Vitiligo

Vitiligo (Latin vitiligo " ringworm, skin disease", med Leucopathia acquisita, Greek λευκὀς "white" πἀθος "suffering" Latin acquisita "acquired" ) or also called white spot disease and vitiligo is a chronic, non-contagious skin disease that is about 0, 5-2 % of people worldwide. Are typical pigment disturbances in the form of white, pigment-free skin patches that can escalate slowly, but not necessarily. One of the most famous cases of vitiligo affected Michael Jackson.

According to the latest findings, the affected cells to a high content of hydrogen peroxide ( H2O2), the formation of melanin ( pigment cells ) have prevented. This condition is reversible, even after years of decline of H2O2 may again lead to repigmentation (see treatment).

Causes

Vitiligo often occurs not only on, but is partly accompanied by autoimmune diseases. The figures show that vitiligo example, very often associated with thyroid disease, Hashimoto 's thyroiditis, but also with other thyroid failure or diabetes mellitus type 1, and pernicious anemia.

Stress could act as a catalyst for vitiligo outbreak. This means that the problems associated with the effects of stress can interfere with the immune system. Thus, the pre-existing autoimmune disease can make for the first time or increasingly noticeable by first or more or larger non-pigmented skin areas may crop up.

Course

The disease can occur at any age and even in apparently not genetically predisposed families. The Vererblichkeitsrate is about 33%. Statistically most commonly affected are the forearms, wrists, hands, fingers, elbows, feet and genitals. In general, the elongated skin are concerned, such as elbows. The unpigmented areas may spread or remain constant in size. Sometimes also form small areas pigments back when the melanocytes wake up out of their "sleep".

Treatment

Vitiligo is incurable today. The absence of such therapy is partly due to lack of knowledge about the disease, but also to the in comparison to other diseases relatively harmless symptoms. Physical performance and life expectancy are not adversely affected per se. Since 1996, however, the rule is that skin diseases such as vitiligo, atopic dermatitis ( etc. clothing) represent, etc. because of the basic mental stress and change in behavior in public is harmful to physical mobility and thus in severe cases leading to a recognized degree of disability of 35 % can.

The treatment or the experimental treatment is usually paid by all health insurance plans. Furthermore, no state funds are allocated for the Vitiligoforschung. All therapies give a patient only a chance of a re-pigmentation of the affected skin. However, the possible success by today's treatments do not ensure that the disease can not even back or may occur strengthened.

The reaction of the persons concerned to sunlight is not uniform: Some get to the white spots quickly violent sunburns. Even very brief but direct sunlight from about ten minutes in length can trigger sunburn. These people need to protect the white skin particularly well when exposed to sunlight. This is achieved through skin-covering clothing or a sunscreen with a protection factor of more than 30 ( sunblock ). In the majority of those affected, the areas redden though, but it does not hurt. Treatments with laser light or UV irradiation aimed precisely on this irritation ( mild redness, not red as a lobster! ) Of the areas out, because this is the best successes have set. This group of people needs the affected area not more than to protect the healthy areas. In the literature, no case is known that it would come in the affected areas of skin cancers. This does not mean that these people basically can not get skin cancer. Large area irradiation, which is also on the non-affected areas, can cause as any excessive (sunlight ) irradiation to premature skin aging, and skin cancer.

It is possible to take a dose of psoralen with simultaneous irradiation with UVA light, so-called PUVA therapy.

Medication

Steroids were used to treat, however, have not proven to be particularly effective. A similar, also immunosuppressive approach is taken by the newer drugs from the group of calcineurin antagonists. The final evaluation of the efficacy of these products is still pending.

Irradiation with ultraviolet light

Furthermore, various forms of UV therapies are used: 311 nm narrow spectrum UVB, UVA therapies in combination with photosensitizing drugs (eg khellin or phenylalanine ) and 308 nm excimer laser. Laser therapies have the advantage that they can be used precisely to the affected areas. However, this assumes that the vitiligo currently not just spreads. Otherwise, large exposures are preferable. UV therapies must be carried out over several months. Average treatment times of six to twelve months are expected to be carried out in the form of many short, regular sessions. With a UV irradiation no previous malignant skin tumors should be available and be patient at least in the pubertal age and have no other light sensitivities. If after three months of UV irradiation has not yet appointed a repigmentation, the now unsuccessful therapy should be discontinued. A "therapy" in the form of direct sunlight should be avoided because of the above mentioned risks. It can cause excessive and thus unsightly browning of non-diseased skin areas in other respects.

Transplantation

In special cases, autologous melanocytes can ( donor and recipient are the same) are grown and replanted. This is done after a pretreatment of the skin by abrasion with lasers or high-speed grinders. Especially in the facial area, the results are satisfactory.

Color balance

By laser irradiation, ingestion of tyrosinase inhibitors or surgery, the remaining melanocytes are destroyed, resulting in a color balance to skin defects. However, this procedure should be performed with great disease-related mental disorders with the recommendation of a psychiatrist only in patients, as this therapy does not involve any physical healing with it, but the primary disease symptoms even promotes through the deliberate " bleaching " the skin areas affected.

Concomitant treatment options

Accompanying therapies offer no cure for vitiligo, but to alleviate the disease or promote the therapies.

Camouflage

As camouflage covering methods are referred to, in which the bright foci are tinted with a special make -up. β -carotene in higher doses, in the form of capsules, leading to discoloration of the bright orange skin, so that the contrast to healthy skin appears less. But it is also possible to use a self-tanning.

Research

The main alkaloid of black pepper, piperine appears to stimulate pigmentation according to a study.

Complications

The disease seems relatively harmless, but the affected skin regions are not protected from sunlight (sunburn, but no browning ). On the other hand, the appearance can seem a little disturbing in an otherwise dark skin. In fair-skinned individuals, the disease may by avoidance of sunlight, even on the non-affected areas of skin, hidden. However, it must be noted that the natural vitamin D production is to reduce or even completely set in total sunlight abstinence. Therefore, it is recommended for those persons regularly for a few minutes (depending on the Sonneneinstrahlwinkel, noon in Greece, for example, about six minutes, in northern Germany about ten minutes) unprotected exposure to the sun, alternatively, an adjustment of diet is possible.

For some people this disease brings but also psychological consequences. So you only go makeup in public.

Stigma

In some cultures associated with vitiligo for the persons concerned a stigma. They are partly seen as evil or contaminated and therefore sometimes shunned by the other group members. In India, Vitiligo is often mistakenly associated with leprosy. Vitiligobetroffene are often stigmatized because of ignorance, because the population is not aware that vitiligo neither contagious nor is a sign of sickness or diseases such as cancer. As a partial psychogenic and thus a charismatic healing accessible disease is a possible explanation for the healing of a leper in the New Testament ( Mark 1:40-45 par, for example. ).

Etymology

The origin of the name vitiligo is not known exactly. It is possible that it derives from the Latin word vitium, which can be translated as a flaw or defect in a medical context as a malformation or malfunction. It is also conceivable to connect to the Latin word vitellus, a designation for calves or their penetrated by white spots fur color.