SlideShare une entreprise Scribd logo
1  sur  59
Télécharger pour lire hors ligne
Dr. Angelo Smith M.D
WHPL
Vitiligo
• Melanocytes are special cells in our skin
that specialize in making a molecule
called melanin.
• What is Melanin?
• Melanin is something called a pigment,
which is the molecule that gives our skin
colour a darker shade.
MELANOCYTES AND MELANIN
What does melanin actually do?
Melanin protects our skin from the damaging
Ultraviolet (UV) rays from the sun.
Going sun tanning induces your body to
produce more melanin, which is why people
who return from tanning look darker.
More melanin in the skin is the reason why
people who are darker usually do not get
sunburned.
MELANOGENESIS
• Melanoblast
• Melanocyte
• Melanin
• Phenylalanine → Tyrosine
• Color of the Race → Rate of melanin
production.
Vitiligo
In our skin, we all have around the same number
of melanocytes, which are the cells that produce
melanin.
However, the melanocytes in each of our bodies
produce different amounts of melanin.
The more melanin you have in your skin, the
darker your skin color will be.
FACTS
• It is a skin condition that can manifest after
birth at any point in someone’s life.
• It leads to death or loss of function of the
melanocytes in the body, which leads to the
inability to produce any more melanin in the
skin.
• Vitiligo is very visible on someone with a very
dark complexion due to the prevalence of white
splotches of skin.
• Chronic skin disease
• Other name = Leukoderma
• White spots occur when the skin no longer
forms melanin (pigment that determines the
color of your skin, hair, and eyes)
• The white patches of irregular shapes begin to
appear on your skin
• Any part of the body may be affected.
• Common sites are exposed areas (face,
neck, eyes, nostrils, nipples, navel,
genitalia), body folds (armpits, groin),
sites of injury (cuts, scrapes, burns)
and around pigmented moles (halo
naevi)
SYMPTOMS & SIGNS
• White patches of skin
• Whitening or graying of the hair on your scalp,
eyelashes, eyebrows or beard (leukotichia – seen in
segmental)
• Loss of color in the tissues that line the inside of your
mouth
• Loss or change in color of the inner layer of your eye
• The degree of pigment loss can vary within
each vitiligo patch which means that there
may be different shades of brown in a
vitiligo patch.
• This is called ‘trichrome’.
• A border of darker skin may circle an area
of light skin.
Vitiligo
Vitiligo
Vitiligo
Vitiligo
Vitiligo
Vitiligo
Vitiligo
ASSOCIATIONS
• Premature graying of hairs in relatives.
• Koebner phenomenon.
• Emotional or Physical stress.
• Drugs → Chloroquine and Clofazimine.
SYSTEMIC
ASSOCIATIONS
• ↑ risk of Autoimmune diseases.
•  Thyroid dis. [Hashimoto’s, Grave’s]
•  Addison’s disease
•  Pernicious Anemia
•  Insulin dependent Diabetes
•  Alopecia Areata
SYSTEMIC ASSOCIATIONS
• Eye disorders
•  Uvietis
•  Depigmentation of Choroid.
• Ear disorders
•  Auditory problems
PSYCHOLOGICAL IMPACT
• Feelings of stress, embarrassment and self
consciousness.
• Perception of discrimination.
• Low self esteem.
• Disturbed sexual relationships.
ETIOLOGICAL THEORIES
• Familial Theory
• Auto-immune Theory
• Autocytotoxic Theory
• Neural Theory
• Self destruction Theory
FAMILIAL THEORY
• Epidemilogically, 25 - 33% have family
members with disease.
• Close biologic relatives → 4 - 5 folds
increased risk.
• HLA studies have variable results.
• No specific genetic pattern.
AUTO-IMMUNE
THEORY
• Antibodies against melanocyte surface
antigens, correlate with the extent of
depigmentation.
• Antityrosinase ab., Antimelanin ab. and
melanin-sensitized lymphocytes.
• Leukocyte migration inhibition factor
levels and circulating immune complex
levels markedly elevated.
Vitiligo
AUTOCYTOTOXIC
THEORY
• Increased melanocyte activity, leads to its own
demise.
• Inhibition of Thioredoxin reductase, by
Calcium.
• Higher Ca levels cause ↑↑ superoxide radicle
formation.
• Levels of Catalase, markedly decreased.
NEURAL THEORY
• Based on the following observations:
• Patients with nerve injury and vitiligo in
denervated areas .
• Clinical evidence of segmental dermatomal
vitiligo.
• Increased sweating and vasoconstriction in
vitiliginous areas.
NEURAL THEORY…
[CONT.]
• Depigmentation in animal models with severed
nerve fibres.
• Degenerative and regenerative autonomic
nerves in depigmented patches.
• Increased urinary excretion of VMA and HVA
in active vitiligo.
• It suggests that melanocytes are
destroyed by flaws in the protective
mechanism that removes the chemical
toxins that is generated in
melanogenesis.
SELF DESTRUCTION THEORY
Vitiligo
Vitiligo
MEDICAL SCREENINGS:
 A family history of vitiligo
 Look to see if there is a rash,
sunburn, or other skin trauma
that has occurred within 2 or
3 months after pigmentation
was discovered
 Premature graying of the hair
(before age 35)
 Stress or physical illness
 Also they may ask for an eye
examination (inflammation of
your eye) and/or blood test
(autoimmune disease)
HISTOPATHOLOGY
• Uniform absence of Melanocytes.
• Periphery of depigmented patch show : signs of
cellular death.
• Dilatation of rough endoplasmic reticulum in
melanocytes.
• Inflammatory changes in dermis.
EVALUATION
• Total body Wood’s light examination.
• TSH levels [Thyroid disease].
• CBC [Pernicious anemia].
• Evaluation about Diabetes Mellitus.
• Ophthalmological examination.
TREATMENT
1. Cosmetic
2. PUVA
a. Topical
b. Systemic
3. Corticosteroids
4. Surgical Treatment
5. Monobenzyl ether of Hydroquinone
COSMETIC TREATMENT
• Patches on exposed parts can be concealed by:
Make up brands : Cover Mark, Derma blend, Derma color
etc.
Topical dyes : Clinique bronze gel, Vitadye, Dyoderm etc.
Tanning creams : Chromelin, self tanning milk etc.
Advantages:
Cost, ease of application, lack of side effects.
Disadvantages:
Vigorous physical activities and in extensive disease.
P U V A
• Historically, Egyptians in 13th century
The herb “Ammi majus linnaeus”
