2. Витилиго
План лекции
• 1. Definition of vitiligo and prevalence
• 2. Etiopathogenesis
• 3. Histopathology
• 4. Clinic
• 5. Diagnostics
• 6. Principles of treatment
3. Витилиго
Vitiligo is a skin disease that is characterized by
the development of white spots due to the loss or
decrease in the function of melanocytes, especially
in the skin, hair and retina.
4. Vitiligo is an autoimmune skin disease
mediated by CD8 + T cells
Vitiligo
The prevalence in the world ranges from 1% to
2%.
In the 1970s, the incidence rate in the United
States was 8% in Massachusetts, and the
global rate in Delhi (India) reached 8.8%.
There is still a myth about the incurability of
vitiligo
More than 70 million people worldwide suffer
from Vitiligo and 70% of them are actively
seeking treatment, more than 49 million
Vitiligo patients who seek treatment (VR
Foundation, USA, 2018)
5. The structure of the incidence of chronic dermatoses in
the Republic of Kazakhstan, * (2018)
0.4 0.5 0.6 1.7 2 3.6
9,6
27.8 28.6 29
31.4
collagenosis allergical vasculitis пузырчатка lichen planus
ihtiosis scabies vitiligo atopical dermatitis
dermatophytosis exzema psoriasis
Intensive rate per 100 thousand
population
* According to the official statistics of the Research Institute of Skin and Venereal Diseases, 2015
6. Vitiligo
The disease can begin at any age, but in
70%
of cases - up to 20 years.
Vitiligo disease is not threatening for
life
At the same time, the presence of vitiligo indicates that a
person has more serious health problems. In addition, vitiligo
is a cosmetic drawback, and therefore patients often feel
psychological discomfort.
7. Etiology and pathogenesis
• The etiology of vitiligo is unknown.
• In the pathogenesis of the disease, the genetic factor is of
particular importance, since an autosomal recessive type of
inheritance is established, due to the lack of the tyrosinase
enzyme in melanocytes and melanosomes that catalyzes the
process of pigmentation.
• In patients with vitiligo, pluriglandular endocrine disorders
are determined with a predominance of functional
insufficiency of the pituitary-adrenal system and thyroid gland.
8. What is the cause of vitiligo
disease?
• Sometimes vitiligo affects people without genetic
abnormalities. In this case, the cause lies in some kind of
trauma, most often a head injury. Among the sick there are
many people who have suffered a car accident.
• The cause may be functional disorders of the nervous
and endocrine systems, all kinds of birth injuries,
deficiency in the body of copper, iron and other trace
elements.
• Sometimes vitiligo is inherited.
9. Histopathology
Melanocytes come from cells of the nerve germ layer.
The precursors of melanocytes - melanoblasts migrate, proliferate and
differentiate along the way to the basal layer of the epidermis and hair follicles.
Epidermal melanocytes and keratinocytes form the melanocytic units of
the epidermis, in which each melanocyte carries its melanosomes through
dendrites to approximately 36 associated keratinocytes.
Skin pigmentation is the result of a close interaction between melanocytes
producing melanosomes and keratinocytes receiving them.
Melanocytes are found in the basal layer of the epidermis in a ratio of one
for every 5 basal keratinocytes.
10. Histopathology
Maintaining this balance occurs through the controlled induction of fission of
melanocytes.
To reproduce, melanocytes detach from the basement membrane and keratinocytes,
migrate through the basement membrane and reattach themselves to the matrix and
keratinocytes to form a new structure for epidermal melanin production.
Keratinocytes influence melanocytes, producing several
factors that regulate their survival.
They create the necessary microenvironment for the
proliferation, differentiation and migration of melanocytes.
12. Histopathology
Although melanocytes in altered skin can be viable, they are usually
absent, which can be verified by Fontana-Masson staining, a specific
technique for melanin or dihydroxyphenyl alanine and for demonstrating
tyrosinase.
