Can vitiligo be cured? – symptoms, treatment, diagnosis

The article was prepared by a specialist for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor.

Vitiligo is a skin disease characterized by the appearance of foci of depigmentation on the body of a child. According to statistics, the incidence of vitiligo in children depends on their age group, the presence of relevant heredity and trigger factors for the development of the disease. Cases of registration of this disease in newborns are rare; vitiligo usually debuts in adolescence.

The formation of skin tone depends on the level of melanin pigment, which is normally produced in human skin over almost the entire area of ​​the body. Exceptions are the palmar surfaces of the hands and the plantar surfaces of the feet - they do not contain melanocyte cells in representatives of any race.

With insufficient production of melanin, light areas of the skin are formed, which are fundamentally different in color from normal pigmentation and represent a serious cosmetic defect.

Clinical manifestations of vitiligo

The main sign of the disease is discolored spots on the skin. They first appear in areas exposed to sunlight - on the arms, legs, face, around the lips. Later, premature graying of hair on the head, eyelashes, eyebrows or beard may occur. In some cases, light spots appear on the mucous membrane of the oral cavity and nasopharynx, as well as on the retina.

The disease can begin at any age, but more often the first signs appear in people under 20 years of age.

Depending on the degree of pathology, discolored spots can cover different areas of the body:

• widespread lesion, symmetrically involving large areas of the skin;
• segmental unilateral lesion that occurs in young people, progresses over 1 to 2 years, and then stops growing;
• focal (local) involvement of a small area of ​​the dermis.

It is impossible to predict what form the disease will take. Sometimes it stops progressing on its own; in rare cases, the skin returns to its normal color. For most people, symptoms increase, with light areas eventually covering most of the skin.

The causes and treatment of vitiligo are unknown to medicine. However, timely contact with an experienced dermatologist will slow down or stop the process of melanin loss from the skin.

Symptoms of vitiligo in children

This skin pathology is characterized by gradual development and long-term course. Foci of depigmentation are preceded by the appearance of small pink spots on the skin, which over time change their color in favor of a milky white color.

As the child grows up, the foci of depigmentation increase and take on different shapes. In young children, such spots are usually oval or round, less often in the form of a blot.

If foci of vitiligo are located in open areas of the child’s body, then under the influence of sunlight, additional symptoms may appear, such as peeling, thickening of the skin in the area of ​​depigmentation, redness and an increase in local temperature. In addition, against a tan background, the spots stand out brighter.

How to diagnose vitiligo?

To understand how to treat vitiligo depending on the trigger factor, speed and form of the lesion, the doctor examines the patient, gets acquainted with his medical history, and excludes other diseases, for example, dermatitis or psoriasis. Diagnostics involves examining the skin under a special ultraviolet lamp.

Additionally, the doctor may suggest the following studies:

• blood tests to rule out anemia, diabetes, autoimmune diseases;

a biopsy of a small area of ​​skin to confirm the diagnosis.

Treatment

Treatment of vitiligo in children is carried out comprehensively. When using pharmacological agents, the emphasis is on the following drugs:

• antioxidants - a group of agents whose effect is aimed at blocking free radicals, the effect of which adversely affects cells, tissues and biological substances (in this case it is melatonin);
• immunomodulators are a group of drugs whose effect is based on correcting the functioning of the immune system and reducing the intensity of autoimmune processes.

Specialists of JSC "Medicine" (clinic of academician Roitberg) have sufficient professional experience and knowledge to prescribe therapy for vitiligo even to the youngest children. Therefore, parents do not have to worry about the safety of the drug used and the method of treatment. The doctor will immediately provide instructions and warn about possible adverse reactions if they have previously been encountered in medical practice.

The following is used as physiotherapeutic procedures for vitiligo in children:

• ultraviolet radiation to enhance pigmentation at the site of exposure;
• laser exposure to stimulate metabolic and regenerative processes in skin cells;
• PUVA therapy is a technique based on the use of photoactive components.

At the moment, innovative methods of surgical treatment of vitiligo are being effectively developed. The essence of the procedure is to “plant” intact melanocytes, which are capable of producing melatonin, on the affected areas of the skin.

This innovative technique allows you to cope with the disease without further use of medications. Shows pretty good results.

