Vitiligo

from Wikipedia, the free encyclopedia
Classification according to ICD-10
L80 Vitiligo
ICD-10 online (WHO version 2019)
Model Winnie Harlow (2018)
Vitiligo on the hand

Vitiligo ( Latin vitilīgō 'lichen', 'skin disease'; med. Leucopathia acquisita, Greek  λευκός 'white' πάθος 'suffering', Latin acquisita 'acquired') or also called white spot disease and check skin is a chronic , non-contagious skin disease that affects around 0 , Affects 5 to 2% of people worldwide. Pigment disorders in the form of white, pigment-free patches of skin that can slowly expand, but not necessarily, are typical .

causes

The cause is unknown; permanent or temporary autoimmune blockages or destruction of the melanocytes are assumed. The disease often occurs with other autoimmune diseases such as Hashimoto's thyroiditis , type 1 diabetes mellitus, or pernicious anemia .

Stress could act as a catalyst for a Vitiligo outbreak. This means that the effects of stress can disrupt the immune system.

course

The disease can occur at any age and in families that do not appear to be genetically predisposed. The inheritance rate is around 33%. Statistically the most commonly affected are forearms, wrists, hands, fingers, elbows, feet and genitals. Usually the stretched areas of the skin are affected, e.g. B. Elbow. The unpigmented areas can expand or remain constant in size. Spontaneous repigmentation occurs.

treatment

Exposure to ultraviolet light

Various forms of UV therapies are used, the effectiveness of which has only been weakly proven: 311 nm narrow spectrum UVB, UVA therapies in combination with light sensitizing preparations (e.g. khellin or phenylalanine ) and 308 nm excimer laser . Laser therapies have the advantage that they can be used precisely on the affected areas. However, this assumes that Vitiligo is not currently spreading. Otherwise, large-scale irradiation is preferable. UV therapies must be carried out over several months. On average, therapy times of six to twelve months can be expected, which must be carried out in the form of many short, regular sessions. With UV irradiation, no previous malignant skin tumors should be present, and the patients should be at least pubescent and should have no other light sensitivity. If after three months of UV irradiation no repigmentation has yet set in, the now unsuccessful form of therapy should be discontinued. "Therapy" in the form of direct exposure to the sun should be avoided because of the high sensitivity of the affected skin areas to light.

transplantation

In special cases, autologous melanocytes (recipient and donor are identical) can also be grown and replanted. This is done after the skin has been pretreated by grinding with lasers or high-speed grinding machines. The results are particularly satisfactory in the facial area. Tissue or cell transplantation is an option, especially if the disease has remained stable for six months and has small lesions.

Color balance

The remaining melanocytes can be destroyed by laser irradiation, ingestion of tyrosinase inhibitors (e.g. monobenzone ) or surgical interventions, which results in a color balance of the skin. However, this intervention is only to be carried out in patients with major illness-related mental disorders with the recommendation of a psychiatrist, as this therapy does not bring about any physical healing, but even promotes the primary symptoms of the disease through the deliberate "bleaching" of the unaffected skin areas.

medication

Topical steroids have been used for treatment, but have not proven to be particularly effective. A similar, also immunosuppressive approach is taken by the newer preparations from the group of calcineurin - antagonists . The final evaluation of the effectiveness of these preparations is still pending.

Naturopathy

In the subjects of a small study, Ginkgo biloba extract caused some repigmentation, but the Cochrane Report from 2015 does not attach any conclusive force to this.

psychotherapy

In some cases, psychotherapy can help to cope with stress and thus helps to reduce accompanying psychosomatic problems and to cope with illness.

camouflage

As Camouflage covering methods are referred to in which the bright herd with a special makeup be tinted. A higher dose of β- carotene , in the form of capsules, leads to an orange discoloration of the light skin areas, so that the contrast to healthy skin appears less. But there is also the option of using a self-tanner .

forecast

A cure is not possible. Physical performance and life expectancy are not directly affected by the disease, but the lack of pigment protection means that the skin is particularly sensitive to light. Light-induced skin changes up to cancer (e.g. skin cancer ) occur. Sun protection with a high sun protection factor is recommended, and exposure to the sun should be avoided in large areas. It must be noted, however, that this reduces the natural production of vitamin D and that medication should be compensated accordingly in order to prevent the consequences of a vitamin D deficiency. The psychological consequences such as social withdrawal can be significant.

disability

If the face and / or hands are affected, the disease is rated with a degree of disability (GdB) of 10 to 20 , depending on its extent .

