Vitiligo (Leukoderma)

Body Parts: Whole Body
Medical Subjects: Skin

What Is Vitiligo

What is vitiligo?

Vitiligo is a common depigmentation of the skin and mucosa that occurs all over the world and can affect all ethnic groups. According to statistics, the world incidence rate is 0.3%–3.8%. Generally, the incidence rate is low for the people with shallow skin color, while the incidence rate is high for the people with deep skin color.
Vitiligo is mainly manifested in the skin above the size of different, irregular shape, clear boundaries, limitations of the white spot, anodyne, white spots on the hair can also be white.
The specific etiology of vitiligo is still unclear, which may be related to autoimmune disorders, melanocyte destruction, fatigue anxiety, family heredity and other factors.
Vitiligo treatment is more difficult, the efficacy is not necessarily ideal. Including photochemotherapy and phototherapy, autologous epidermal grafting, laser, drugs and other methods. For the patients with small white spot area, exposure site and short course of disease, the curative effect is better.


What Is The Cause Of Vitiligo

How is vitiligo formed?

Want to know how leukoplakia is formed, we must first understand the melanin. Melanin is present in the skin or hair of animals and is a dark brown pigment produced by and stored in melanocytes. It is because of the presence of melanin, the skin has a color. Once melanin cannot be formed or transported for some reason, it causes depigmentation and thus forms leukoplakia.

What is the cause of vitiligo?

The etiology of vitiligo is currently unclear and may be related to the following factors:

  • Problems with your autoimmune system;

  • Melanocyte are damaged;

  • Mental trauma, overwork, anxiety and other neuropsychiatric factors;

  • Familial inheritance.

Is vitiligo hereditary?

Vitiligo has a certain heredity, belonging to a polygenic inheritance disease with more pathogenic genes. Our country's scholars have located several of the related genes. The prevalence rates of vitiligo in relatives of patients studied vary from unit to unit, with the reported heritability rates in China ranging from 4.9% to 15.6% and abroad ranging from 18.75% to 38%.

Is vitiligo contagious?

No, vitiligo is not an infectious disease.

Does vitiligo happen to infants?

Yes, at present, clinical diagnosis has been made in children with vitiligo less than two months after birth, and the specific etiology is still unclear.


What Are The Symptoms Of Vitiligo

What are the symptoms and manifestations of vitiligo?

Leukoplakia generally occurs in the skin, mouth and genital mucosa and other areas. Although vitiligo are manifested as white spots, but the degree of loss of pigment can be different, can be light white, cream, white and porcelain.

Generally speaking, white spots and normal skin boundary is clear, but the progress of the white spot edge can also be vague, and some can be around the white spot in a color bound between the normal skin and white spot ring.

White spots within the hair can be white, can also be normal, but also black and white.

Vitiligo easy to grow in which parts?

Common sites are: face, neck, waistband, coccyx, dorsum of toes and fingers, female bra straps or button compression, perianal, female perineum.

Why can vitiligo patients become white after wound healing?

This phenomenon is called homomorphic reaction, and refers to the fact that after non-specific damage to normal skin (such as trauma, scratch, surgical incision, sun exposure, inoculation, or some skin diseases), the same skin changes as those caused by a pre-existing skin disease can be induced. The pathogenesis of homomorphic response is not completely clear, and it is currently considered to be related to the immune process in the human body.


How To Check Whether Suffering From Vitiligo

What check does vitiligo need to do?

At present, the hospital can do the following checks:

  • Wood lamp: it is a traditional inspection method with low cost;

  • Skin CT: The skin condition can be observed layer by layer, and the cost is higher;

  • Skin mirror: The skin color can be observed under the direct vision of the naked eye, with low cost.

Vitiligo will have white spots, the emergence of white spots is vitiligo?

Not necessarily, white spot may also have the following:

  • Pityriasis white: common in children's faces, with small desquamation visible on the white spots that can spontaneously resolve.

