarcated surrounding areas, often darker. There may be a red or dark colored ring on the borders. As the number of lesions increases, they may merge to form amorphous forms. Vitiligo lesions can be in a single area or widespread, the widespread form is located symmetrically in the body. The most frequently affected areas are the face, neck and scalp. Skin folds are also frequently involved. The most common sites are bony prominences exposed to repetitive trauma, forearm outer surface, wrist inner face, back of hand, fingertips. Vitiligo occurs quite often around areas such as lips, genital area, gums, areola and nipple. Moles called halo nevus with a white ring around it are common in vitiligo patients. Scalp vitiligo usually occurs as regional patches of white or gray hair, but total whitening of the entire scalp can also be seen. Scalp involvement is observed. This is followed by eyebrow, inguinal region and armpit involvement, respectively. Whitening of the hair can be a bad sign for treatability. (The coloration of vitiligo by treatment or by nature is due to the melacids found in the hair follicles.) If vitiligo is limited to a small area, it is called “local vitiligo”, if it is in a certain anatomical area, for example, it is called “segmental vitiligo”, if it is widespread and symmetrical in the whole body, it is “vitiligo”. vulgaris” and “universal vitiligo” definitions are used if it is common in the form to cover the whole body.
What are the causes of vitiligo?
The cause of vitiligo is unknown. However, the following hypotheses have been developed. The immune system malfunction hypothesis; The causes of vitiligo are not completely understood, but medical research suggests that it is related to the immune system (our body’s defense system). T lymphocyte cells, one of the white blood cells found in our blood, attack their own color cells as a result of the deviation in the defense system control. Neural hypothesis: A mediator released from the borders destroys the production of color cell melanocytes or color matter melanin. Hypothesis of self destruction Color component melanin synthesis can be destroyed by color cell melanocytes.
Genetic hypothesis; An inherited abnormality of melanocytes inhibits their growth and development.
Microchimerism Hypothesis: In some studies, it has been shown that there is cell transfer between individuals during pregnancy (between mother and baby), organ transplantation or blood transfusion. These cells or DNAs remain in the recipient for decades, creating a state of microchimerism. It is thought that vitiligo may have formed in this way. Viral causes: Hair loss in the form of vitiligo and para, especially due to CMV (citomegalovirus) has been suggested and antiviral treatments have been applied for this purpose.
B12 and Folic acid deficiency: It is thought that high homocysteine due to B12, B6 and folic acid deficiency may cause vitiligo. The high level of this amino acid is valuable because it also causes cardiovascular diseases and frequent bone fractures. Since none of these theories alone is satisfactory enough, theories involving several of them are also supported by some experts.
Is blood analysis necessary in vitiligo and what are the diagnostic formulas?
Although the diagnosis of vitiligo is mostly made clinically, biopsy can rarely help in distinguishing it from other diseases. Vitiligo may be associated with other autoimmune diseases, especially thyroid diseases and diabetes mellitus. 30% have thyroid disease. Other coexisting autoimmune diseases include: Perniosis anemia, Addison’s disease, Alopecia areata, insulin dependent Diabetes, Uveitis, Chronic mucocutaneous Candidiasis, Polyglandular autoimmune syndromes. Patients should be alert to the initial signs and symptoms of hypothyroidism, Graves’ (thyroid disease), diabetes, and other autoimmune diseases.
Diagnosis can be made by examination under Wood’s light. This light makes the color loss even more pronounced. Especially the armpits, anus, and genital areas are not very obvious without Wood’s light.
Is Vitiligo Disease Contagious?
Vitiligo is definitely not a contagious and microbial disease. It cannot be transmitted from one part of the body to another.
Does vitiligo spread?
This is a contradictory issue. The onset is usually slow and sometimes it can stay in that form. However, since there may be a rapid increase in the spots after months, the patient should definitely be under close follow-up.
Does vitiligo go away ex officio?
Usually single lesions can already regress by showing freckles on them.
Is There a Recommended Nutrition Form for Vitiligo Disease?
