Care Well Medical Center

VITLIGO



Vitiligo is a condition that causes depigmentation of sections of skin. It occurs when melanocytes, the cells responsible for skin pigmentation, die or are unable to function.

The cause of vitiligo is unknown, but research suggests that it may arise from autoimmune, genetic, oxidative stress, neural, or viral causes.

The incidence worldwide is less than 2%. The most common form is non-segmental vitiligo, which tends to appear in symmetric patches, sometimes over large areas of the body.
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Incidence            1-2% worldwide. No different in india
Sexes                  Equal in both males & females
Family History    Positive in 30 – 40 %
Inheritance         Polygenic, variable penetrance and expression

Aetiopathogenesis
There are two types of Allergens:-
  • Exact cause not known
  • Auto Immune hypothesis
  • Neurogenic hypothesis (neuropeptide Y)
  • Destructive theory
    • Chemical
    • Contact
    • Defective Keratinocytes metabolism
    • Low catalase level in Epidermis in vitiligo
  • Lack of dopa positive melanocytes in vitiligo
Clinical Presentation

  • Skin
  • Mucous Membrane
  • Hair


Disorders
  • Thyroid disease
  • Pernicious anaemia
  • Addisons Disease
  • Diabetes mellitus
  • Hypoparathyroid
  • Myasthenia gravis
  • Alopecia areata
  • Morphea / lichen sclero
  • Halo neavus
  • Malignant elanoma
  • Vogt Koyanagi Syndrome
  • Vitiligo
  • Uveitis
  • CNS Involvement
  • Premature Canitis







Investigations
  • Haemogram
  • Thyroid Blood Screening
  • ANA)
  • IgE
  • Blood sugra
  • LFT
  • Urea & Electrolytes
  • Skin Biopsy ( Rarely
  • Scleroderma







Treatment - Medical Management :
Immunosuppressive therapy :
  • Systemic
    • Corticosteriods
    • MTX
    • Azathioprine
  • Topical
    • Steroids
    • Tacrolimus
    • Pimecrolimus
    • Methotrexate
Other Topical Preparation :
  • Calcipotriol (Vitamin D Analogue)
  • Placenta Extract
  • Monobenzyl ether of Hydroquinone
  • BFGF derived peptide
Other Systemic Medications
Commonly used :
  • Injection B12
  • Folates
  • Copper
  • Antoxids
    1. Salenium
    2. Methionine
    3. Tocopherol
Phototherapy (Photochemotherapy)
Chemical Used :
  • Psolalen/ Baghchi
  • Khellin
  • Phenylallanine
  • Calcipotriol
  • Tacroliums
Rays Used :
  • UVA
  • UVB
  • NBUVB
  • Targeted NBUVB(311 nm)
  • Xenon Chloride Excimer Laser (308 nm)
Delivery System :
  • Bath
  • Oral
  • Topical






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