Vitiligo, its causes and treatment

VITILIGO
It is a skin disease called ala, baras, ebreĊŸ and albino among the people. Vitiligo is a well-defined, milky-white or chalk-white color that can occur at any age. It is in the form of patches of different sizes. Although it usually occurs later, it can also occur congenital (congenital). Due to the cosmetic disorder in physical appearance, it causes disorders in social relations and emotionally bad effects in the society. It can lead to low self-esteem, social anxiety and depression.

history
Vitiligo has been known for thousands of years because of its glaring appearance. The earliest documents about vitiligo, known since ancient times, were found in the Ebers Papyrus in Egypt. Throughout history, it has taken names such as Shwetakustha, Suitra, Kilas, Baras. It is believed to be derived from the Latin words “vitium” meaning stain or fault, or “vitelius” meaning “calf” used by the Roman physicist Celcus in the 2nd century AD. White mottled areas in vitiligo have been likened to white patches in mottled calves

prevalence
Although vitiligo is seen in 0.14-8.8% all over the world, regardless of race, gender and age, the rate of catching this disease is 0.15-0.32 in our country. Vitiligo can occur at any age. The onset of the disease can occur at any age between birth and 81 years of age. Congenital vitiligo is very rare. 50% of cases are between the ages of 10 and 30.

FORMATION OF VITILIO
Vitiligo is a multifactorial polygenic disease with a complex formation mechanism. Although theories have been developed to explain the loss of cells that give color to our skin (epidermal melanocytes), the main reason is still unknown. Autoimmune, cytotoxic, biochemical, oxidant-antioxidant, neural and viral causes are emphasized. It is the autoimmune hypothesis that is most emphasized today. That is, the body destroys its own melanocytes.

CLINICAL FEATURES
White patches surrounded by clinically normal skin are the most common form. It can be of different shapes, well circumscribed, varying in diameter, round, oval or striated. The color is usually homogeneous and milky white. The hairs on the areas with vitiligo usually turn white (leukotrichia), sometimes even when the skin is normal, only the hairs may turn white. Vitiligo can be seen all over the body. However, the most common areas are the face, under the arms, the back of the hands and the groin area. Often the first place to start is around the mouth.
It is classified as localized, generalized, universal and mixed vitiligo according to the extent of vitiligo involvement and the distribution of lesions.

VITILIO TREATMENT
Treatment of vitiligo is difficult and time-consuming, but it is possible. Even spontaneous remission, which we call spontaneous recovery, can be seen. However, this rate does not exceed 15% to 25%. However, it should be noted that there are also cases that are resistant to treatment.
In general, we can divide the treatment into 3 main categories.

A) Supportive treatments;
.Improvement of general health and nutritional status
Elimination of underlying suspicious factors, elimination of concomitant infection, if any, control of other autoimmune disorders such as diabetes and thyroid diseases
.Sunscreens should be used to prevent burns as sunburns can trigger vitiligo. In addition, since normal skin areas will darken with the sun, the diseased areas will become more striking. What seems like a paradox here is that the sun’s rays or the light created by PUVA devices, which we can call artificial sunlight, are also used for therapeutic purposes. However, therapeutic sunlight is given in a controlled manner and for certain periods.
.Cosmetic camouflage; Concealers with a duration of 1-2 weeks that are resistant to water and washing can be used, especially for people with focal vitiligo, which affects small areas.
.Antioxidants; Free radicals increase in vitiligo and antioxidants decrease. Therefore, in some cases, the use of B12, Folic Acid, Zinc, Manganese, Nickel, Cobalt, Calcium, Ascorbic Acid (Vitamin C) and alphatecopherol (Vitamin E) for antioxidant, vitamin and mineral support can increase the response rate to treatment.

B) Specific Treatments;
a.) Topical treatments (rubbing drug) ; In the treatment of vitiligo, especially if small areas are involved, treatment with smear drugs should be started first. For this purpose, various preparations such as topical steroids, calcipotriol (vitamin D3), tacrolimus, pimecrolimus are used.
b.) PUVA Treatment It is the application of ultraviolet rays after taking the sun-sensitizing drugs called psoralen orally or applying them to the skin. It can be applied to the whole body as well as with PUVA devices that can only be applied to the hand and/or foot. In addition, treatment can be performed with devices that produce particulate ultraviolet, called microphototherapy, which can be used in small areas. After the sun-sensitizing psoralen version, this treatment can be applied by being exposed to natural sunlight for certain periods instead of the PUVA device.
c.) Systemic Treatments;
.systemic cortisones: They are not used much today due to their high side effects and low effectiveness.
Immunomodulators: Levamisole, vitamins, trace elements and immunosuppressive cyclophosphamide, azathioprine, cyclosporine can suppress disease activity and provide recovery.
d.) Surgical treatments;
Techniques such as autologous minigraft, autologous epidermal grafting, cellular grafts, punch grafting can be applied in patients who have not developed new vitiligo lesions in recent years.
e.) Laser Treatments;
Successful results can be obtained from time to time with Excimer and Helium-Neon Laser.

C) IRREVERSIBLE DEPIGMENTATION;
It can be used to provide cosmetic benefits when more than 50% of the body is involved in vitiligo and when there is resistance to treatment. In this treatment, it is aimed to whiten the color in healthy skin areas, as the opposite of coloring the diseased areas.
As you can see, vitiligo treatment is a grueling and time-consuming process. Promising results may not always be obtained. Despite this, it is pleasing that vitiligo disease is not harmful, does not turn into another disease and is not contagious, but only as a cosmetic problem.