Dr. V. J. Tannu Consultant Dermatologist & Cosmetologist M.D., D. D. V., F. R .S. H. (London) Contact: +91 98231 30197 Ema...
 
WHITE SPOTS WHITE  SPOTS
WHITE SPOTS
PITYRIASIS ALBA
LOSS OF MELANIN melanocyte
LEUKODERMA SEEN CLEARLY IN UV LIGHT
u v  shows progress of the spots
Hair dye rubber Ammoniated mercury CHEMICAL LEUKODERMA
intrinsic <ul><li>Lack of M S H </li></ul><ul><li>Increase in melatonin </li></ul><ul><li>Auto immune against enzyme moiet...
 
Is it curable ? curable challenging
TREAT WHITE SPOTS DEPENDS ON SITE ,AGE , EXTENT <ul><li>NONINVASIVE </li></ul><ul><li>APPLY PSORALIN LOTIONS </li></ul><ul...
PUVA THERAPY <ul><li>P : PSORALENS e.g. TAB MELANOCYL, NEOPSORA </li></ul><ul><li>U V : ULTRA VIOLET </li></ul><ul><li>A :...
P U V A  THERAPY : VITILIGO <ul><li>PT CONSUMES 8 MOP .6 MG/KG </li></ul><ul><li>APLLIES DILUTE PSORALEN LOTION </li></ul>...
PUVA THERAPY
PUVA THERAPY
U V THERAPY CHANGES
Effect of uva therapy
PROGRESSIVE BENEFIT P U V A
INTRALSIONAL  STEROIDS
Which therapy for me ? <ul><li>Age: </li></ul><ul><ul><li>Young adults: P U V A and tachrolimus </li></ul></ul><ul><ul><li...
Benefits of aggressive therapy <ul><li>Quick results </li></ul><ul><li>Can prolong the visits </li></ul><ul><li>Economical...
 
PUNCH GRFTING ON VITILIGO AREA <ul><li>BIOPSY PUNCH USED TO HARVEST NUMEROUS GRAFTS OF FULL THICKNESS SKIN </li></ul><ul><...
PUNCH GRAFT  TECHNIQUE <ul><li>THE HARVESTED GRAFTS ARE IMPLANTED IN SIMMILAR TROUGHS MADE IN THE VITILIGINOUS SKIN AT UNI...
PUNCH GRAFT 2
PUNCH  GRAFT  3
SKIN  GRAFT PREOPERATIVE SPLIT SKIN GRAFT
Dr. V. J. Tannu Consultant Dermatologist & Cosmetologist M.D., D. D. V., F. R .S. H. (London) Contact: +91 98231 30197 Ema...
wish you success !!
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Treat leukoderma