  • Tinea versicolor: It often grows on the neck, chest, shoulders, upper arms, and armpits, and the color can be brown, pale brown, pale red, pale yellow, or white, with positive fungal microscopic examination.

  • Bloodstained nevus: from early childhood began to appear, a lot of growth in the face, friction when the white spot is not red, and the skin around the white spot is red.

  • No pigmented nevus: present at birth or discovered shortly after birth, with localized pale leukoplakia and serrated edges.

  • Post-inflammatory hypopigmentation: There was a significant inflammatory response in this area before the formation of leukoplakia.

  • Idiopathic punctate leukoplakia: It is more common in the elderly. The small white spot with clear edge will not continue to expand, with no deepening of pigment at the edge and no scale on the surface.


How To Prevent Vitiligo

Can vitiligo be prevented?

At present there is no way to prevent the occurrence of vitiligo.


How To Treat Vitiligo

Vitiligo should see what department?


How is vitiligo treated?

Vitiligo treatment is difficult, although there are many treatment methods, but these methods are not effective for every patient, the general use of comprehensive therapy, and a course of at least 3 months.
For patients with small white spot area, exposure site and short course of disease, the therapeutic effect is better.
Commonly used treatment methods include:

  • Photochemotherapy and phototherapy.
  • Autologous epidermal grafting.
  • 308 excimer light or 308 excimer laser.
  • Drugs for external use.
  • Oral medications, etc.

What is the photochemotherapy of vitiligo?

The photochemotherapy is a therapy that the patients are treated with oral administration or external application of photosensitizer and then irradiated with UVA. The patients are orally administrated with 8- methoxypsoralen generally.

During the treatment, lime, coriander, mustard, carrot, celery, and fig were prohibited, and other photosensitive drugs were prohibited or taken together with phenothiazine drugs.

It is contraindicated in children and pregnant women.

What is the light therapy of vitiligo?

The phototherapy of vitiligo mainly refers to irradiating patients with narrow-wave UVB twice or three times a week, and the effective rate of treatment of vitiligo reaches more than 75%.
Narrow-band UVB is the ultraviolet light with a wavelength of 311nm, and some patients may be concerned about its safety. In fact, narrow-wave UVB radiation treatment of vitiligo, is a treatment in use all over the world, curative effect, safety is acceptable. There are no definitive data on the maximum safe cumulative dose, and the literature currently recommends a maximum treatment duration of 15 months, 133 treatments, and a cumulative dose of 246 J/cm2 for white people.
Eye protection is required during irradiation. The therapy is prohibited in active pulmonary tuberculosis, hyperthyroidism, severe heart and liver disease, sensitive person light.

Vitiligo autologous epidermal grafting is how to return a responsibility?

It is to transplant the normal skin to the white spot. It is suitable for vitiligo in stable stage and has stable and long-lasting curative effect.
The longer the course of disease is, the better the curative effect will be. Vitiligo in the trunk of face and neck had the best curative effect, but it was slightly worse in the extremities. Vitiligo in joints and movable parts has poor curative effect.
As for the safety of autologous epidermal grafting, only literatures have reported the possible occurrence of pigmentation in the donor site, and no other adverse reactions have been found.

308 excimer laser treatment of vitiligo is how to return a responsibility?

The 308 excimer laser has the advantages of laser monochromaticity, high energy and directivity, and no significant damage to the surrounding tissues except the irradiation point.
According to the literature, treatment of vitiligo once or twice a week in stable stage could significantly shorten the course of the disease and the number of treatments, and the therapeutic effects were in the order of face and neck > trunk and limbs > limb joints, with no significant side effects.
The therapeutic mechanism is still unclear.

What are the oral medications for vitiligo?

At present, oral drugs for the treatment of vitiligo are mainly glucocorticoids (hereinafter referred to as hormones). The curative effect of oral administration of hormone is certain, and it has certain side effects after being used for more than 3–4 weeks. Standardized use under the guidance of a doctor can minimize the side effects, and it is definitely impossible to reduce the drug amount or stop the drug by oneself.

What side effects does vitiligo use hormone treatment have?