Ammoidin
8-MOP, 5-MOP and 8-isoamylene OP
• 1904, Montgomery, Light therapy in vitiligo
• 1948, Al-Moftey, First use of light therapy in
combination with psoralens.
MECHANISM OF ACTION [PUVA]
• Immunologically mediated action.
• Stimulation of tyrosinase activity.
• Inhibition of DNA and protein synthesis.
• Depletion of EGF expression.
• Depletion of vitiligo - associated melanocyte
antigens.
MELANOCYTE
REPIGMENTATION
• Activation of inactive cells [spared in vitiligo
process] in the middle and lower part of follicle
and in outer sheath.
• These inactive cells contain structural and
melanosomal proteins, but do not contain
enzymes, required for melanogenesis.
MELANOCYTE REPIGM. [CONT.]
• Migration of melanocyte from lower hair follicle to
epidermis, depends on :
a) Cytokine release, like FGF, IL-1,
b) Inflammatory mediators such as : TGF-α,
leukotriene C4, D4, and endothelin-1.
TOPICAL PSORALENS
• Patients with less than 20% of total body
surface.
• Initially 0.05% or 0.1% strength.
• Artificial UVA source for 30 seconds initially
and increasing exposure to up to10 minutes 2 - 3
times per week.
• At 10 minutes, higher strength (0.1% to 0.15%)
prescribed.
TOPICAL PSORALENS (CONT.)
• Shielding uninvolved skin and eyes.
• Wash off the topical solution immediately
after treatment.
• Sun blocks, Avoiding direct and filtered
sunlight for the rest of the day.
• Side effects →→ Blistering, Burning and
Perilesional hyperpigmentation.
• Most effective treatment available
• PUVA therapy is to repigment the
white patches
• time-consuming, and care must be
taken to avoid side effects
• Psoralen is a drug that contains
chemicals that react with ultraviolet
light to cause darkening of the
skin.
• Psoralen is injected orally or is
applied to the skin
• Then skin is carefully timed
exposure to sunlight or to
ultraviolet A (UVA) light that
comes from a special lamp.
ORAL PSORALEN / UVA
• Patients with extensive disease.
• 0.5 mg / kg, 2 hours before treatment.
• Started at 1-2 j / cm2
of light 2 - 3 times a week.
• Darker pigmented patients and children
respond better to PUVA.
ORAL PSORALEN / UVA
• Trunk, proximal extremities and face respond
better to PUVA.
• Distal extremities, periorificial and dermatomal
lesions do not respond better.
• Side effects →→ burns, nausea, erythema,
pruritus, xerosis, fatigue, carcinogenecity,
pigmentation, cataracts and aging.
ORAL PSORALEN / UVA
• Contraindicated in →
• Pregnant women, breast feeding, h/o skin cancer,
arsenic exposure, photosensitivity, radiotherapy,
and cataracts.
• Advised to →
• Visit Ophthalmologist yearly, wear goggles, avoid
direct and filtered sunlight for 24 hours after
treatment.
CORTICOSTEROIDS
• First used in 1959 by Japanese.
• Both systemic and oral.
• Localized depigmented patches.
• High potency steroids for 1 - 2 months.
• Slowly tapered to lower strength.
• Usual side effects.
TOPICAL STEROID THERAPY
• The use of steroid creams may be helpful in returning the color to
the white patches
• A mild topical corticosteroid cream for children under 10 years
old and a stronger one for adults
• Cream must be applied to the white patches on the skin for at
least 3 months before seeing any results
• Corticosteroid creams are the simplest and safest treatment for
vitiligo, but are not as effective as psoralen photo chemotherapy
• SIDE EFFECTS occur in areas where the skin is thin, such as on
the face and armpits, or in the genital region
• They can be minimized by using weaker formulations of steroid
creams in these areas.
SURGICAL MODALITIES
• Localized non-progressive patch in a non- acral
location.
• Epidermal grafting
• Autologous minigrafting
• Transplantation of in vitro-cultured epidermis.
• Transplantation of non-cultured melanocytes.
EPIDERMAL GRAFTING
• Blisters at donor and recipient sites by suction or
liquid nitrogen.
• Roof of the blister is removed from both sites and
donor epidermis is placed on denuded recipient site.
• Reinforcement with biological dressing.
• Repigmentation seen in 2 weeks to 3 months.
• Pre-treating donor site with topical PUVA, to
stimulate melanogenesis, may enhance re-
pigmentation.
• Low incidence of scarring.
AUTOLOGOUS MINIGRAFTING
Multiple small punch biopsy specimens.
At Inconspicuous donor site, close together.
At recipient site, separated by 4 - 5 mm.
Test area chosen and 3 - 5 minigrafts are placed to
determine the ability.
After 2 months, if the pigment has spread, grafting
of the entire region continued.
IN VITRO CULTURED EPIDERMIS
Blisters at both donor and recipient sites.
Epidermis from donor site is treated with trypsin.
Melanocytes isolated and grown in cell culture for
3 weeks.
Melanocytes adhere to Vaseline gauze, which is
divided, and placed over the denuded recipient
site.
IN VITRO CULTURED EPIDERMIS
With this procedure, repigmented site can be as
large as 10 times the donor site.
Pitfalls of this technique :
1. Variegated color, due to variable
melanocyte concentration on the gauze.
2. Spotty graft failure
NON CULTURED MELANOCYTES
Non cultured melanocytes obtained with
dermatome from donor site.
Melanocytes treated with trypsin, EDTA, and
placed in a saline solution.
Injected as suspension into blisters in the recipient
site created by liquid nitrogen.
Repigmentation is faster than in vitro melanocytes.
HYDROQUINONES
Used in extensive disease where, remaining normal
skin is depigmented.
Inhibit tyrosinase, Decrease the number of
melanized melanosome, Alter melanosomal
configuration, and Cause melanocyte organelle
disuption and lysis.
Results may take from one month to one year, to
depigment completely.
• Vitiligo frequently begins with a rapid loss of
pigment which may be followed by a lengthy
period when the skin color does not change.
• Later, the pigment loss may begin again.
• The loss of color may continue until, for
unknown reasons, the process stops.
• Cycles of pigment loss followed by periods of
stability may continue indefinitely.
PROGNOSIS

