Transcript Vitiligo - Shorecrest Preparatory School

Ali Rahall
Arvr
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
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VisualDxHealth
White patches of skin
 Whitening or graying of the hair on your
scalp, eyelashes, eyebrows or beard
 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
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Revolution
Health
 Chalk
white color
 Convex margins
 5mm to 5cm or
more in diameter
 Round, oval, or
elongated in shape
AVRF
Focal pattern—the depigmentation is limited
to one or only a few areas
 Segmental pattern—depigmented patches
develop on only one side of the body
 Generalized pattern—(most common)
depigmentation occurs symmetrically on both
sides of the body
 Focal and segmental patterns do not spread.
The generalized pattern is hard to predict and
can randomly stop
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Can appear at any age, usually first appears
between the ages of 20 and 30
 White patches may begin on your face above
your eyes or on your neck, armpits, elbows,
genitals, hands or knees
 1-200 of the world population develops
 Affects both genders and all races equally
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When no melanin is
produced, the involved patch
of skin becomes white
 When a white patch grows or
spreads the cause may be
Vitiligo
 Exact cause is unknown
 May be due to an immune
disorder, heredity, or
environmental causes like
sunburn or emotional
distress that trigger the
condition
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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
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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)
Vitiligo is difficult to
treat
Early treatment options include:
 Exposure to intense ultraviolet light, such as narrow-band
UVB therapy
 Medicines taken by mouth such as trimethylpsoralen
(Trisoralen)
Medicines:
 Corticosteroid creams
 Immunosuppressants such as pimecrolimus (Elidel)
and tacrolimus (Protopic)
 Repigmenting agents such as methoxsalen
(Oxsoralen)
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The use of steroid creams may be helpful in returning the
color to the white patches
Doctors often prescribe 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
Corticosteriod creams are the simplest and safest
treatment for vitiligo, but are not as effective as psoralen
photochemotherapy
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.
 Topical
Calcineurin
Inhibitors
RDNL
AVRF
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Most effective treatment
available in the United States.
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.
WWHT Dermatology
Topical psoralen
photochemotherapy
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Oral psoralen
photochemotherapy
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Used for children 2 years old and older who have small number white spots in
a few areas
Treatments are done under an artificial UVA light once or twice a week.
Psorglen is applied to your depigmented patches about 30 minutes before
exposing you to enough UVA light to turn the affected area pink.
The doctor usually increases the dose of UVA light slowly over many weeks.
Eventually, the pink areas fade and a more normal skin color appears.
SIDE EFFECTS:
› (1) severe sunburn and blistering
› (2) too much repigmentation or darkening (hyperpigmentation) of the
treated patches or the normal skin surrounding the vitiligo.
For people with extensive vitiligo (affecting more than 20 percent of the body)
or for people who do not respond to topical PUVA therapy
Not recommended for children under 10 years of age because it increases the
risk of damage to the eyes caused by conditions such as cataracts.
You take a prescribed dose of psoralen by mouth about 2 hours before exposure
to artificial UVA light or sunlight.
Treatments are usually given 2 or 3 times a week, but never 2 days in a row.
For patients who cannot go to a facility to receive PUVA therapy, the doctor
may prescribe psoralen that can be used with natural sunlight exposure.
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SIDE EFFECTS include:
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Sunburn, nausea and vomiting, itching, abnormal hair growth, and
hyperpigmentation.
May also increase the risk of skin cancer,
Autologous skin grafts
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Skin grafts using blisters
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Used for people with small patches of vitiligo
The doctor removes sections of the normal, pigmented
skin and places them on the depigmented areas
Infections may occur at the donor or recipient sites
The recipient and donor sites may develop scarring, a
cobblestone appearance, or a spotty pigmentation, or
may fail to cure the white spot area
Takes time and is very costly
Doctor creates blisters on your pigmented skin by
using heat, suction, or freezing cold
The tops of the blisters are then cut out and
transplanted to a depigmented skin area
SIDE EFFECTS: scarring and lack of repigmentation
Less risk of scarring with this procedure than with
other types of grafting.
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Micropigmentation
(tattooing)
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Takes a sample of your normal pigmented skin and places it
in a laboratory dish containing a special cell-culture solution
to grow melanocytes.
 When the melanocytes in the culture solution have
multiplied, the doctor transplants them to your depigmented
skin patches
 Currently experimental and is impractical for the routine care
of people with vitiligo
 Very expensive and its side effects are not known.
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Autologous melanocyte
transplants
Implanting pigment into the skin with a special surgical instrument
Works best for the lip area, particularly in people with dark skin
Difficult to match perfectly the color of the skin of the surrounding
area
The tattooed area will not change in color when exposed to sun,
while the surrounding normal skin will.
Tattooing tends to fade over time
Also tattooing of the lips may lead to episodes of blister outbreaks
caused by the herpes simplex virus
Sunscreen
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Blue Lizard Baby&
Sensitive Sunscreen
Helps protect the skin
from sunburn and longterm damage
Minimizes tanning,
which makes the
contrast between normal
and depigmented skin
less noticeable
AVRF
 Some
vitiligo patients cover depigmented
patches with stains, makeup, or self-tanning
lotions.
 Dermablend, Lydia O’Leary, Clinique,
Fashion Flair, Vitadye, and Chromelin offer
makeup or dyes that you may find helpful
for covering up depigmented patches
 Self tanning lotions have an advantage
over makeup in that the color will last for
several days and will not come off with
washing.
AVRF
April
AVRF
SUPPORT
organizations
1)National Vitiligo Foundation
2)Vitiligo Support International
3)American Vitiligo Research
Foundation Inc.
Our 16-year-old daughter Jess started treatment for her vitiligo with the
narrowband-UVB lamp about 1 1⁄2 years ago. She has had vitiligo since the age of
6. I couldn’t imagine having to visit a doctor’s office to use their lamp 2 times a
day every day. Knowing that our insurance would not cover the costs of a lamp,
we had to weigh the costs of traveling to the doctors everyday. Traveling which
meant gas and time lost from work and school, verses buying our own lamp.
Twice a day every day, the costs add up quickly. The decision was not hard to
make. Pressure and stress was taken off everyone in the family once that decision
was made. No more “who is taking her to the doctor, when do we have to go,
when can we fit it into our schedule”. That is the convenience of having your own
lamp. Our daughter can do her treatments around her schedule and in the
comfort and privacy of her own room. Her results from using the narrowband
UVB lamp are phenomenal. I’m sure if we did not have our own lamp, we would
not see the progress that we have. There would have been missed appointments,
which mean fewer treatments. Going from 75% depigmented to 80 %
repigmented or more is incredible after years of unsuccessful treatments.
Sacrifices had to be made to be able to afford the lamp, but my daughter’s mental
and physical health with her vitiligo was more important than the things that
were sacrificed. I would recommend to anyone that a purchase of the
narrowband-UVB lamp for home treatment be well worth the investment.
Nation Library of Medicine (Medicine Plus)
 American Vitiligo Research Foundation
 National Institutes of Health, Department of Health and
Human Services : National Institute of Arthritis and
Musculoskeletal and Skin Diseases
 Drugs.com (Treatments)
 youtube.com (Lee Thomas- Turning White 20/20
Interview)
 National Vitiligo Foundation (video gallery-Elizabeth
Vargas Interview)
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National Vitiligo Foundation
2) American Vitiligo Research Foundation Inc.
3) Visualdxhealth
4) Revolution Health
5) WWHT Dermatology
6) Elidel
7) National Vitiligo Foundation
8) Vitiligo Support International
1)
Kids coping with Vitiligo
Lee Thomas
Elizabeth Vargas Interview