December 26, 2017

Vitiligo

Vitiligo

Vitiligo is a long-term condition characterized by patches of the skin losing their pigment. The appearance of white patches of skin on different parts of the body such as skin, mucus membranes an retina is as a result of the destruction of the cells that make pigment (melanocytes). The lesion are present all over the body and are usually sympathetic on both side of the body but the most common areas involved in face, lips, hands, arms, legs and genital area.

The exact cause of vitiligo is unknown. It is believed to be due to genetic susceptibility that is triggered by an environmental factor that an autoimmune disease occurs. However, several factors such as emotional stresses or sun-burning may act as a stimulant agent for occurrence of vitiligo based on the conducted researches. The estimated prevalence of vitiligo is 0.5-1% worldwide. It occurs before age of 40 in most patients, but the average age of onset is mainly in second decade of life. Nonetheless, the risk of morbidity for vitiligo occurs at any age. Gender and race have no effect on its occurrence. Vitiligo incidence is reported more frequent in patients with immunity deficiency disorders including hyperthyroid, adrenal gland deficiency, alopecia areata and lethal anemia. Since heredity is involved in this disorder, the physician should be informed from any family history of autoimmune disease or severe allergic reaction to sun light of patients.

Although this disease is not contagious and does not have severe complications, but the vitiligo causes bad effect on mental and psychological health of patients. This disorder makes stress, depression, anxiety and aggravation problems for patients. In this case, many researchers are looking for ways to treat vitiligo disease.

 

Vitiligo signs and symptoms:

The vitiligo morbidity is expressed in one of the three following patterns:

  1. Focal pattern: The several lesions occur in one or few points of the body
  2. Segmental pattern: The traumas only involve ipsilateral body
  3. Generalized pattern: The lesions appear symmetrically in both side of body. This type of involvement is more frequent pattern.

The other symptoms, which may appear in this disorder, are the premature whitening of hair on head, cilia, eyebrow, and bread as well as pallid in some part of oral mucus. Furthermore, hand, legs, face and lips are the most common areas involved in this disorder. However, groin, under armpit, peripheral part of mouth, eyes, nasal septum, navel, and anus are other regions involved as well. Vitiligo is diagnosed according to clinical record and examination.

 

Treatments

The treatment of this disorder is mainly aimed at removal of contrast between healthy skin and the vitiligo areas. Selection of therapeutic method depends on quantity, size, location, and wideness of lesions as well as patient’s tendency. At present, there are pharmaceutical option, surgical options and numerous protective measures available for this purpose.

 

Pharmaceutical treatment:

Topical drugs: Corticosteroid creams may contribute to the return of normal colors in lesions at the primary phases. Taking such therapies may be followed by side effects such as creation of creases, wrinkles and stria (Colorful stripes).

Phototherapy (treatment by light): This is an effective treatment technique, but its effects may not remain for long time.

Psoralen- ultraviolet A (PUVA): Psoralen is a medicine that causes darkening of skin after being exposed to ultraviolet light. It is administered orally. This method is often used for double-side vitiligo. The side effects of taking this medication include phototherapy technique produces pigments in areas in which whitish patches develop, but it is considered as a time-consuming method with side effects.

Depigmentation (removal of pigment): The healthy parts of skin are depigmented with this technique in order to be coordinated with other parts of skins. In the cases where more than 50% of total body surface areas are involved, it is considered as an effective method. Furthermore, the patients who treat by this method will be abnormally sensitive to light. Depigmentation is also a permanent treatment and is not easily reversible.

 

Surgical therapies

In some cases when the drug therapies are not effective, the surgical treatments will be employed. Autologous skin graft (some body): In this technique, some healthy part of patient’s skin is taken to be grafted to other part of the same patient, which is more feasible in small lesions. Some of the side effects are infection, scar (injury track), mosaic appearance (tessellate), point-pigmentation and breakdown of pigmentation.

Skin graft with blister: Some blisters are created on patient’s skin by heating, suction and freezing. Then the roof parts of blisters are removed and skin graft is placed over the involved parts. The risk of creating scar is less than the previous technique.

Micro pigmentation (tattoo): Tattoo is the injection of the pigments between epidermis and dermal by means of special tool. This therapeutic method is implemented optimally in lip region, particularly in persons with dark skin. Adjustment process of the lesion color to its surrounding skin is a difficult task. The regions under treatment and the surrounding skin may change color as they are exposed to sunlight, and tattoo is gradually diminished.

All of the above- said therapies are followed with many side effects, whereas their therapeutic effects are not considered as a viable strategy: therefore, it is required to take new and sustainable treatments.

 

Cell therapy by autologous melanocyte

In this method, melanocyte cells (named the RicolorCell product) are extracted from healthy areas of the skin in sterile conditions and grafted in other location to create pigments in area of lesions. This product contains keratinocyte and melanocyte cells which derived from the skin epidermis layer. To produce this product, you need to have a skin sample from the patient, usually from the patient’s buttocks. In this method of treatment, the sample is extracted from healthy areas of the skin and transplanted into non-pigmented regions to be pigmented in skin lesions.

Separation of cells from healthy skin is carried out in a clean room under GMP standards, and by digestion effects of enzymes, the keratinocyte and melanocyte cells are removed from the epidermal layer of the skin. Dressing (pansement) is remained on grafted point for 1 week. The pigmentation process starts after one month, while it takes 4 months or more for the grafted part to match color.

The autologous melanocytes graft is possible in the patients with stable status, while the lesions need to be relatively fixed in size and no new lesion is added to the area during 12 months before the graft operation. Likewise, the patients with history of creating colloid tissue in wound point are not appropriate candidates for taking this type of therapeutic method.