Contenu connexe

Tendances (20)

Alopecia Areata
Alopecia AreataAlopecia Areata
Alopecia Areata
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Acne Vulgaris
Acne VulgarisAcne Vulgaris
Acne Vulgaris
 
Urticaria
UrticariaUrticaria
Urticaria
 
Tinea dermatophytes
Tinea   dermatophytesTinea   dermatophytes
Tinea dermatophytes
 
Eczema
EczemaEczema
Eczema
 
Urticaria
UrticariaUrticaria
Urticaria
 
Bacterial infection of the skin
Bacterial infection of the skin Bacterial infection of the skin
Bacterial infection of the skin
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Rosacea
RosaceaRosacea
Rosacea
 
Warts
WartsWarts
Warts
 
Telogen Effluvium
Telogen EffluviumTelogen Effluvium
Telogen Effluvium
 
Acne
AcneAcne
Acne
 
Disorders of hypoigmentation
Disorders of hypoigmentationDisorders of hypoigmentation
Disorders of hypoigmentation
 
Keloids
KeloidsKeloids
Keloids
 
acne vulgaris
acne vulgarisacne vulgaris
acne vulgaris
 
Seminar on lecoderma
Seminar on lecodermaSeminar on lecoderma
Seminar on lecoderma
 
Pruritis or itching
Pruritis or itchingPruritis or itching
Pruritis or itching
 
Alopecia - scaring & non-scaring type.
Alopecia - scaring & non-scaring type.Alopecia - scaring & non-scaring type.
Alopecia - scaring & non-scaring type.
 