If you follow the treatment plan drawn up by the specialists of JSC "Medicine" (clinic of Academician Roitberg), you can notice significant changes:

• there is a significant reduction in the size of white spots;
• the pigmentation disorder becomes less pronounced due to a decrease in contrast and darkening of the affected skin areas.

Aesthetic problems prompt patients and their parents to worry exclusively about the manifestations of the disease on visible parts of the body (face, neck, hands). Unfortunately, at the moment there are no drugs that would have such a targeted tropism and contribute to the darkening of the affected skin on the face. All medications used to stimulate melatonin production have the same effect on all parts of the body.

The main difficulty of all therapy is the impossibility of prescribing drugs in sufficient dosages to young children. Medicines have a starting dosage, so using a smaller amount will be ineffective, and using enough can provoke the development of adverse reactions.

To achieve the desired result in therapy, conduct a complete examination of the child and strictly follow the doctors’ prescriptions.

Treatment of vitiligo

To choose the most effective way to cure vitiligo, you should consult a dermatologist. Your doctor may recommend a variety of options, ranging from covering up spots with self-tanning or makeup to surgery. Treatment of vitiligo in Moscow and other large cities allows you to choose the most suitable method of therapy.

Drug therapy

No medicine for vitiligo can completely stop the pathological process. Tablets for treatment are ineffective; preference is given to external therapy. Some medications can reduce the intensity of discoloration:

• at the onset of the disease, glucocorticoid creams are effective and should be used for several months; however, they can cause atrophy of the epidermis;
• Milder but less effective hormonal treatments may be used in children or people with large areas of discolored skin;
• anti-vitiligo ointment that affects the immune system, containing tacrolimus or pimecrolimus, is effective for small areas of depigmentation on the face and neck; such treatment can be combined with ultraviolet irradiation of the skin (phototherapy);
• vitiligo therapy with psoralen and PUVA therapy, such sessions are repeated up to 3 times a week for 6 – 12 months;
• depigmenting agents that help even out skin tone, making it lighter and spots less noticeable.

Surgery

If medications for vitiligo are ineffective, the following are suggested:

• grafting the patient's own intact skin to replace small discolored areas;
• epidermal transplantation with preliminary artificial creation of a blister on healthy skin; then the top layer of such a bubble is removed and transplanted into the affected area;
• micro-tattooing - applying pigment to small areas around the lips and on the face, well suited for people with dark skin;
• removal of small spots using laser or cryodestruction.

Home methods

Treatment of vitiligo with folk remedies includes:

• protecting the skin from the sun with SPF of at least 30, which must be applied every 2 hours;
• the use of self-tanning containing dihydroxyacetone, as the safest for the skin;
• compresses with a decoction of Ginko biloba leaves and radish seeds;
• internal use of infusions of calendula, oregano, St. John's wort, nettle, sage and chamomile
• applying creams enriched with alpha-lipoic, folic acid, vitamins C and B12;
• medicinal baths with pine extract.

A complex effect on the skin will slow down the appearance of new spots, however, for the most pronounced effect, we recommend contacting specialists from the Mama Papa Ya network of family clinics.

Causes of vitiligo in children

The true causes of vitiligo in children have not been fully established, but there are a number of factors that play an important role in the formation and development of this skin pathology.

Provoking factors include:

• Hereditary predisposition;
• Previous infectious diseases;
• The presence of helminthic infestations in the child’s body;
• Weakening of the body's defenses;
• Impact of stress and unfavorable environment.

It is possible to prove or disprove the influence of one of the above factors only after carrying out appropriate diagnostic measures.

Why you need to contact the Mama Papa Ya clinic

Our clinic offers quality services at affordable prices:

• consultation with a qualified dermatologist familiar with modern methods of treating the disease;
• the opportunity to attend physical therapy;
• the use of non-traditional methods of treatment, such as acupuncture;
• the ability to treat family members of different ages;
• careful observation of a specialist for the effectiveness of treatment, if necessary, the use of additional methods.

Call our clinic by phone or make an appointment at a time convenient for you through the form on our website.

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When should you see a doctor?

