Vitiligo is a discoloration of the skin, characterized by the appearance of discolored, often symmetrically located spots of various sizes and shapes, milky-white; spots show a tendency to marginal growth.
Diseases of internal organs and glands of internal secretion (for example, diseases of the thyroid gland are observed in 30% of patients with vitiligo).
Immune system disorders.
Impaired function of the nervous system and emotional stress.
Chronic inflammatory diseases.
Multiple or single discolored (ivory-colored) spotted eruptions appear on healthy skin, prone to marginal growth. On the edge of the spots, a thickening of the pigment is noted, which contributes to a sharper contrast of bleached eruptions and healthy skin. Gradually, the rash spreads, and in some patients large areas of the skin become snow-white.
Vitiligo can be located on any parts of the skin (except the skin of the palms and soles) and mucous membranes. Hair on the stains of vitiligo also discolor; 35% of patients develop premature gray hair. Subjective sensations, as a rule, are absent, however, 10% of patients note itching.
In 50% of cases, the disease begins at the age of 10-30 years. Children usually develop limited forms of vitiligo, often in the presence of autoimmune and endocrine diseases (for example, in cases of thyroid disease, rheumatoid arthritis, etc.). Older people usually do not develop the disease.
In addition to the characteristic white spots on the skin, the diagnosis is based on laboratory values.
To make an accurate diagnosis of suspected vitiligo, it is recommended to pass the following tests:
- complete blood count (KLA)
- urinalysis (OAM)
- blood for biochemistry (glucose, liver and kidney function)
- blood for antibodies to thyroglobulin (AT-TG) and antibodies to thyroid peroxidase (AT-TPO).
Vitiligo must be distinguished from the following diseases:
- multicolored, simple or white versicolor
- secondary leucoderma on the background of atopic dermatitis, syphilis or lupus.
If the lesion area is not more than 20% of the body, topical glucocorticosteroid preparations in the form of creams and ointments are primarily prescribed.
methylprednisolone aceponon (advantan and analogues)
Alclomethyzone dipropionate (afloderm and analogues)
betamethasone dipropionate (aktiderm and analogues)
There are several schemes for the use of these drugs, the optimal scheme is chosen by the doctor based on the results of the tests, the area of the lesion, the age of the patient and other factors.
If a visible effect is not observed within 4-6 months, second-line drugs are prescribed – topical calcineurin inhibitors:
tacrolimus, ointment of various degrees of concentration
It is worth considering that despite the successful studies (2013), the diagnosis of vitiligo is still not officially included in the indications for use.
1. Narrow-band ultraviolet therapy (the course consists of 20-100 procedures).
2. Selective phototherapy (broadband ultraviolet therapy) is more effective, reduces the activity of vitiligo. Procedures are prescribed 2-3 times a week. Course duration – 20-100 procedures.
3. Treatment with laser radiation or monochromatic light is identical in effectiveness. The course is designed for 20-60 procedures. According to 2013 studies, it is more effective than narrowband therapy.
4. In the treatment of vitiligo also use drugs that increase sensitivity to light, in combination with PUVA therapy (ultraviolet irradiation).
Drugs that increase sensitivity to light:
methoxalen (puvalen, oxoralen, lamadin, etc.)
PUVA therapy is carried out by courses of 15-25 procedures with a break of 1-3 months.
The presence of contraindications for PUVA-therapy:
hypersensitivity to radiation,
diseases of the stomach, liver, kidneys, cardiovascular system, blood,
age up to 5 years and over 60 years.
It should be noted that PUVA therapy is most effective, but it has the greatest number of side effects, compared with other non-drug methods.
Surgical treatment of vitiligo
Transplantation of donor skin sites previously prepared by the PUVA method (which stimulates the synthesis of skin pigment and improves transplant survival) is a quick treatment method, allows to achieve a uniform skin color and is effective in treating patients who were not helped by conservative therapy methods.
Vitiligo patients are recommended to exclude direct sun exposure, the use of sunscreen.
Diet therapy for vitiligo:
The main goal of the diet is to restore normal metabolism, increase the content of copper, zinc, iodine, iron and vitamins in the body, as a possible cause of the onset of the disease in the absence of an obvious source or as an additional reinforcing agent during treatment.
Products containing copper: cod liver, fish, seafood, mushrooms, pineapples, bananas, cherries, raspberries, buckwheat, parsley, celery, figs, apricots, pears, blackberries, raspberries, cherries, walnuts, melons, legumes (peas, beans , lentils).
In order not to aggravate the course of vitiligo, patients are not recommended long-term exposure to the sun, skin trauma is undesirable in the affected areas.
Treatment of vitiligo is long and with an effective selection of treatment takes from 6 months to a year.
In 20% of patients, treatment of vitiligo is completely ineffective, especially with a long duration of the disease.
Independent recovery occurs in 5% of cases.