Eczema
EczemaEczema
Eczema
 

En vedette

En vedette (20)

Vitiligo
VitiligoVitiligo
Vitiligo
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Vitiligo - dermatologia
Vitiligo - dermatologiaVitiligo - dermatologia
Vitiligo - dermatologia
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Vitíligo
VitíligoVitíligo
Vitíligo
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Vitiligo, causes and treatment
Vitiligo, causes and treatment  Vitiligo, causes and treatment
Vitiligo, causes and treatment
 
El vitíligo
El vitíligoEl vitíligo
El vitíligo
 
Qué es el vitíligo
Qué es el vitíligoQué es el vitíligo
Qué es el vitíligo
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Disorders of pigmentation
Disorders of pigmentationDisorders of pigmentation
Disorders of pigmentation
 
Disorders of pigmentation
Disorders of pigmentationDisorders of pigmentation
Disorders of pigmentation
 
Disorders of Hyperpigmentation
Disorders of HyperpigmentationDisorders of Hyperpigmentation
Disorders of Hyperpigmentation
 
Vitiligo,by Mohammadreza Khademi,GUMS-IRAN
Vitiligo,by Mohammadreza Khademi,GUMS-IRANVitiligo,by Mohammadreza Khademi,GUMS-IRAN
Vitiligo,by Mohammadreza Khademi,GUMS-IRAN
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Vitiligo in Croatia: a case report Vedrana Bulat, Mirna Šitum Department of...
 Vitiligo in Croatia: a case report  Vedrana Bulat, Mirna Šitum Department of... Vitiligo in Croatia: a case report  Vedrana Bulat, Mirna Šitum Department of...
Vitiligo in Croatia: a case report Vedrana Bulat, Mirna Šitum Department of...
 
DLQI SCORE IN VITILIGO PATIENTS IN RE-MEDIKA HOSPITAL Cross-sectional study -...
DLQI SCORE IN VITILIGO PATIENTS IN RE-MEDIKA HOSPITAL Cross-sectional study -...DLQI SCORE IN VITILIGO PATIENTS IN RE-MEDIKA HOSPITAL Cross-sectional study -...
DLQI SCORE IN VITILIGO PATIENTS IN RE-MEDIKA HOSPITAL Cross-sectional study -...
 

Similaire à Vitiligo

Vitiligo: A Chronic Skin Disorder
Vitiligo: A Chronic Skin DisorderVitiligo: A Chronic Skin Disorder
Vitiligo: A Chronic Skin Disorderamzad ansari
 
Structures of skin having different problems
Structures of skin having different problemsStructures of skin having different problems
Structures of skin having different problemsMonika Dahiya
 
Skin pigmentation | Skin Pigmentation Disorders
Skin pigmentation | Skin Pigmentation DisordersSkin pigmentation | Skin Pigmentation Disorders
Skin pigmentation | Skin Pigmentation DisordersDr. Rajat Sachdeva
 
Melasma| Melasma and its Treatment| Facial Pigmentation| Post-Pregnancy Pigm...
 Melasma| Melasma and its Treatment| Facial Pigmentation| Post-Pregnancy Pigm... Melasma| Melasma and its Treatment| Facial Pigmentation| Post-Pregnancy Pigm...
Melasma| Melasma and its Treatment| Facial Pigmentation| Post-Pregnancy Pigm...Dr. Rajat Sachdeva
 
Life style dermatoses pps
Life style dermatoses ppsLife style dermatoses pps
Life style dermatoses ppsHANISH BABU
 
Skin Pigmentation & Dark spots
Skin Pigmentation & Dark spotsSkin Pigmentation & Dark spots
Skin Pigmentation & Dark spotsAhmed AliKasem
 
Nonsurgical Facial Rejuvenation and Skin Resurfacing ppt by Maheen.pptx
Nonsurgical Facial Rejuvenation and Skin Resurfacing ppt by Maheen.pptxNonsurgical Facial Rejuvenation and Skin Resurfacing ppt by Maheen.pptx
Nonsurgical Facial Rejuvenation and Skin Resurfacing ppt by Maheen.pptxMaheen Fatima
 
Skin care & benign dermatologic conditions
Skin care & benign dermatologic conditionsSkin care & benign dermatologic conditions
Skin care & benign dermatologic conditionsKaung Htike
 
