White spot disease - causes and therapy

Striking white skin patches caused by a pigmentation disorder are the characteristic feature of the white spot disease (vitiligo). Although this chronic skin disease does not cause any further physical discomfort, the cosmetic impairment can be a major psychological burden.

definition

Vitiligo refers to the formation of white patches on the skin due to a loss or deficiency of the skin pigment melanin. Depending on the extent of the pigment disorder, hypopigmentation (reduced pigmentation) or depigmentation (complete absence of the skin pigment melanin) is mentioned. The disease should be differentiated from other symptoms, which may also lead to skin blemishes, but are not due to a pigmentation disorder (eg fungal skin infections).

symptoms

The symptoms of white spot disease are - as the name implies - essentially characterized by the appearance of pale skin spots. The irregularly shaped spots are increasingly found on the hands, forearms, feet and around the genitals, but theoretically they can occur anywhere in the body. In most cases, the spots are localized, but it is possible to spread over a large area, for example, in the areas of the mucous membranes and the hairy areas of the skin to detect the spots. The hair also appears white in the affected area due to the lack of melanin. In many patients, the disease is confined to the area of ​​the face as well as the hands and feet, which is referred to in the professional world as vitiligo acrofacialis. Apart from the lack of pigmentation, the skin shows no further impairment, but it is in the affected areas much more susceptible to sunlight or UV rays, which in turn can increase the likelihood of sunburns and thus ultimately the risk of skin cancer. Patients of all ages are affected by the disease.

Although the disease does not result in any further physical impairment, the white spots are often perceived as a major cosmetic defect, leading to mental health problems for many patients in the course of the disease. Sufferers feel inferior, vulnerable and increasingly shy away from the public due to their apparent illness and fear of others' reactions, which can lead to growing social isolation in the long term.

causes

The exact causes of the diminished or lack of production of the skin pigment melanin in white spot disease is still poorly understood. Both a misguided reaction of the immune system (autoimmune disease), as well as disorders of cell metabolism and neurological causes are under discussion here. In addition, a hereditary component of the disease is considered secure. Vitiligo is increasingly associated with other autoimmune diseases, confirming the thesis of an excessive immune response as the cause of the pigmentation disorder. For example, thyroid hypofunction, hyperthyroidism, as well as diseases of type 1 diabetes are mentioned here.

Noticeable is also the often documented connection of vitiligo with mental stress or stress, which, according to the current state of knowledge, rather indirectly promotes the onset of the disease via its effect on the immune system. Furthermore, skin injuries and a strong sunburn are considered as possible triggers of vitiligo, as well as repeated mechanical irritation due to pressure or friction.

diagnosis

Since other skin diseases can be behind the skin spots, sufferers should always consult a specialist or dermatologist, in order to have security here. This can usually make a relatively reliable diagnosis based on the striking appearance of the white spot disease. The observation of the skin spots under special UV light by means of a so-called Wood lamp reveals a typical whitish-yellow coloring, which likewise can contribute to the diagnosis. In case of doubt, the laboratory examination of a skin smear, with the fungal infections and bacterial infections can be reliably diagnosed or excluded. It is also possible to take a tissue sample (biopsy) and subsequently examine for melanin present in the cells of the epidermis. The laboratory examination of a blood sample is primarily used to determine possible comorbidities, such as diabetes, hypothyroidism or hypothyroidism. In order to find out about possible causes of the pigment disorder, the patients are also asked about the general conditions under which the patches appeared for the first time as well as other cases of vitiligo in the family environment.

treatment

The white spot disease is still not curable, even if the pigmentation of the skin can be increased to a normal level with various therapeutic procedures. Since no physical impairment is associated with the disease, the need for treatment is generally considered to be rather low. In view of the mental stress, which may be associated with the vitiligo, however, a therapy is often desirable for those affected. However, the costs are not covered by all health insurance companies.

