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Vitiligo: Those White Spots On The Skin

Posted by Milton Ruiz

Vitiligo

This skin disease has had great social significance throughout history. There are references to it in the sacred books of India, 1,400 years before Christ. The stigma associated with vitiligo, in some cultures, goes back to those times when it was confused with leprosy or other contagious or disfiguring disorders. It originates a great aesthetic and psychological repercussion for the people who suffer from it.

Vitiligo

Vitiligo is a disease of unknown cause, with a certain genetic predisposition, which appears in all races. It affects between 1 and 2% of the population and both sexes equally; and, although it can occur at any age, it is more common to do it between 10 and 30 years.

Despite the great scientific advances, it has not yet been possible to elucidate the reason why melanocytes (melanin-producing cells) are not present in white spots. However, several factors are posited, such as genetics, autoimmune and neurogenic mechanisms (nearby nerve endings release a toxic neurochemical mediator for melanocytes). Many patients attribute the beginning of the disease to some specific circumstance of their life, a crisis or certain illness: the loss of work, the death of a close relative, an accident or a serious systemic pathology. Continue reading https://www.medicalnewstoday.com/articles/319887.php

Clinical picture

The clinical manifestations of vitiligo are very specific and, in general, asymptomatic. The characteristic lesion is a chalky or milky white spot with well-defined limits, ranging in size from punctate to large spots, of different shapes. Their number is variable because it can be presented as a single injury or in a quantity that is uncountable.

Vitiligo

Types of Vitiligo

  • Focal: isolated spot or a few scattered.
  • Segmental: unilateral spots with a distribution of a metamera (field or area associated with a nerve that leaves the spinal cord). Tends to be early onset and more stable than the generalized. It usually appears in the area of the trigeminal nerve, neck, and trunk.
  • Generalized: it is the most common type and is characterized by scattered spots. It is common that these spots are arranged symmetrically on the extensor surfaces of the extremities, mainly in the joints of the fingers, elbows, and knees. Other compromised surfaces are the wrist, the umbilical, the lumbosacral area, the anterior tibia and the armpit. They can be periorificial, being located around the eyes, the nose, the ears, the mouth and the anus. It can also affect the mucous membranes (lips, a distal part of the penis and nipples). It can be associated with premature canice.
  • Universal affects virtually the entire body surface.

Associations

It can be associated with alopecia areata, pigmentary abnormalities of the iris and retina, thyroid diseases (hyperthyroidism, hypothyroidism, toxic goiter, and thyroiditis), diabetes mellitus, diseases of the adrenal glands (Addison) and pernicious anemia (due to vitamin B12 deficiency).

Diagnosis

It is easy, although, in people with light skin, Wood’s light exploration may be useful.

Treatment

Four aspects of the disease should be considered:

  • Protect areas without pigment with clothes or sunscreen to avoid sunburn, frequent due to the absence of melanin.
  • Try the regimentation of the white areas, from the regeneration of the melanocytes of the surrounding healthy skin or of the healthy hair follicles of the affected area. This is a difficult task for which they can be used: potent topical corticosteroids when the lesions are small, topical immunomodulators (tacrolimus) and photochemotherapy (PUVA). You can also perform healthy skin grafts or melanocyte cultures in the areas of the affected skin.
  • Try depigmentation of healthy pigmented areas with monobenzylether of 20% hydroquinone. It is used if repigmentation fails.
  • Disguise the lesions with makeup.

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