Methods that identify pigmented autoantibodies and electron
microscopy also show that achilic vitiligo spots lack melanocytes.
At the edges of the vitiligo focus, melanocytes are larger, often
vacuolated.
13. Vitiligo
• Non-segmented
vitiligo
• generalized;
• acrofacial;
• universal;
• mixed vitiligo
• vitiligo of the mucous membranes
(the presence of more than one
lesion)
• rare options.
• uni-, bi- or plurisegmental
vitiligo.
Non-segmented vitiligo:
14. vitiligo
Acrofacial vitiligo: face, head, arms and legs, and preferably
include the perioral region;
Vitiligo of the mucous membranes: affects the mucous
membranes of the oral cavity and genitals. In addition,
patches of the mucous membrane can also be affected in
patients with an acrofacial type;
Generalized vitiligo: Spots are often symmetrical; can be located on
any part of the integument, mainly on the hands, fingers, face and
open areas.
15. Universal type: damage to 80-90% of the
body surface, the most common form in
adulthood. The common form usually
precedes it.
Mixed type: this is a combination of
segmental and non-segmented vitiligo.
Most often, the segment form precedes
non-segmented vitiligo.
Rare forms: punctate vitiligo, minor and
follicular. These types were also
considered among unclassified.
16. Segmented Vitiligo: Involves one, two, or more segments.
The single-segment form is the most common and consists of one or
more white spots on one side of the body, usually without crossing the
midline of the body, and involving the hair on the body (leukotrichia),
has a fast onset.
Two or more segments are less likely to be involved, and there may
even be a bilateral segmental arrangement starting simultaneously or
sequentially
17. Clinic
• It can begin at any age, but more often at a young
age, with the appearance of white spots of various
sizes and shapes on unchanged skin.
• The spots gradually increase in size, merge, forming
vast areas of white-milky color.
• The hair in the affected areas often also bleaches.
• Foci of vitiligo can occur anywhere on the skin, but
most often on the hands, elbows, knees - where the
skin is most injured.
18. Most often, the disease appears in the
spring-summer season.
It is characterized by a chronic long course
(years), until the end of life, self-healing is
very rare.
19. When irradiated with ultraviolet
rays, the spots do not tan
Subjective sensations are absent, peeling
and atrophy of spots with vitiligo
can not be.
20. Diagnostics:
The diagnosis of vitiligo is based on the
history and clinical picture of the disease -
the presence of milky-white spots on the
skin with clear contours and typical
localization.
At the initial examination, it is advisable to
fix the appearance and location of white
spots by photographing.
Very often, the emergence of Setton's nevi
For a clearer visualization of vitiligo foci
and differential diagnosis, it is
recommended that they be examined using
a Wood lamp.
22. Purpous of treatment
• stop the progression of the disease;
• reduce the activity of the pathological process;
• restore pigmentation in vitiligo foci and reduce the incidence
of skin lesions;
• improve the quality of life of patients.
24. Treatment of vitiligo
• Drug therapy is ineffective, the tyrosinase enzyme
that catalyzes pigmentation is activated by copper
salts, so often patients are prescribed a 0.1-0.5%
solution of copper sulfate 10-20 drops 3 times a day
after meals for a month.
• At the same time, it is recommended to take
preparations of iron, zinc, nicotinic acid, vitamins
B6, B12.
25. Фототерапия
Furocoumarin compounds are often
used - puvalen, psoralen, beroxane,
ammifurin, meladinin in combination
with ultraviolet radiation - PUVA
therapy.
More effective UV irradiation with a
spectrum of 311 nm, leading to the
appearance of persistent pigment.
26. Surgical treatment
Transplantation of an autologous
uncultured suspension of follicular
and epidermal cells
Preparation of follicular uncultured
cell suspension
28. Results after transplantation of epidermal and follicular cells
(results of Dr. Kasymkhanova A.A., Shymkent, 2019)
Across 1 m 3 days
Across 3 m 6 days