Stigma

In some cultures, vitiligo carries a stigma to those affected . They are sometimes seen as evil or contaminated and therefore sometimes avoided by the other group members. In India, vitiligo is often mistakenly associated with leprosy . Vitiligo sufferers are often stigmatized out of ignorance, as the population is not aware that Vitiligo is neither contagious nor a sign of infirmity or diseases such as cancer. As a disease that is partly psychologically conditioned and thus accessible to charismatic healing, it is a possible explanation for the healing of a leper in the New Testament (e.g. Mk 1.40-45 par.).

Etymology and history

The etymology of the Latin word vitiligo is not exactly known. It is possible that it is derived from the Latin word vitium , which can be translated as “error” or “defect”, in a medical context also as “malformation” or “malfunction”. However, a connection to the Latin vitellus "calf" is also conceivable , referring to the color of the fur, which is interspersed with white spots.

The Roman encyclopaedist and medical writer A. Cornelius Celsus mentions in the 1st half of the 1st century BC Three types of vitiligo , two of which he identifies as white and one as black. The Greeks called the incurable white species leuke (Λευκἠ).

literature

Web links

Wiktionary: Vitiligo  - explanations of meanings, word origins, synonyms, translations
Commons : Vitiligo  - collection of images, videos and audio files

Individual evidence

  1. ↑ a b Jürgen Diehle: Vitiligo and the thyroid. Dissertation . 2004. (PDF; 347 kB)
  2. ↑ a b Dual Series Dermatology. 3. Edition. Hippokrates-Verlag, 1995, ISBN 3-7773-1180-4 .
  3. ↑ Vitiligo - Causes Skin Lexicon Dermanostic Skin Lexicon - Vitiligo
  4. ↑ a b c M. E. Whitton, M. Pinart et al .: Interventions for vitiligo. In: Cochrane Database of Systematic Reviews. Number 2, 2015, Art. No. CD003263, doi: 10.1002 / 14651858.CD003263.pub5 .
  5. ↑ Skin grafts against white spot disease. In: The Standard . March 11, 2010.
  6. ↑ Dr. Anja Braunwarth: White spots on the skin: therapy for Vitiligo. In: Medical Tribune. April 5, 2018, accessed July 9, 2019 .
  7. ↑ Franz v. Bruchhausen, G. Dannhardt, Siegfried Ebel, August Wilhelm Frahm, Eberhard Hackenthal, Ulrike Holzgrabe: Hager's Handbook of Pharmaceutical Practice Volume 8: Substances EO . Springer-Verlag, 2013, ISBN 978-3-642-57994-3 , pp. 1032 ( limited preview in Google Book search).
  8. ↑ Torsten Schlote, Ulrich Kellner: Undesired drug effects in ophthalmology . Thieme, Stuttgart / New York 2011, ISBN 978-3-13-153241-1 , pp. 53 ( limited preview in Google Book search).
  9. ↑ D. Parsad, R. Pandhi, A. Juneja: Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo. In: Clinical & Experimental Dermatology. Volume 28, No. 3, 2003, pp. 285-287, PMID 12780716 , doi: 10.1046 / j.1365-2230.2003.01207.x .
  10. ↑ Annex to Section 2 of the Medical Care Ordinance (Part B, December 17)
  11. ↑ Walter Grundmann: The Gospel according to Markus, Theol. Hand comment on the NT. 10th edition. Volume 2, Berlin 1989, p. 70.
  12. ↑ For example, the entry "vitiligo" . In: Karl Ernst Georges: Comprehensive Latin-German concise dictionary . Unchanged reprint of the eighth, improved and increased edition, ed. by Heinrich Georges. Second volume. Hahnsche Buchhandlung, Hannover 1913 (again: Wissenschaftliche Buchgesellschaft, Darmstadt 1998), Sp. 3522.
  13. ^ Entry "vitium" . In: Georges: Comprehensive Latin-German concise dictionary . Second volume. Sp. 3524.
  14. ↑ entry "vitellus" . In: Georges: Comprehensive Latin-German concise dictionary . Second volume. Sp. 3522.
  15. ↑ Cels. 5,28,19a-c .