Vitiligo is not an allergic disease and is not caused by a reasonable diet. The use of antioxidants, namely vitamins A, E and B, protects the patient with vitiligo against the damaging effects of the sun.
Is vitiligo associated with a disease in the internal organs?
It is not a disease related to internal organs. However, some diseases can be seen together with vitiligo: thyroid gland diseases, hair loss, diabetes, adrenal gland diseases. However, absolute examination is required for all these diseases.
Does Vitiligo Disease Turn into Skin Cancer?
No ! However, since melanocytes, which are the natural protection system of the skin, are not present in vitiligo disease, sun-borne skin cancers are observed more frequently. In addition, some treatment methods used unsupervised may increase the risk of skin cancer. For this reason, it is valuable to continue the treatment under the supervision of a specialist.
Does vitiligo have anything to do with tension and trouble?
Although it has not been proven, spots may increase as heavy tension affects the body’s defense system. For this reason, it is absolutely necessary to make psychological evaluation when necessary.
What is the treatment for vitiligo?
Although there are many treatment formulas in the treatment of vitiligo, there is no single treatment procedure that gives satisfactory results in all patients. Therefore, treatment should be individualized according to the patient. Patients should also be warned about the duration and risks of treatment. The response to the treatment is in the form of small freckling islets of color within the white spots and then they merge and close the area.
A. Medical treatments consisting of topical and systemic drugs
B. Surgical applications
C. Additional treatment approaches can be evaluated under their headings.
A. Topical Treatments
1. Corticosteroids (drugs with cortisone); They are the most commonly used vitiligo drugs. It is not preferred in common patients because it has systemic and side effects where it is used. More in children, localized areas and new-onset vitiligo
it is effective. It gives the fastest and most accurate response, especially in facial lesions, but care should be taken in terms of side effects such as popular cataracts and increasing eye pressure. The response is more adequate for dark skinned ones. The advantages of being inexpensive and easy to administer are the disadvantages of side effects and recurrences after treatment.
PUVA therapy is a treatment that can be summarized if photosensitizing factors such as 8-methoxypsoralen, 5-methoxypsoralen, trimethylpsoralen are given and then UVA is applied. It is especially preferred in patients with extensive skin type IV-VI. However, it is not used much anymore because it can be used over the age of 12, the disease recurs within 1-2 years after the treatment, it cannot be used in light skinned people, and it is at risk of developing cataract and skin cancer, which is appreciated in long follow-ups.
Ultraviolet B Treatment: UVB treatment was applied as an alternative to PUVA. Apart from the ease of application and the lack of need for a chemical issue, no statistically significant difference was observed compared to PUVA. However, although the narrow band results seem satisfactory, since UVB or PUVA is applied to the normal skin during the treatment, the contrast between the lesion and the normal skin increases, the risk of skin aging, telangiectasias and skin cancers in the normal skin increases. It is not possible to apply different doses to different areas.
Excimer Laser: In order to overcome the problems in PUVA and UVB treatments, special devices called Excimer laser have been developed under the name of microphototherapy. These devices detect the white skin and direct the UV rays there. We’re lucky to give different doses to different areas. The total dose given is reduced. Higher doses can be applied to distressed areas compared to the minimal erythema dose.
3. Immunomodulators; For this purpose, successful results have been obtained with tacrolimus and pimecrolimus in recent years. Side effects are less than topical steroids, irritant effects can be and it is safer than topical steroids in children. For this reason, it is preferred especially in limited involvement of the face and length, and in children. Combination with excimer laser/light systems and UVB gave better results. It is not used in combination with UVA treatments due to the increased risk of cancer.
4. Calcipotriol; Calcium reuptake is impaired in vitiligo skin. Calcipotriol regulates calcium hemostasis by stimulating D vit 3 receptors in melanocytes. It is mostly used in combination with narrowband UVB.
5. PGE2(prostaglandin E 2); It has been found to be successful especially in vitiligo with UV.
6. Pseudocatalase; Catalase is an antioxidant enzyme normally found in the skin that reduces the damage of free oxygen radicals. Good results are obtained with the use of UV in patients with vitiligo.
