Vitiligo is a condition in which the skin and hair lose pigment and produce milky white spots of different size and shape. If a piece of white vitiligo skin is examined under the microscope, then the pigment cells (melanocytes) appearing in the lower part of the epidermis appear to be completely absent. About 50% of all vitiligo cases reveal themselves before the 20th year of life and 70-80% before the 30th year of life. Vitiligo can occur shortly after birth, while the oldest person with a startup vitiligo has been 97 years old. Besides a medical problem, vitiligo is especially an important social psychological problem. Vitiligo is not contagious. At least 0.5 percent of the world's population is suffering from vitiligo.
How does vitiligo develop?
There are five theories to explain the emergence of vitiligo:
- the genetic theory
- the autoimmune theory
- the neurogenic theory
- the melanocyte cell destruction theory
- the convergence theory
GENETIC THEORY
According to this theory, vitiligo would be a hereditary disease. In identical twins, vitiligo appearances appear in the same places at the same time. The fact that vitiligo often occurs in different individuals within one family indicates that hereditary factors can play a part in the emergence.
AUTOIMMUUN THEORY
Some researchers believe that vitiligo is an autoimmune disease. In autoimmune disease, the immune system is directed against tissues and / or individual cells of the own body, which leads to disease of the associated organ or organ system. In the case of vitiligo it is believed that this immunological response causes the destruction of pigment cells. This theory about the emergence of vitiligo is partly based on the fact that other autoimmune diseases occur more frequently in patients with vitiligo, such as certain thyroid diseases, Addison's disease (malformation of the adrenal gland), alopecia areata (a certain form of hair loss) and diabetes. However, these relationships are so rare that systematic examination of all patients with vitiligo on the occurrence of autoimmune diseases is not meaningful.
NEUROGENE THEORY
This theory is based on the observation that vitality disorders cause a disorder in the function of the nervous system. It is believed that vitiligo may be due to increased secretion of certain harmful substances by nerve endings, which are able to slow down the formation of melanin (skin pigment) and pale pigment cells. Although such substances have never been shown immediately, there are observations and research results that support this theory. For example, cases of vitiligo have been completely located in the care area of a particular nerve.
MELANOCYTEN DESTRUCTION STORY
This theory assumes that the pigment cells are destroyed by substances that are also needed for the formation of melanin (skin pigment) and therefore harmful to pigment cells. Normally there is a protection mechanism that makes these substances harmless. In Vitiligo, however, this protective mechanism would be disregarded. What this theory advocates is that white spots in vitiligo patients are the most common in those areas that are usually the most pigmented and thus have the strongest formation of melanin.
CONVERGENCE THEORY
Since each of the above-mentioned theories has provided more or less sufficient scientific evidence, it is also assumed that there is a so-called "convergence theory", in which the above-mentioned causative mechanisms can function both independently and synergistically, with ultimately the same result : loss of pigment cells.
RISK FACTORS AT VITILIGO
Regardless of the cause, it is believed that some factors can trigger vitiligo in people who have an assumed aptitude for vitiligo. These factors include severe emotional tension, sunburn, serious illnesses, surgery, pregnancy, childbirth and physical injury.
What does vitiligo look like?
The places vary in size and shape; They can gradually expand and often have a border that is darker than normal skin. The line drawing in the vitiligo sound is normal. Vitiligo rides are often found around body openings and in the body pleats at the sexual organs, at pressures, hands and feet, in places of repeated trauma (injury) and in the face. The hair in the vitiligo rinks is often white. Sometimes we see a white border around a mother's spot; This is what we call a halo naevus.
Vitiligo in the armpit
Unilateral form of vitiligo
Poliosis: getting white from the hair
Koebner phenomenon; Vitiligo occurs in a scar
How is vitiligo determined?
Vitiligo is generally so easy to recognize that the diagnosis can usually be made based on the clinical image. Additional diagnostics are almost never needed. Vitiligo must, however, be distinguished from a number of other diseases, which are also associated with total depigmentation. In these cases, a skin biopsy is always done which processes the cells with a special pigment color.
Microscopic image of a special pigment coloring; On the left side the coloration is negative, here is the vitiligo spot
Microscopic image of a special pigment coloring; On the left side the coloration is negative, here is the vitiligo spot
How is vitiligo treated?
To date there is no treatment available that completely cures vitiligo. With current therapy forms, in most cases an acceptable degree of repigmentation (= return of pigment) in white spots can be achieved and further loss of pigmentation is counteracted. The treatment generally takes a long time, ie months to years. It is recommended to start treatment as soon as possible after the disease has been established. It has been found that the longer the vitiligo exists and the more vitiligo is, the worse the response will be to the given treatment.
A. OUTSTANDING RESOURCES
1. Corticosteroids. The treatment with corticosteroid creams is in some cases successful, especially in early vitiligo. Corticosteroids are able to counteract the expansion of vitiligo. So far, it has not been shown that these agents have a direct effect on pigment cells. During this treatment, corticosteroid creams are applied once a day on the edges of the vitiligo shelves. Sometimes treatment with corticosteroid-containing creams can also be combined with a sun bed or light therapy. Treatment with corticosteroids should not be continued for too long, as these creams may have adverse side effects in the longer term. In general, after a few weeks, no more than three months, it will be clear whether this treatment is successful.