What kind of pigmentation are you?
What kind of pigmentation are you?What kind of pigmentation are you?
What kind of pigmentation are you?Theresa Mau Mei
 
Treatment of ageing skin
Treatment of ageing skinTreatment of ageing skin
Treatment of ageing skinMikhin Thomas
 
Skin Care at Every Age
Skin Care at Every AgeSkin Care at Every Age
Skin Care at Every AgeSummit Health
 
7.vitiligo , melasma
7.vitiligo , melasma7.vitiligo , melasma
7.vitiligo , melasmaAlaaZeineh
 
Fc k5 presentation
Fc k5 presentationFc k5 presentation
Fc k5 presentationfriulchemK5
 
Kena leen cream and vitiligo
Kena leen cream and vitiligoKena leen cream and vitiligo
Kena leen cream and vitiligoDr. Hani Malkawi
 
атопийн дерматит
атопийн дерматит  атопийн дерматит
атопийн дерматит Sanjdorj Zorig
 
Psychocutaneous disorders.pptx
Psychocutaneous disorders.pptxPsychocutaneous disorders.pptx
Psychocutaneous disorders.pptxRajS979327
 

Similaire à Vitiligo (20)

Vitiligo: A Chronic Skin Disorder
Vitiligo: A Chronic Skin DisorderVitiligo: A Chronic Skin Disorder
Vitiligo: A Chronic Skin Disorder
 
Structures of skin having different problems
Structures of skin having different problemsStructures of skin having different problems
Structures of skin having different problems
 
Skin pigmentation | Skin Pigmentation Disorders
Skin pigmentation | Skin Pigmentation DisordersSkin pigmentation | Skin Pigmentation Disorders
Skin pigmentation | Skin Pigmentation Disorders
 
Melasma| Melasma and its Treatment| Facial Pigmentation| Post-Pregnancy Pigm...
 Melasma| Melasma and its Treatment| Facial Pigmentation| Post-Pregnancy Pigm... Melasma| Melasma and its Treatment| Facial Pigmentation| Post-Pregnancy Pigm...
Melasma| Melasma and its Treatment| Facial Pigmentation| Post-Pregnancy Pigm...
 
Life style dermatoses pps
Life style dermatoses ppsLife style dermatoses pps
Life style dermatoses pps
 
Skin Pigmentation & Dark spots
Skin Pigmentation & Dark spotsSkin Pigmentation & Dark spots
Skin Pigmentation & Dark spots
 
Psoriasis.pptx
Psoriasis.pptxPsoriasis.pptx
Psoriasis.pptx
 
Nonsurgical Facial Rejuvenation and Skin Resurfacing ppt by Maheen.pptx
Nonsurgical Facial Rejuvenation and Skin Resurfacing ppt by Maheen.pptxNonsurgical Facial Rejuvenation and Skin Resurfacing ppt by Maheen.pptx
Nonsurgical Facial Rejuvenation and Skin Resurfacing ppt by Maheen.pptx
 
Facial melanoses
Facial melanosesFacial melanoses
Facial melanoses
 
Skin care & benign dermatologic conditions
Skin care & benign dermatologic conditionsSkin care & benign dermatologic conditions
Skin care & benign dermatologic conditions
 
Dermatology 5th year, 3rd lecture (Dr. Ali El-Ethawi)
Dermatology 5th year, 3rd lecture (Dr. Ali El-Ethawi)Dermatology 5th year, 3rd lecture (Dr. Ali El-Ethawi)
Dermatology 5th year, 3rd lecture (Dr. Ali El-Ethawi)
 
What kind of pigmentation are you?
What kind of pigmentation are you?What kind of pigmentation are you?
What kind of pigmentation are you?
 
Treatment of ageing skin
Treatment of ageing skinTreatment of ageing skin
Treatment of ageing skin
 
Skin Care at Every Age
Skin Care at Every AgeSkin Care at Every Age
Skin Care at Every Age
 
7.vitiligo , melasma
7.vitiligo , melasma7.vitiligo , melasma
7.vitiligo , melasma
 
Fc k5 presentation
Fc k5 presentationFc k5 presentation
Fc k5 presentation
 
Kena leen cream and vitiligo
Kena leen cream and vitiligoKena leen cream and vitiligo
Kena leen cream and vitiligo
 
атопийн дерматит
атопийн дерматит  атопийн дерматит
атопийн дерматит
 
Psychocutaneous disorders.pptx
Psychocutaneous disorders.pptxPsychocutaneous disorders.pptx
Psychocutaneous disorders.pptx
 
Whitening cream
Whitening creamWhitening cream
Whitening cream
 

Plus de drangelosmith

Plus de drangelosmith (20)

