DEFINITIONS:

 

Vitiligo is a skin disease belonging to the family of leukodermias * (characterized by a decrease or absence of pigmentation of the skin). This disease affects approximately 0.5% of world population. It affects both sexes equal frequencyThe disease predominates in the age group between 10 and 30. It is characterized by the appearance of order, often progressive and ubiquitous lesion (s) (patches, plaques, maculesaspect hypochromic (decrease in pigmentation) or amelanotic(total loss of pigmentation). Cases family are present in almost 30% of cases.

* leukodermaeg leprosy, Pityriasis versicolor.....etc;

** Ménalocytescells responsible for the skin pigmentation

 

VITILIGO IN THE WORLDS:

 
Pays
Nomination
 
USA
Vitiligo
FRANCE
Vitiligo
ALLEMAGNE
Vitiligo
Espagne
Vitiligo
Italie
Vitiligine

 

 
CLINICAL FORMS:
 
  • Localized or focal vitiligo: This is a single or few isolated lesions
  • Segmental vitiligo: depigmentation is unilateral (key only part of the bodyaffecting one or more dermatomes in a topography similar to herpes zoster. It takes the form of a band. It is common in children and adolescents. The evolutionis very characteristic: the lesions are very stable that is to say that they continue to evolve as they arise.
  • Generalized vitiligo or vulgaris: these spots appearing bilateral and more or less symmetric.This is the most common form. In this case, the lesions may remain stable and localized as they can spread quickly (without treatment).
  • Universal vitiligo (universalis): in this case, lesions affecting almost the entire body and spread rapidly (less common form).
  • Mucosal Vitiligo :  affecting the lips in both sexes and external genital organs in women.

 Note: The hair that grows in areas affected by vitiligo may turn white (failure of melanocytes present in the hair follicles).;

Special forms:

  • Vitiligo Spotted: remaining pigmented areas within the plaques of vitiligo especially around the hair (presence of melanocytes in the hair follicles)
  • Vitiligo punctuated: consists of small lesions in "Confetti"
 
CAUSES:

The etiology of vitiligo is unknown, but until now many schools criminalize the genetic, environmental, nervous, toxic or autoimmune:

  • Genetic theory: at least 10 genes are involved (assuming recent 2010)

  • Theory environmental: stress, emotional trauma, psychological stress

  • Nerves Theory: the accumulation of neurotransmitters or their massive release during stress may promote psycho disappearance of melanocytes,

  • Autoimmune theory: it is the most tangible hypothesis because a significant percentage of patients with vitiligo suffer in addition to another autoimmune disease. examples:

    • thyroid disease: Hashimoto's thyroiditis, Graves' disease, and ....
    • Biermer's anemia,
    • Addison's disease,
    • Adrenal insufficiency,
    • Diabetes type 1.
  • Toxic Theory: accumulation of free radicals that are harmful to melanocytes.

 
RISK FACTORS:
  • Koebner phenomenonthe appearance of vitiligo lesions in areas of friction (eg elbows, knees, hands, feet, etc ...
  • The emotional shock: psychological stress (parental death, divorce, traffic accident, etc ...).
  • Overexposure to sunlight: UVA and UVB (increase the contrast between normal skin and lesions of vitiligo and a worsening of the latte

COMPLICATIONS:

  •  Psychological imbalance caused by the aesthetic disgrace  frequently responsible of divorce;   social, work and school problem.
  • Skin Cancer

  • Skin burns

Caused by sunlight

 

CONVENTIONAL TREATMENT:

 

 

Objectives : stimulate the proliferation of melanocytes in the skin that still exist.

Treatment is more successful if begun early.

1. Corticosteroids: use from the age of 6 years.


2. Topical treatments: oriented small patches of vitiligo. They realize a reduction in autoimmune reaction most frequently implicated in this disease:

3.Oral PUVA photochemotherapy with (UVA): taking oral psoralens followed by 2-3hours after exposure to an ultraviolet lamp type A, reserved for the extended forms of vitiligo.

  • Practical: 2-3 sessions per week, max 300 sessions in life.

  • Against indicated in children under 12, pregnant and lactating women.

4. Local photochemotherapy: use of topical psoralens followed by exposure to UVAlight.

5. Heliotherapy: same principle as PUVA but using the sun's rays;

6. Phototherapy narrowband UVB radiation (recent method) :simpler than PUVA, three sessions a week, geared for extended forms, fewer adverse effects thanPUVA.

7. Laser: excimer type.

8. Depigmentation cure: the treatment is to remove the few still healthy skin surfacesin the form of vitiligo universalis. Are used preparations of hydroquinone to 20% associated with vitamin C, sometimes associated with a topical corticosteroid.Despite the irritation caused by its products, it is a method most often effective.

 9. Surgery:

  • Skin graftis for the form of segmental vitiligo, these autologous

  • New techniquemelanocyte transplantation (transplant melanoma), retrieve the melanocytes in areas of healthy skin and inject them into the depigmented patches

10. Psychotherapy: creation of integral association of people with vitiligo.

 

 POSITIVE DIAGNOSIS:

 

there is clinical:

  • The elementary lesion is a macule color "white chalk" or "ivory" along with sharp, sometimes surrounded by hyperpigmentation.

  • This lesion is ubiquitous seat.

  • Pruritus is present in 60% of cases, it usually announces the onset or worsening of vitiligo lesions.

 

 

DIFFERENTIAL DIAGNOSIS:

 

 

 

We must differentiate the lesions of vitiligo from achromic acquired secondary  (psoriasis,eczema, leprosy), despite the possibilityof an association: vitiligo-psoriasis.

 

 

VITILIGO PREVENTION:

 

    1. Avoid the stress and emotional shock 

    2.  

      Avoiding sun overexposure:Use creams both UVA and UVB. 

    3.  

      Avoid the Koebner phenomenon (physical aggression: friction and / or friction): 

      •  

        In the face:

        • friction in toilet (frequency of vitiligo lesions at the periphery orificiels) 

        • avoid electric razor 

      •  

        In the neck: in women especially, avoid heavy necklaces and friction by the collartoo tight. 

      •  

        Trunk: Avoid:

        • friction caused by the washcloths

        • underwear made ​​from wool and / or polyester straps bra fitting (in women). beltstoo tight (frequency of vitiligo lesions in the hips) 

      •  

        Lower limbs: avoid

        • pants and underwear too tight and irritating (Jeans), frequency of vitiligo lesions in the folds of the groin, anterior and posterior knee

        • shoes too tight, frequency of lesions especially in the first and fifth toe.   

      •  

         Upper limbs: avoid:

        • wounds, burns, abrasions, rubbing of the skin of the hands and elbows with rough objects

        • The wearing of bracelets, watches and rings tight

      NB: It is advisable to wear cotton-based

                 4. Avoid chemical attack caused by detergents (bleach),thinners, etc.... phenol.(these are bleaches)

                 5Avoid inbreeding (frequency of familial cases and hereditary)

                 6. Ensuring attendance at appointments for consultations and follow the rule of themedical advice.

 

PROGNOSIS:

 

  1. Segmental Vitiligo: Once installed, it is not scalable and responds poorly to conventional therapy. This is the major indication of melanocyte transplantation.

  2. Generalised Vitiligo:  non-compliance by patients anticipatory guidance listed above, as well as non-compliance of medical treatment we recommend the extension of vitiligo causesover the years which can then evolve into the universal form.