If white spots appear on your child’s skin, you should contact your pediatrician. At the initial stage, a specialist will be able to conduct an objective examination of the baby and draw up the necessary plan for laboratory diagnostic methods that may be required, and identify the first signs of vitiligo in the child. The attending physician will also give referrals to highly specialized doctors.

Since vitiligo is a multivalent disease (it involves not only the immune system, but also the nervous system), treatment must be comprehensive. Therefore, the child needs examination and consultation:

• dermatologist;
• immunologist;
• neurologist.

A comprehensive assessment of the child’s health status by several specialists will more likely help select the most effective treatment that will help eliminate the visible manifestations of the disease. Only a complete picture provides enough information to make decisions regarding the advisability of using a particular drug, physiotherapeutic procedure, etc.

The specialists of our medical center, located in the central district at the address: 2nd Tverskoy-Yamskaya Lane 10, will be able to determine the first signs of vitiligo in children after conducting a visual examination of the child. Therefore, when the first symptoms of a violation of the integrity of the integument appear, you should make an appointment with a doctor.

Features of pathogenesis and therapy of patients with vitiligo

Vitiligo, a heterogeneous disease with a polygenic mode of inheritance, is an idiopathic skin dyschromia, characterized by the appearance of depigmented, often symmetrically located spots of various sizes, milky-white outlines with a surrounding zone with moderate hyperpigmentation and a tendency to peripheral growth [1]. Vitiligo is characterized by a chronic, in most cases progressive course, expressed in an increase in the number and size of lesions. It has been established that the appearance of foci of depigmentation is due to the destruction of melanocytes in the affected skin. The disease can appear at any age, regardless of gender. The prevalence of vitiligo varies depending on the geographic region and in different ethnic groups and ranges from 0.1 to 2 or more percent of the population. Vitiligo can begin at any age, but is more common in the age group of 10–30 years. Thus, this pathology mainly affects socially active people, in whom the presence of a cosmetic defect has a significant impact on the quality of life [2]. At the same time, predisposing and provoking factors have been established. There is evidence about the role of dysfunction of the nervous system, stress factors, chronic inflammatory diseases of the urogenital tract, internal organs, deficiency of zinc and copper in the blood, intoxications, dysfunction of the endocrine glands, and the immune system [3].

The most recognized theories of the pathogenesis of vitiligo are:

• theory of immune disorders (the leading role belongs to cell-mediated reactions);
• theory of oxidative stress (free radicals with insufficient antioxidant protection have a direct damaging effect on keratinocytes and melanocytes);
• neurogenic theory (depigmentation is formed due to a functional deficiency of the indoleamine and catecholamine systems that occurs in response to stress, dysfunction of the neurotransmitter system, peptides and receptors), and depigmentation is one of the possible symptoms of somatization disorders;
• genetic theory (molecular genetic studies have identified a significant number of genes that may be involved in the molecular pathogenesis of vitiligo, but it is still impossible to name the key genes responsible for susceptibility to the disease) [4].

At the same time, according to most experts, the leading role in damage to melanocytes and disruption of melanogenesis processes in the skin of patients with vitiligo is given to autoimmune mechanisms [8].

The multifactorial concept of pathogenesis and the identified disorders in the study of various body systems justify the need to use a wide range of traditional therapeutic measures in the treatment of this disease, since the course and outcome of vitiligo largely depend on the correct choice of pharmacotherapy and treatment methods for a particular patient.

Current approaches to the treatment of patients with vitiligo are defined in domestic and foreign clinical guidelines and include the following main areas: systemic therapy (glucocorticoids, immunotherapy, antioxidants); phototherapy; external therapy (calcineurin inhibitors, corticosteroids, antioxidants). But despite this, active scientific research is being carried out in this direction to develop new, more rational and effective products with a high safety profile, which have an increased cost-effectiveness of the costs incurred, taking into account that this dermatosis is caused by long-term drug treatment. The main goal of vitiligo treatment is to stop the progression of the disease, achieve stabilization of the process, and then regression of clinical manifestations. As a result of numerous studies, convincing data have been obtained indicating that the most important and significant of the above areas of the therapeutic complex for the management of patients with vitiligo is external therapy [5], which may be associated not only with high efficiency due to the direct use of the drug on vitiligo lesions , but also by low absorption of drugs when applied topically, i.e., less likelihood of developing systemic side effects.