7. Phenyl alanine; It is used alone and in combination with UV treatments.
8. Placenta; placenta extract. It stimulates the production of melanin in the skin. There is a gel form.
9. Depigmentation; It may be considered in patients with more than 50% involvement and in whom repigmentation attempts, particularly on the face and length, do not respond. After depigmentation, a complete color integrity is provided regardless of skin type. Patients should be given sufficient information about the application and its results, and patients should accept that they will never sunbathe. The monobenzyl ether of hydroquinone (monobenzene) is the only spy available in the US and Europe. It permanently destroys epidermal melanocytes by increasing the release of free oxygen radicals.
10. Camouflage applications; Micropigmentation Iron oxide pigments were used for the first time in 1989. Today, the precedent technique is used for permanent eyeliner. Tatuaj can only be used on dark-skinned individuals for the purpose of repigmentation of the depigmented area. Color harmony is difficult, and color tends to fade.
Although leather can be dyed with dihydroxyacetone preparations (sunburn), color matching is often not successful.
B. Systemic treatments;
1. Steroids; In actively progressive lesions, cytotoxic effects against melanocyte antibodies provide rapid smoothing. However, their use is limited due to their side effects and treatment should be started by considering the benefit-harm stability.
2. Treatment with Levamisole: It has been found reliable and effective in the treatment of vitiligo.
3. Vitamins: B 12, Ascorbic acid, Folic acid has been suggested in the treatment.
4. Suplatast tosilate: It is recommended to be used together with other drugs. Tcell is an anti-allergic agent that inhibits IL-4 mRNA transcription.
* Surgical Approach: Patients with small areas and stable (no progression for 4-6 months) vitiligo are candidates for surgical transplantations. The application is time consuming, only finite for patients with segmental or localized vitiligo. Other treatments are difficult to achieve on the dorsal sides of the fingers, wrists, forehead and hairline. Surgical applications can be performed here.
The surgical techniques applied are as follows;
1-Epidermal and melanocyte suspensions: The melanocyte and skin suspensions prepared from the patient’s normal skin are placed on the vitiligo area removed by dermabrasion or laser. If the melanocytes taken are cultured and multiplied, they can be used in larger areas. However, it is a long, laborious and more valuable application.
2-Thin dermoepidermal grafts: the normal skin taken with a dermatome is placed in the area of vitiligo skin taken with a dermatome again.
3- Suction bulla grafts: Grafts are obtained from ordinary pigmented skin by vacuum and overt pressure. The roof of the bulla removed from the vitiligo area by freezing or suction is removed and this usual donor is placed in its place.
4- Punch minigraft: Ordinary pigmented skin is taken with special tools called punches with a diameter of 0.7 or 1 mm, and these are placed on the skin with vitiligo to the places taken with punches of the same diameter.
C. Adjunctive Therapies;
1. Spiritual Basis: Scientific studies have shown that providing a psychological support in vitiligo patients increases the quality of life and contributes to the improvement of the disease. Therefore, various methods of psychotherapy can be used when necessary, with or without appropriate drugs.
2. Herbal Medicines: Similarly, herbal treatments and natural medicines cannot provide long-term beauty. Herbal and natural medicines taken orally can have severe visceral (eg liver) toxicities, valuable side effects, and drug interactions. For this reason, the treatment of vitiligo, which is a skin disease, should be done by a dermatologist with approved drugs that have proven safety as well as activity. Your doctor is the source where you will find the most reliable and true information about newly developed drugs or other treatment formulas.
What should a person with vitiligo pay attention to?
The element that gives color to the skin also protects the skin from sun rays. Since this element is absent in vitiligo spots, these spots have become defenseless against the sun. A quick sunburn can occur. For one reason or another, since the susceptibility to some skin cancers increases in these spots, a sunscreen cream should be used at the recommendation of a dermatologist, and if possible, white spots should be protected from sunlight. New stains may appear in places of impact, scratch and friction. Therefore, it is necessary to protect the skin from harmful effects.