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Treat leukoderma

  1. 1. Dr. V. J. Tannu Consultant Dermatologist & Cosmetologist M.D., D. D. V., F. R .S. H. (London) Contact: +91 98231 30197 Email: [email_address] Website: www.komalclinic.co.in
  2. 3. WHITE SPOTS WHITE SPOTS
  3. 4. WHITE SPOTS
  4. 5. PITYRIASIS ALBA
  5. 6. LOSS OF MELANIN melanocyte
  6. 7. LEUKODERMA SEEN CLEARLY IN UV LIGHT
  7. 8. u v shows progress of the spots
  8. 9. Hair dye rubber Ammoniated mercury CHEMICAL LEUKODERMA
  9. 10. intrinsic <ul><li>Lack of M S H </li></ul><ul><li>Increase in melatonin </li></ul><ul><li>Auto immune against enzyme moiety </li></ul><ul><li>Allergy </li></ul><ul><li>Atopy </li></ul><ul><li>Free radicals </li></ul><ul><li>Apoptosis (defined death) </li></ul>extrinsic <ul><li>Contact with rubber,nylon,mbeh, </li></ul><ul><li>Tight clothings </li></ul><ul><li>Antibiotics:strepto, tetra, cipro </li></ul><ul><li>Photography developers </li></ul><ul><li>Radiations from t .v and other c r t </li></ul>predisposing <ul><li>Family history </li></ul><ul><li>Septic foci </li></ul><ul><li>Git and liver problems </li></ul><ul><li>Trauma </li></ul><ul><li>Diet deficient in zinc </li></ul><ul><li>Less of acid in stomach </li></ul><ul><li>Blood group: B AB </li></ul>
  10. 12. Is it curable ? curable challenging
  11. 13. TREAT WHITE SPOTS DEPENDS ON SITE ,AGE , EXTENT <ul><li>NONINVASIVE </li></ul><ul><li>APPLY PSORALIN LOTIONS </li></ul><ul><li>ORAL PSORALENS </li></ul><ul><li>EXPO TO U V L A & NB UVB </li></ul><ul><li>APPLY / INJECT STEROIDS </li></ul><ul><li>APPLY TACROLIMUS </li></ul><ul><li>INVASIVE </li></ul><ul><li>TATTOO </li></ul><ul><li>SPLIT SKIN GRAFT </li></ul><ul><li>PUNCH GRAFT </li></ul><ul><li>BLISTER GRAFT </li></ul><ul><li>MELANOCYTE CULTUREAND TRANSFER </li></ul>
  12. 14. PUVA THERAPY <ul><li>P : PSORALENS e.g. TAB MELANOCYL, NEOPSORA </li></ul><ul><li>U V : ULTRA VIOLET </li></ul><ul><li>A : AROUND 367 NM </li></ul><ul><li>PATIENT CONSUMES .6 MG/KG PSO </li></ul><ul><li>2 HRS LATER EXPOSES TO U V FOR 10 MINUTES (M E D ) </li></ul><ul><li>EVERY WK ONCE </li></ul><ul><li>EFEECT ENHANCED BY TOPICAL STEROIDS AND ORAL STEROIDS </li></ul><ul><li>PT GETS PERIFOLLICULAR PIGMENTATION IN 10 EXPOSURES </li></ul><ul><li>LIMITATIONS ARE : NOT USEFUL ON LIPS ,PALMS </li></ul><ul><li>CAN CAUSE SEVERE ITCH ,PHOTODERMATITIS </li></ul>
  13. 15. P U V A THERAPY : VITILIGO <ul><li>PT CONSUMES 8 MOP .6 MG/KG </li></ul><ul><li>APLLIES DILUTE PSORALEN LOTION </li></ul><ul><li>EXPOSES TO UV A TILL MAXIMUM ERYTHEMA DOSE </li></ul><ul><li>REPEATS RX EACH WK FOR 20 TO 30 EXP </li></ul>
  14. 16. PUVA THERAPY
  15. 17. PUVA THERAPY
  16. 18. U V THERAPY CHANGES
  17. 19. Effect of uva therapy
  18. 20. PROGRESSIVE BENEFIT P U V A
  19. 21. INTRALSIONAL STEROIDS
  20. 22. Which therapy for me ? <ul><li>Age: </li></ul><ul><ul><li>Young adults: P U V A and tachrolimus </li></ul></ul><ul><ul><li>Adults with slow growth: P U V A </li></ul></ul><ul><ul><li>Adults with fast growth: Immunosuppressants </li></ul></ul><ul><ul><li>Old : P U V A ,mtx, psoralens </li></ul></ul><ul><ul><li>children :oral medication and tachrolimus, steroids for stopping march </li></ul></ul><ul><ul><li>STABILITY </li></ul></ul><ul><li>few patches : i.l. inj, surgery,tattooing </li></ul><ul><ul><li>Unstable few patches: tachrolimus </li></ul></ul>
  21. 23. Benefits of aggressive therapy <ul><li>Quick results </li></ul><ul><li>Can prolong the visits </li></ul><ul><li>Economical </li></ul><ul><li>Useful in difficult cases </li></ul>
  22. 25. PUNCH GRFTING ON VITILIGO AREA <ul><li>BIOPSY PUNCH USED TO HARVEST NUMEROUS GRAFTS OF FULL THICKNESS SKIN </li></ul><ul><li>GENERALLY THE AREA IS FROM GLUTEAL REGION </li></ul><ul><li>GRATS ARE TEMPORARILY STORES IN SALINE </li></ul>
  23. 26. PUNCH GRAFT TECHNIQUE <ul><li>THE HARVESTED GRAFTS ARE IMPLANTED IN SIMMILAR TROUGHS MADE IN THE VITILIGINOUS SKIN AT UNIFORM DISTANCE </li></ul><ul><li>AFTER IMPLANTING GRAFTS,AREA DRESSED FOR TWO DAYS USING PROPYLELENE GLYCOL </li></ul>
  24. 27. PUNCH GRAFT 2
  25. 28. PUNCH GRAFT 3
  26. 29. SKIN GRAFT PREOPERATIVE SPLIT SKIN GRAFT
  27. 30. Dr. V. J. Tannu Consultant Dermatologist & Cosmetologist M.D., D. D. V., F. R .S. H. (London) Contact: +91 98231 30197 Email: [email_address] Website: www.komalclinic.co.in
  28. 31. wish you success !!

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