2. Tacrolimus ointment. This ointment, which does not contain corticosteroid, is officially registered for the treatment of atopic eczema. Studies, however, show that vitiligo sites can be treated with it. Although the first results are promising, long-term data is not yet known.
B. LASER THERAPY (EXCIMER LASER)
With the help of the Excimer laser, we can treat small and small body careers selectively and selectively. Because the laser beams of this laser are in the wavelength range of ultraviolet B, you can also consider this mode of treatment as a form of light therapy. There are at least 20 treatments needed to assess whether treatment is useful. Approximately 50 to 60 treatments are needed to achieve an acceptable degree of repigmentation.
C. LIGHT THERAPY
1. UVB (narrow spectrum). UVB (narrow-spectrum) light therapy is currently considered the most effective treatment for patients with extensive vitiligo in both stable and progressive stages. Studies have shown that UVB (narrow-spectrum) treatment results in approximately 60% of patients, until all or most of the pigment is returned. As a rule, this result is achieved after treatment of 2 irradiations per week for 1 year. For the time being, it is advised to interrupt therapy for at least 3 months after that year. After that, a treatment regimen can be re-prescribed for 1 year if necessary. During the UVB (narrow-spectrum) treatment you are in a closed light cabin. The irradiation time is raised very slowly to prevent combustion. The optimal dosage is achieved when the white skin is given a light pink color. Due to the appearance of skin in the skin, the dose may increase slightly over time to achieve a new optimal dose. If someone gets too much UVB (narrow spectrum), redness of the skin may appear, which appears to be on sunburn. Especially the face is sensitive to this. The burned skin is then not exposed further (eg face cover) until an overall recovery has taken place. During the next treatment, this skin will be exposed to a dose equal to the initial dose. During the next sessions, the dose is then raised more cautiously. Between 2 consecutive irradiations, we recommend 1 to 2 rest days, so that the skin gets the time to recover. Other areas of the body may then get additional exposure even though a pink color occurs about 2 hours after exposure.
2. UV home treatment. Light therapy is not only possible in (polic) clinics, day care centers and spas, but also at your home. For approval of UV home exposure, there are a number of conditions.
D. PIGMENT TRANSPLANTATION
In pigment transplant, pieces of normally pigmented skin are moved to a vitiligo area. This occurs under local anesthesia; You do not need to be hospitalized. Only patients with a stable form of vitiligo and patients over 12 years of age are eligible for this. If patients meet these selection criteria, more than 80% of the cases will pass the transplant.
E. THE "REVISED" OR DEPIGMENTATION THERAPY
The "reverse" method (treating healthy skin) can be used once in patients who have a so extensive form of vitiligo, that only few spots with normal pigmented skin are left over. In these cases it sometimes pays to further depigment the remaining skin by applying a "bleach", which makes the skin evenly bleached. Skin bleaching occurs with a hydroquinone-containing cream and / or with the help of a special pigment laser.
F. THE NATURAL THERAPHY
For Best Natural Treatment of Vitiligo Follow this link and check their informative video presentation: The Natural Vitiligo Treatment System [TM]
What can you do vitiligo yourself?
A. CAMOUFLAGE
Camouflage of dipped pigments with skin makeup has no healing effect, but is a good method for masking the disgusting skin abnormalities especially in the face. This method will always be considered in the presence of spots in the face. Explanation about the possibilities of this method and instructions should be discussed with a skin therapist who has had a special education for this purpose. Afterwards, one can apply this method at home.
B. SELF-USING RESOURCES
With these means it is possible to artificially give a brown color to your skin. Important advantages over natural sunlight, light therapy or solarium are:
- No risk of burn and long term, no risk of skin aging or skin cancer.
- Quick tanning possible (within seconds to hours)
An advantage of these means relative to camouflage agents is that they are not washable by sweating or swimming. One of the best known agents is dihydroxyacetone (DHA). DHA is a natural substance (called "a sugar" in chemistry) used for more than 50 years in the cosmetics industry. It is very popular because the resulting tanning is very similar to that achieved by sunlight or solarium. DHA reacts with certain amino acids (including lysine, glycine and histidine) in the upper layers of the epidermis, after which a tan product is formed which adheres to the skin layers. DHA is a relatively innocent substance; There are only few cases of contact allergy described in the literature. The maximum tanning is only achieved after 4 to 6 hours. The color begins to take off after about 4 days. It is important to know that DHA does not protect against ultraviolet radiation. For this you will need to use an extra antisense cream. However, the use of this drug in vitiligo has a number of disadvantages:
There is only 1 color possible, so the nice nuances achieved with "normal" camouflage, with DHA alone, are not possible.
The edge of the white to the dark skin is hard to tan as the white hides themselves; This edge is usually darker in color.
The drug is only suitable for lighter skin types.
DHA is available in a cream. Nowadays you can also go to a tanning studio for an 8-second (!) Spray treatment with DHA.
C. SUN PROTECTION
There are 2 reasons for vitiligo patients to protect themselves well from the sun:
1. After exposure to sunlight, there may be easy combustion symptoms in the vitiligo fields. White spots can even arise or worsen after sunburn!
2. Because the normal non-vitiligo skin usually contributes to the tanning process, the contrast between the white and the tanned skin will only increase. As a result, the white spots are more likely to occur !!
For these reasons, skin should always be well protected from sun exposure by clothing or by a sunscreen cream in patients with vitiligo.
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