Topical corticosteroids are still the first-line treatment when 10–20% of the skin is affected. Their characteristic feature is immunosuppressive activity, which is manifested by suppression of the activity of T- and B-lymphocytes, as well as inhibition of the release of cytokines (IL-1, IL-2, interferon-γ - 1 KKu) from leukocytes and macrophages [7]. In addition, corticosteroids reduce the formation and increase the breakdown of components of the complement system, block Fc receptors of immunoglobulins, and also have a suppressive effect on the mechanisms of impaired melanin synthesis in the active stage of the disease. But despite such high efficiency, topical corticosteroids also have local side effects, such as skin atrophy, telangiectasia and acne vulgaris. In this regard, in order to reduce the risk of developing local side effects and achieve a faster repigmentation process, topical corticosteroids are combined with various therapeutic methods, including physiotherapeutic methods, topical immunomodulators, etc. There are also cases of the use of topical corticosteroids in combination with trans-retinoic acid (tretinoin ), helping not only to prevent skin atrophy, but also to inhibit melanocyte apoptosis.

Modern drugs for topical treatment include immunosuppressive drugs such as tacrolimus and pimecrolimus, which belong to the ascomycin class of drugs. They are the drugs of choice for immune-mediated dermatoses due to their comparable efficacy, ease of use, and greater safety than their systemic counterparts. In vitro studies have shown that the interaction between calcineurin inhibitors and keratinocytes induces the release of stem cell factor and increased matrix metalloproteinase-9 activity, which promotes melanogenesis.

Prostaglandin analogues are also used in the local treatment of vitiligo with varying degrees of success. It is known that prostaglandins are involved in the processes of melanocyte proliferation and melanogenesis, tyrosinase expression, and also have an immunomodulatory effect. Topical application of prostaglandin PG E2 gel (0.5 mg dinoprostone in 3 g sterile gel) on depigmented skin areas in 24 patients with vitiligo was reported. According to the study results, after approximately 6 months, severe repigmentation was observed in 15 patients.

Great hopes are placed on the action of intralesional injectable drugs, which have become widespread in medical practice and have great advantages, including the speed of onset and duration of the effect, ensuring maximum bioavailability directly at the site of the lesion, which is manifested by a decrease in the duration of the disease. Medicines administered intradermally remain in the required area for a longer period than with other parenteral methods of administration (intramuscular and intravenous), since they are evacuated from the injection site more slowly, but the volume of the solution should not exceed 1-2 ml.

One of the most widely used forms of injectable glucocorticosteroid is triamcinolone acetonide, which is characterized by low solubility, slow absorption from the injection site, while inducing maximum local action, limiting diffusion and spread through tissues, without generating systemic side effects when used in therapeutic doses.

In recent years, in the treatment of restoration of a compromised immune system, local (intradermal) administration of immunocorrective drugs has been justifiably used, which is a rational approach especially to the treatment of immune-mediated diseases, including vitiligo.

In patients with common forms of vitiligo with a lesion area of ​​more than 10–20% of the body surface, the methods of choice are narrowband phototherapy with a wavelength of 311 nm or broadband ultraviolet medium wave therapy with a wavelength of 280–320 nm. In patients with common forms of vitiligo with a lesion area of ​​more than 10–20% of the body surface, the methods of choice are narrowband phototherapy with a wavelength of 311 nm or broadband ultraviolet medium wave therapy with a wavelength of 280–320 nm [8, 9].

Thus, in recent years, treatment options for vitiligo have expanded due to the development of new methods of drug administration. Unfortunately, existing methods are not indicated for all types of vitiligo, so at present there are still questions regarding the use of each method necessary to create lasting results and correct large areas of depigmentation. The introduction into the practice of vitiligo therapy of new local modern technologies for correcting affected skin, which have a number of advantages compared to other traditional routes of administration, contributes to the development of safer methods of therapy with high therapeutic efficacy [6].

