Vitiligo – the disease which is characterized by emergence on skin of sites of a depigmentation (white spots), their gradual growth and merge. Hair on sites of defeat are also deprived of a pigment. The disease gives generally cosmetic inconvenience. Aggravation of a disease and solar burns of the depigmented sites at long insolation are possible. Vitiligo begins with emergence of one depigmented site, in the subsequent increasing in sizes. Diagnostics is based on visual survey, for a vitiligo differentiation from other dermatological diseases carrying out a biopsy of skin is possible. Treatment of vitiligo includes photo and hormonal therapy, however it remains still ineffective.
Vitiligo – a chronic disease of skin from a class of diskhromiya which is characterized by emergence of the depigmented sites. At melantotsita vitiligo partially or completely lose the functions owing to what skin becomes colourless. Incidence on vitiligo makes about 3% of the population, skin most often is surprised; damages of a retina of eyes, brain covers and hair meet less often. Generally the disease begins to be shown at young age, incidence at persons after 40 years is significantly lower.
Reasons and mechanisms of development of vitiligo
In an etiology of vitiligo the main reasons for emergence, but inheritance on prepotent type are not established yet, specify that genetic predisposition is one of major factors. Diskhromiya who arose once because of violations of nervous system, processes of metabolism and violations in work of endocrine glands is genetically fixed and shown in the subsequent generations. At psychological injuries which are followed by neuroendocrine violations such as diabetes, vitiligo is diagnosed more often. Violations of work of a thyroid gland, dysfunction of ovaries and change of a functional state hypophysial systems are the contributing factors in emergence of vitiligo. The combination of several factors increases risk to ache.
Work on harmful production, continuous contacts with aggressive chemicals, such as formaldehyde, phenol, fenolsoderzhashchy reactants and rigid cleaners increases risk of professional vitiligo.
Infectious diseases, especially those which cause chronic violations in work of internals depressions, frequent physical injuries of skin (for example, burns) and intestinal invasions I am of great importance in development of vitiligo. Constant wearing clothes from synthetic fabrics, neglect rules of personal hygiene and use of cosmetics which part chemically aggressive substances are can cause violation of functions of melantotsit and as a result – to provoke vitiligo.
Clinical displays of vitiligo
Debuts vitiligo from one depigmented spot of color of ivory which can be localized on any site of skin. Differs in existence of a zone of a hyperpegmentation on the periphery of the center of defeat from other diskhromiya of vitiligo. In a zone of a hyperpegmentation the pigment condensation is observed. Primary spot of vitiligo has tendency to peripheral growth, further the quantity of the centers increases, they are inclined to merge to formation of extensive sites of the depigmented skin. Depending on depth of violations of functions of melantotsit of a spot of vitiligo can be as color of ivory, and completely snow-white if melantotsita completely lose the functions.
At vitiligo loss of a melantotsitama of the functions can be observed both gradually, and at once. The reasons for which the disease progresses and badly moves therapies, are not studied.
Important diagnostic sign is that spots of vitiligo can settle down on any sites of an integument and mucous membranes, but they are never localized on palms and soles of feet. Hair including pushkovy, on sites of vitiligo become colourless, at 30-40% of patients the premature gray hair is noted. Pain and other subjective feelings are absent, but 10% of patients with vitiligo show complaints to an itch. The itch, most likely, has secondary character because of impact on an affected area of sunshine and any other aggressive factors as shit with nonfunctioning melantotsita loses the protective functions.
Spots have roundish outlines and settle down generally on sgibatelny and razgibatelny surfaces, in axillary hollows, in wrists, on a face and on buttocks. Post-traumatic vitiligo is localized along a surgical seam or a hem. Often constant travmatization of skin, for example, clothes seams, leads to post-traumatic vitiligo too.
The Akrotsefalny form of vitiligo is characterized by sites of a depigmentation on a face, a hairy part of the head, ears and a neck. At a universal form of vitiligo there are skin islands with normal pigmentation which have the concave sinking-down edge.
Most often spots are symmetrized that facilitates diagnostics. At atypical forms of vitiligo just before emergence of a depigmentation there can be a shelled eritema that demands the differentiated diagnosis with pink is deprived. Vitiligo mesh meets on skin of genitals and on the internal surface of hips. As a result of uneven loss of pigmentation of a cage with healthy melantotsita form a grid of points. At dot vitiligo sites of a depigmentation small, but the characteristic hyperpegmentation around the center is expressed more brightly.
Duration of formation of spots of vitiligo is variable, from several years to several months. At a prompt form of a spot of vitiligo can appear in several hours. One of complications of vitiligo are solar burns of affected areas as due to the lack of melantotsit skin completely loses the protective functions from radiation.
Diagnosis of vitiligo
Clinical manifestations and poll of the patient help to make the diagnosis, for its confirmation resort to a biopsy. At a histologic research total or partial absence of melantotsit and changes of collagenic fibers, characteristic of vitiligo, is found.
At the edges of the depigmented zone insignificant inflammatory reaction is observed, at late stages of vitiligo a small amount of lymphocytes and increase in number of melantotsit with hypertrophied melanosoma is observed.
Treatment of vitiligo
Vitiligo will badly respond to treatment, only in 5% cases there is a spontaneous restoration of coloring of skin. Adequate vitamin therapy with the obligatory content of copper and zinc in vitaminokompleks helps to stop progressing of vitiligo. Radiation of the struck vitiligos of sites uzkovolnovy UV rays and laser therapy within two years reduce probability of peripheral growth of spots too. Treatment of diseases of a liver and diseases which provoked vitiligo in certain cases help to restore normal pigmentation of skin
In treatment of vitiligo use PUVA-therapy and selective phototherapy. For masking of cosmetic defects application of means voice-frequency cosmetic with the high level of protection against ultraviolet is shown. The exception of direct solar radiation, except medical ultraviolet and wearing the clothes covering the affected skin helps to avoid solar burns.
Greasing of skin kortikosteroidny ointments of moderate activity with a combination the photosensitizing medicines for example containing render good therapeutic effect though at 25% of patients of positive dynamics during vitiligo it is not observed in general.
Alternation of hormonal therapy of vitiligo and phototherapy in each case is appointed individually, if necessary kortikosteroidny medicines are appointed inside.
Forecast of a disease always adverse.