Migraine
MigraineMigraine
Migraine
 
Ovulation
OvulationOvulation
Ovulation
 
Menstruation
MenstruationMenstruation
Menstruation
 
OVARIAN RESERVE AND INFERTILITY
OVARIAN RESERVE AND INFERTILITYOVARIAN RESERVE AND INFERTILITY
OVARIAN RESERVE AND INFERTILITY
 
Infertility
InfertilityInfertility
Infertility
 
Obesity
ObesityObesity
Obesity
 
Hemorrhoids
HemorrhoidsHemorrhoids
Hemorrhoids
 
Telephone etiquettes
Telephone etiquettesTelephone etiquettes
Telephone etiquettes
 
Communication
CommunicationCommunication
Communication
 
Types of personalities and traitsPersonality development
Types of personalities and traitsPersonality developmentTypes of personalities and traitsPersonality development
Types of personalities and traitsPersonality development
 
Skin rash
Skin rashSkin rash
Skin rash
 
Listening
ListeningListening
Listening
 
Premature ovarian failure
Premature ovarian failurePremature ovarian failure
Premature ovarian failure
 
Integumentary system
Integumentary systemIntegumentary system
Integumentary system
 
Renal failure acute and chronic
Renal failure   acute and chronicRenal failure   acute and chronic
Renal failure acute and chronic
 
Tonsillitis
TonsillitisTonsillitis
Tonsillitis
 
Muscular dystrophy
Muscular dystrophyMuscular dystrophy
Muscular dystrophy
 
Vasculitis
VasculitisVasculitis
Vasculitis
 
Scleroderma
SclerodermaScleroderma
Scleroderma
 
Systemic Lupus Erythematoses
Systemic Lupus ErythematosesSystemic Lupus Erythematoses
Systemic Lupus Erythematoses
 

Dernier

DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 

Dernier (20)

DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 

Vitiligo

  • 1. Dr. Angelo Smith M.D WHPL
  • 3. • Melanocytes are special cells in our skin that specialize in making a molecule called melanin. • What is Melanin? • Melanin is something called a pigment, which is the molecule that gives our skin colour a darker shade. MELANOCYTES AND MELANIN
  • 4. What does melanin actually do? Melanin protects our skin from the damaging Ultraviolet (UV) rays from the sun. Going sun tanning induces your body to produce more melanin, which is why people who return from tanning look darker. More melanin in the skin is the reason why people who are darker usually do not get sunburned.
  • 5. MELANOGENESIS • Melanoblast • Melanocyte • Melanin • Phenylalanine → Tyrosine • Color of the Race → Rate of melanin production.
  • 7. In our skin, we all have around the same number of melanocytes, which are the cells that produce melanin. However, the melanocytes in each of our bodies produce different amounts of melanin. The more melanin you have in your skin, the darker your skin color will be.
  • 9. • It is a skin condition that can manifest after birth at any point in someone’s life. • It leads to death or loss of function of the melanocytes in the body, which leads to the inability to produce any more melanin in the skin. • Vitiligo is very visible on someone with a very dark complexion due to the prevalence of white splotches of skin.
  • 10. • Chronic skin disease • Other name = Leukoderma • White spots occur when the skin no longer forms melanin (pigment that determines the color of your skin, hair, and eyes) • The white patches of irregular shapes begin to appear on your skin
  • 11. • Any part of the body may be affected. • Common sites are exposed areas (face, neck, eyes, nostrils, nipples, navel, genitalia), body folds (armpits, groin), sites of injury (cuts, scrapes, burns) and around pigmented moles (halo naevi)
  • 12. SYMPTOMS & SIGNS • White patches of skin • Whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard (leukotichia – seen in segmental) • Loss of color in the tissues that line the inside of your mouth • Loss or change in color of the inner layer of your eye
  • 13. • The degree of pigment loss can vary within each vitiligo patch which means that there may be different shades of brown in a vitiligo patch. • This is called ‘trichrome’. • A border of darker skin may circle an area of light skin.
  • 21. ASSOCIATIONS • Premature graying of hairs in relatives. • Koebner phenomenon. • Emotional or Physical stress. • Drugs → Chloroquine and Clofazimine.
  • 22. SYSTEMIC ASSOCIATIONS • ↑ risk of Autoimmune diseases. •  Thyroid dis. [Hashimoto’s, Grave’s] •  Addison’s disease •  Pernicious Anemia •  Insulin dependent Diabetes •  Alopecia Areata
  • 23. SYSTEMIC ASSOCIATIONS • Eye disorders •  Uvietis •  Depigmentation of Choroid. • Ear disorders •  Auditory problems
  • 24. PSYCHOLOGICAL IMPACT • Feelings of stress, embarrassment and self consciousness. • Perception of discrimination. • Low self esteem. • Disturbed sexual relationships.
  • 25. ETIOLOGICAL THEORIES • Familial Theory • Auto-immune Theory • Autocytotoxic Theory • Neural Theory • Self destruction Theory
  • 26. FAMILIAL THEORY • Epidemilogically, 25 - 33% have family members with disease. • Close biologic relatives → 4 - 5 folds increased risk. • HLA studies have variable results. • No specific genetic pattern.
  • 27. AUTO-IMMUNE THEORY • Antibodies against melanocyte surface antigens, correlate with the extent of depigmentation. • Antityrosinase ab., Antimelanin ab. and melanin-sensitized lymphocytes. • Leukocyte migration inhibition factor levels and circulating immune complex levels markedly elevated.
  • 29. AUTOCYTOTOXIC THEORY • Increased melanocyte activity, leads to its own demise. • Inhibition of Thioredoxin reductase, by Calcium. • Higher Ca levels cause ↑↑ superoxide radicle formation. • Levels of Catalase, markedly decreased.
  • 30. NEURAL THEORY • Based on the following observations: • Patients with nerve injury and vitiligo in denervated areas . • Clinical evidence of segmental dermatomal vitiligo. • Increased sweating and vasoconstriction in vitiliginous areas.
  • 31. NEURAL THEORY… [CONT.] • Depigmentation in animal models with severed nerve fibres. • Degenerative and regenerative autonomic nerves in depigmented patches. • Increased urinary excretion of VMA and HVA in active vitiligo.
  • 32. • It suggests that melanocytes are destroyed by flaws in the protective mechanism that removes the chemical toxins that is generated in melanogenesis. SELF DESTRUCTION THEORY
  • 35. MEDICAL SCREENINGS:  A family history of vitiligo  Look to see if there is a rash, sunburn, or other skin trauma that has occurred within 2 or 3 months after pigmentation was discovered  Premature graying of the hair (before age 35)  Stress or physical illness  Also they may ask for an eye examination (inflammation of your eye) and/or blood test (autoimmune disease)
  • 36. HISTOPATHOLOGY • Uniform absence of Melanocytes. • Periphery of depigmented patch show : signs of cellular death. • Dilatation of rough endoplasmic reticulum in melanocytes. • Inflammatory changes in dermis.
  • 37. EVALUATION • Total body Wood’s light examination. • TSH levels [Thyroid disease]. • CBC [Pernicious anemia]. • Evaluation about Diabetes Mellitus. • Ophthalmological examination.
  • 38. TREATMENT 1. Cosmetic 2. PUVA a. Topical b. Systemic 3. Corticosteroids 4. Surgical Treatment 5. Monobenzyl ether of Hydroquinone
  • 39. COSMETIC TREATMENT • Patches on exposed parts can be concealed by: Make up brands : Cover Mark, Derma blend, Derma color etc. Topical dyes : Clinique bronze gel, Vitadye, Dyoderm etc. Tanning creams : Chromelin, self tanning milk etc. Advantages: Cost, ease of application, lack of side effects. Disadvantages: Vigorous physical activities and in extensive disease.
  • 40. P U V A • Historically, Egyptians in 13th century The herb “Ammi majus linnaeus” Ammoidin 8-MOP, 5-MOP and 8-isoamylene OP • 1904, Montgomery, Light therapy in vitiligo • 1948, Al-Moftey, First use of light therapy in combination with psoralens.
