Clinical Dermatology
Vitiligo
Information on Vitiligo
Vitiligo is a skin lesion, in which white signs of irregular shape are created on the skin. The white marks are due to the loss of melanin, the substance of the skin that protects us from the sun.

It is estimated to affect about 1% of the population, male and female. It does not belong to the infectious diseases and is not transmitted during physical contact. It is more common in sunny countries, especially in northern Africa, and has been described as "illness of light".

Although from a medical point of view, vitiligo is usually not harmful nor does it cause physical pain, the effects of the disease on the psychology and feelings of the patient are substantial. However, treatment may not be necessary in cases where vitiligo is limited or does not disturb the patient.
 
Why Does Vitiligo Appear?
The causes of vitiligo are essentially unknown. From time to time, there have been several theories about the origins of vitiligo, but the prevailing view is that it is an autoimmune disease. So the body itself considers its melanocytes unknown, thus is directed against them and destroys them. It may also be associated with other autoimmune diseases, such as Hashimoto's thyroiditis, type 1 diabetes, rheumatoid arthritis and Adisson's disease.

Vitiligo is usually present on the neck, the eye area, around the mouth and nose, the nipples of the breasts, the hands, the navel and genitals, and its presence usually has three forms:
  • Focal form that appears with slight blotches in one or more areas that do not expand.
  • Sectional form that includes visible spots on only one side of the body, and does not extend.
  • Generalized form that shows symmetrical spots on both sides of the body. It is the most common form of vitiligo and its course is not predictable.
Vitiligo does not differ from healthy skin in appearance and touch, except in the area of lesions, and in some cases it causes itching and hyperhidrosis. Vitiligo does not belong to infectious or contagious diseases and is not transmitted through physical contact. 

How Is Vitiligo Diagnosed?
The diagnosis of vitiligo at Dermatology & Cosmetics Lab is only performed by a specialist dermatologist. The doctor, after recording the patient's family history, goes through clinical examination and then proceeds with the use of Wood light. Combined with differential diagnosis and psychological tests, the discolouration points are photographed and the degree of discolouration is determined. At the same time, laboratory testing including microbiological - biochemical and immunobiological blood tests is performed, and, if necessary, a biopsy specimen is taken. Although most vitiligo patients are generally healthy, it is likely that certain conditions will occur more frequently or coexist at higher rates than the general population.

Can I Prevent Vitiligo?
Although in most cases of vitiligo there is an automatic improvement in adulthood, the prognosis of vitiligo is uncertain and difficult to define. The truth is, however, that the prognosis is worse in cases of childhood vitiligo or universal vitiligo in the hands and face.

How Is Vitiligo Treated?
The causes and pathophysiological mechanisms governing vitiligo are still poorly understood and remain poorly elucidated. This is the main reason for delaying progress in the diagnosis and treatment of vitiligo.

The first advice given by dermatologists in cases of vitiligo is to continuously use of sunscreen as well as the possible, as well as cover the signs with a make-up which, of course, only contributes to the stimulation of the self-confidence of the individual.

The most common therapies for treating vitiligo are:
  • Topical treatment: This treatment includes formulations containing corticosteroids at a strong dose. After the use of 5 or 6 months, it is estimated that the majority of patients experience some decolorization of the marks. Sometimes, corticosteroids are combined with other substances for better results. The formulations used in topical treatment have more success in facial vagina, and of course they should be administered by examining the specificities of each case separately as they can cause side effects.
  • Alternative therapies: At times, treatments with certain vitamins, minerals, amino acids and enzymes have been considered helpful in treating vitiligo. However, there is not enough evidence to support these vitiligo treatments and no knowledge of possible side effects.
  • Discolouration of the skin with hydroquinone monobenzylether: It is usually applied to a patient who has few areas with healthy skin. Destruction of the remaining pigment leaves the skin completely white. The treatment is made with locally applied cream and can last for several years.
  • Chemotherapy (PUVA): This treatment uses light in the UVA spectrum in combination with the photosensitizing drug, psoralen, which the patient takes in the form of a cream or pill. The purpose of the treatment is to restore the skin color to 75% in the case of vitiligo in the face or in the lower limbs, and does not show great success in the hands or feet. Treatments can last up to six months, and you require continuous monitoring by a dermatologist and ophthalmologist because psoralen can cause eye problems.
  • Laser excimer laser therapy: This therapy uses light of specified wavelength to re-pigment the skin. This treatment, which can be combined with topical treatment, has been successful in about 70% of patients. However, many patients relapse a few years after the treatment, which does not make it permanent. Phototherapy has more success in facial vitiligo than in hands and feet.
  • Surgery: It is a treatment recommended to patients with stabilized vitiligo for at least 6 months and is the last choice when other methods have failed. It is not recommended to children with vitiligo, as well as patients whose skin tends to scar or appear keloids. Surgery can be effective for 90% of patients, depending, of course, on the incident.
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