Literature

1. Yusupova L. A., Yunusova E. I., Garayeva Z. Sh., Mavlyutova G. I. Modern approaches to external therapy of patients with vitiligo // Practical Medicine. 2014. No. 8 (84). pp. 24–26.
2. Ismailov R. G. Etiopathogenetic aspects of vitiligo in modern interpretation // Bulletin of problems of biology and medicine. 2012. pp. 14–17.
3. Skripkin Yu. K., Butova Yu. S., Ivanova O. L. Dermatovenereology. National leadership. M.: GEOTAR-Media, 2013. 917 p.
4. Usovetsky I. A., Sharova N. M., Korotkiy N. G. Cellular dermatobiology is an effective tool for the treatment of vitiligo // General Medicine. 2011. No. 1. P. 76–79.
5. Hossani-Madani AR, Halder RM Topical treatment and combination approaches for vitiligo: new insights, new developments // G. Ital. Dermatol. Venerol. 2010; 145(1):57–78.
6. Sharafutdinova L. A., Lomonosov K. M. Modern aspects of topical therapy for vitiligo // Russian Journal of Skin and Venereal Diseases. 2014. No. 5, t. 17. p. 40–45.
7. Yusupova L. A. Immunopathology of chronic dermatoses. Kazan: NB KSMA. 2022. 108 p.
8. Federal clinical guidelines. Dermatovenereology 2015: Skin diseases. Sexually transmitted infections. 5th ed., revised. and additional M.: Business Express. 2016. 768 p.
9. Yunusova E. I., Yusupova L. A., Garayeva Z. Sh., Mavlyutova G. I., Klimova R. N. Vitiligo: modern concepts. Collection of materials of the All-Russian scientific and practical conference with international participation “Kazan dermatological readings: synthesis of science and practice.” Kazan, 2016. pp. 66–70.

E. I. Yunusova, Candidate of Medical Sciences L. A. Yusupova1, Doctor of Medical Sciences, Professor Z. Sh. Garayeva, Candidate of Medical Sciences G. I. Mavlyutova, Candidate of Medical Sciences

GBOU DPO KSMA Ministry of Health of the Russian Federation, Kazan

1 Contact information

Features of the pathogenesis and therapy of patients with vitiligo / E. I. Yunusova, L. A. Yusupova, Z. Sh. Garayeva, G. I. Mavlyutova.

For citation: Attending physician No. 11/2017; Page numbers in the issue: 24-25 Tags: skin diseases, dyschromia, quality of life, immunocorrection

general information

This is a disease associated with impaired pigmentation in certain areas of the skin due to a lack of melanin.

From the Latin language ( vitiligo ) the name of the disease is translated as “skin defect” or “flaw”.

Lesions on the skin appear as a result of various factors, for example, exposure to chemicals, medications, or due to inflammatory processes associated with an autoimmune disease.

The disease tends to be inherited, meaning a person genetically predisposed to it.

The true nature of vitiligo is not fully understood, but modern medicine has learned to cope with it.

Adviсe

With timely treatment and correctly performed complex therapy, vitiligo may not completely disappear, but the severity of visual manifestations is significantly reduced. The clinic’s specialists ensure that treatment of vitiligo in children produces visible results. If you follow all the doctor’s recommendations, the contrast between the affected and healthy skin is reduced, and the volume of discolored areas is significantly reduced.

If there is a need to quickly and temporarily restore a normal aesthetic appearance to an older child, then to achieve a short-term result, you can use decorative cosmetics. It is important to consult a doctor in advance regarding the correct selection of cosmetics, and then use the stylist’s tips. There is no need to choose cosmetics for your child’s delicate skin on your own, as it can only lead to an increase in the manifestations of the disease.

It is worth paying attention to the composition; it should not contain the following components:

• synthetic compounds;
• aggressive substances, even if natural agents (acids, alkalis) are used in their production;
• various fragrances.

When visiting a specialist, you can ask about the results and success of treatment for vitiligo in children. Consultations with doctors will teach parents how to deal with this disease and quickly reduce its visible manifestations.

Forecast

What does Dr. Komarovsky say about the prognosis for the recovery of a child with vitiligo? No doctor can give an accurate prognosis. In some cases, it is possible to completely return the skin to its previous appearance, while in others, the treatment has no effect.

The reasons lie in the individual characteristics of the patients’ bodies. However, it is worth knowing that this disease does not entail serious consequences or complications.

In some cases, there is a risk of developing cancer, but the probability is very low.

Patients with vitiligo lead the same life as everyone else. The only difference is skin color.