  • 41. MECHANISM OF ACTION [PUVA] • Immunologically mediated action. • Stimulation of tyrosinase activity. • Inhibition of DNA and protein synthesis. • Depletion of EGF expression. • Depletion of vitiligo - associated melanocyte antigens.
  • 42. MELANOCYTE REPIGMENTATION • Activation of inactive cells [spared in vitiligo process] in the middle and lower part of follicle and in outer sheath. • These inactive cells contain structural and melanosomal proteins, but do not contain enzymes, required for melanogenesis.
  • 43. MELANOCYTE REPIGM. [CONT.] • Migration of melanocyte from lower hair follicle to epidermis, depends on : a) Cytokine release, like FGF, IL-1, b) Inflammatory mediators such as : TGF-α, leukotriene C4, D4, and endothelin-1.
  • 44. TOPICAL PSORALENS • Patients with less than 20% of total body surface. • Initially 0.05% or 0.1% strength. • Artificial UVA source for 30 seconds initially and increasing exposure to up to10 minutes 2 - 3 times per week. • At 10 minutes, higher strength (0.1% to 0.15%) prescribed.
  • 45. TOPICAL PSORALENS (CONT.) • Shielding uninvolved skin and eyes. • Wash off the topical solution immediately after treatment. • Sun blocks, Avoiding direct and filtered sunlight for the rest of the day. • Side effects →→ Blistering, Burning and Perilesional hyperpigmentation.
  • 46. • Most effective treatment available • PUVA therapy is to repigment the white patches • time-consuming, and care must be taken to avoid side effects • Psoralen is a drug that contains chemicals that react with ultraviolet light to cause darkening of the skin. • Psoralen is injected orally or is applied to the skin • Then skin is carefully timed exposure to sunlight or to ultraviolet A (UVA) light that comes from a special lamp.
  • 47. ORAL PSORALEN / UVA • Patients with extensive disease. • 0.5 mg / kg, 2 hours before treatment. • Started at 1-2 j / cm2 of light 2 - 3 times a week. • Darker pigmented patients and children respond better to PUVA.
  • 48. ORAL PSORALEN / UVA • Trunk, proximal extremities and face respond better to PUVA. • Distal extremities, periorificial and dermatomal lesions do not respond better. • Side effects →→ burns, nausea, erythema, pruritus, xerosis, fatigue, carcinogenecity, pigmentation, cataracts and aging.
  • 49. ORAL PSORALEN / UVA • Contraindicated in → • Pregnant women, breast feeding, h/o skin cancer, arsenic exposure, photosensitivity, radiotherapy, and cataracts. • Advised to → • Visit Ophthalmologist yearly, wear goggles, avoid direct and filtered sunlight for 24 hours after treatment.
  • 50. CORTICOSTEROIDS • First used in 1959 by Japanese. • Both systemic and oral. • Localized depigmented patches. • High potency steroids for 1 - 2 months. • Slowly tapered to lower strength. • Usual side effects.
  • 51. TOPICAL STEROID THERAPY • The use of steroid creams may be helpful in returning the color to the white patches • A mild topical corticosteroid cream for children under 10 years old and a stronger one for adults • Cream must be applied to the white patches on the skin for at least 3 months before seeing any results • Corticosteroid creams are the simplest and safest treatment for vitiligo, but are not as effective as psoralen photo chemotherapy • SIDE EFFECTS occur in areas where the skin is thin, such as on the face and armpits, or in the genital region • They can be minimized by using weaker formulations of steroid creams in these areas.
  • 52. SURGICAL MODALITIES • Localized non-progressive patch in a non- acral location. • Epidermal grafting • Autologous minigrafting • Transplantation of in vitro-cultured epidermis. • Transplantation of non-cultured melanocytes.
  • 53. EPIDERMAL GRAFTING • Blisters at donor and recipient sites by suction or liquid nitrogen. • Roof of the blister is removed from both sites and donor epidermis is placed on denuded recipient site. • Reinforcement with biological dressing. • Repigmentation seen in 2 weeks to 3 months. • Pre-treating donor site with topical PUVA, to stimulate melanogenesis, may enhance re- pigmentation. • Low incidence of scarring.
  • 54. AUTOLOGOUS MINIGRAFTING Multiple small punch biopsy specimens. At Inconspicuous donor site, close together. At recipient site, separated by 4 - 5 mm. Test area chosen and 3 - 5 minigrafts are placed to determine the ability. After 2 months, if the pigment has spread, grafting of the entire region continued.
  • 55. IN VITRO CULTURED EPIDERMIS Blisters at both donor and recipient sites. Epidermis from donor site is treated with trypsin. Melanocytes isolated and grown in cell culture for 3 weeks. Melanocytes adhere to Vaseline gauze, which is divided, and placed over the denuded recipient site.
  • 56. IN VITRO CULTURED EPIDERMIS With this procedure, repigmented site can be as large as 10 times the donor site. Pitfalls of this technique : 1. Variegated color, due to variable melanocyte concentration on the gauze. 2. Spotty graft failure
  • 57. NON CULTURED MELANOCYTES Non cultured melanocytes obtained with dermatome from donor site. Melanocytes treated with trypsin, EDTA, and placed in a saline solution. Injected as suspension into blisters in the recipient site created by liquid nitrogen. Repigmentation is faster than in vitro melanocytes.
  • 58. HYDROQUINONES Used in extensive disease where, remaining normal skin is depigmented. Inhibit tyrosinase, Decrease the number of melanized melanosome, Alter melanosomal configuration, and Cause melanocyte organelle disuption and lysis. Results may take from one month to one year, to depigment completely.
  • 59. • Vitiligo frequently begins with a rapid loss of pigment which may be followed by a lengthy period when the skin color does not change. • Later, the pigment loss may begin again. • The loss of color may continue until, for unknown reasons, the process stops. • Cycles of pigment loss followed by periods of stability may continue indefinitely. PROGNOSIS