Side effects can occur 3–4 weeks after the hormone is applied in excess of the physiological dose (cortisone 30 mg per day), and the side effects occur earlier with the high dose of hormone. Specific side effects include:

Easily infected (virus, bacteria, tuberculosis, fungi, etc.);

Resulting in gastrointestinal ulcers or perforations;

Electrolyte disorders, such as low potassium;

Osteoporosis or ischemic osteonecrosis;

Neuropsychiatric changes;

Aggravation of the original diabetes, hypertension;

Inappropriate drug withdrawal or excessive reduction may also cause rebound of the disease.

How long can vitiligo be cured?

No specific data are available. According to vitiligo treatment guidelines, a course of at least 3 months.

Can vitiligo be cured?

Vitiligo can be treated, but not every program is effective for every patient, there are cases of cure, but specific to each patient, it is not expected to be able to effect a radical cure.

Will vitiligo recur after cure?

It could recur. One of the causes of vitiligo is immune dysfunction, and in some patients a variety of antibodies can be detected in the blood. Autoimmune disease is characterized by a slow course of disease and a clear tendency to relapse, so the recurrence phenomenon is objective in vitiligo. In a follow-up of the long-term efficacy of autologous epidermal grafting for vitiligo, the recurrence rate was 14.22%.

Is the child patient of vitiligo treated well?

Clinical experience has shown that the therapeutic effect of vitiligo in children is superior to that in adults, presumably because children are less interfered by emotional factors.

How does the child of vitiligo and infantile patient treat?

Topical and oral glucocorticoids can be applied to the treatment of vitiligo in children, pay attention to the choice of hormone types:

  • Under 2 years old, moderate-effect glucocorticoids should be selected and used intermittently;

  • Medium and strong glucocorticoid and calcineurin inhibitor can be selected for patients over 2 years old.

  • In the rapidly progressing stage of the disease, small doses of glucocorticoids can be taken orally, and the use must be under the guidance of a specialist.

Can the child patient of vitiligo use UVB to treat?

At present, the domestic and foreign experiences all specify that UVB can only be used for children over 6 years old.

How does the pregnant woman patient of vitiligo treat?

Maternal and fetal factors should be considered in the selection of treatment plan for pregnant women, and it is recommended that the treatment not be used for the time being, and the corresponding treatment plan should be selected after the delivery.

How is vitiligo patient treated during lactation?

Nursing treatment plan should consider the effect of the selected treatment on the baby, and some treatment methods can be selected, such as topical hormone ointment, 308 excimer laser irradiation, etc.


What Should Patients With Vitiligo Pay Attention To In Life

What should be noticed in vitiligo life?

  • Keep optimistic, avoid bad emotional stimulation, eliminate psychological pressure.

  • Avoid overwork and staying up late.

  • Protect the skin from damage (mechanical, physical, chemical). Because often contact gasoline, paint, asphalt, etc., also easily lead to vitiligo disease.

What should patients with vitiligo diet?

  • Eat more nuts (walnuts, peanuts, sunflower seeds), soy products, black sesame, animal liver, etc.

  • White spots growing up during the fast seafood, no drinking.

  • Avoid excessive intake of vitamin C, do not eat or eat less food rich in vitamin C such as tomatoes, apples, oranges and so on.

Can vitiligo be covered with hand cream, lotion or contact with washing powder, detergent and so on?

Can be applied with hand cream and skin lotion to protect skin barrier; Washing powder and detergent can stimulate the skin and damage the skin barrier, and it is recommended to avoid direct contact.

Can vitiligo be pregnant?

Can be pregnant, because vitiligo is hypopigmentation, does not cause changes in the body organs and functions. However, whether the existing leukoplakia develops, disappears or remains unchanged after pregnancy has not been reported at home and abroad.
Does vitiligo pass to the child because of lactation?
No, first of all, vitiligo is not an infectious disease, followed by the transmission between two generations belongs to the genetic, genetic is determined by DNA, and milk has nothing to do.

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