In accordance with the different manifestations of white spot disease, the spectrum of possible therapeutic measures is relatively broad. For example, patients who quickly develop severe sunburns on the affected areas of skin will initially be advised to thoroughly protect themselves with body-covering clothing and sunscreen (at least SPF 30). In addition, a so-called phototherapy or UV therapy, in which the affected skin areas are specifically irradiated with light of a specific wavelength (spectrum of 310 to 315 nanometers), stimulate the formation of melanin. This applies in a similar manner to the treatment by means of a so-called narrow-band excimer laser, in which spot-on irradiation of individual skin areas is possible.

In addition to the treatment with UVA and UVB light, photosensitizing drugs may be used to enhance the response of the skin to the low dose treatment. In general, the photo- or UV therapy must be applied over a period of at least six months in order to achieve extensive success. After a few weeks, however, the first signs of repigmentation often appear. The UV therapy is contraindicated in patients with past skin cancers or excessive photosensitivity. Also, the therapy is unsuitable for patients before the age of puberty. In addition, it should be noted that in the worst case treatment can increase the visible contrast between the skin spots and the rest of the skin. Because there is no repigmentation, the spots remain white and the rest of the skin is tanned more due to the treatment. Overall, regrettably, the results of the treatment often fail to meet the expectations of those affected.

To date, creams and ointments containing cortisone and / or the psoriasis medicine calcipotriol are sometimes used to treat vitiligo. However, the achievable treatment success remains extremely vague and in view of the imminent side effects of a longer-term use is rather discouraged. Fundamentally questionable is the use of immunosuppressive drugs in vitiligo, because it has not been conclusively clarified, what role the immune response plays at all in the disease and because there is no clear scientific evidence for the effectiveness, however, significant side effects are to be expected.

The most radical treatment approaches are the transplantation of healthy skin or endogenous melanocytes as well as the opposite measure - a color balance by destruction of the remaining melanocytes in the healthy skin - to mention. Skin grafting is only considered in patients with tremendous psychological distress and localized treatment. This also applies to transplantation in the laboratory of bred, endogenous melanocytes, as it is offered in some specialized treatment centers.

In the color balance also the healthy skin loses its color through the destruction of the melanocytes by means of laser irradiation, special remedies or surgical interventions and the stains are no longer visible. In principle, the physical symptoms of the disease are spread in order to reduce the psychological burden on those affected. This is only in patients with extreme psychological distress or psychological complications that are psychiatric attested in question.

Naturopathy with vitiligo

The naturopathic treatment of white spot disease starts with the suspected causes of skin lesions. If, for example, based on traditional Chinese medicine, an impaired circulation of Qi is assumed to trigger vitiligo, medicinal plants and tinctures are used to stimulate the flow of Qi. If there is a suspicion that there is a link with immune system disorders, measures that generally strengthen the immune system can be taken. Also, exercise and nutrition therapy often play a role here. Furthermore, sometimes a recovery of the intestine is recommended to those affected. Homeopathic remedies (especially silica, silica) are also often part of naturopathic vitiligo treatment. Last but not least, light therapy - albeit without the use of photosensitizing ointments - is also one of the naturopathic treatment approaches.

The choice of the therapeutic procedure should be based on the patient's individual symptoms, which requires a detailed medical history, inter alia, querying possible connections with mental stress, nutrition or other health impairments. Naturopathy can not show a sure way to a cure either, but there are certainly good chances to positively influence the overall clinical picture.

Further measures

Vitiligo patients, who perceive their light skin patches as a significant aesthetic impairment, they can cover by so-called camouflage. Special make-up ensures a color match of the light skin patches so that they are no longer visible. Self-tanning or so-called tanning cream can also mitigate the contrast to the extent that the stains are barely recognizable. The use of beta-carotene leads to an orange coloration of the pale skin spots, whereby they are generally less noticeable. The possibilities of color matching are quite effective, especially in the more limited forms of vitiligo. However, large skin patches can hardly be hidden with their help.

If the treatment attempts are unsuccessful and the stains can not be cosmetically covered, then patients who are under considerable psychological stress may be able to help with psychotherapy. As part of the therapy, patients also learn to deal better with emotional stress, which can sometimes have an additional positive effect on the course of the disease. By learning stress management techniques (Autogenic Training, Progressive Muscle Relaxation), stress as a factor influencing the development of vitiligo can be significantly reduced. Nevertheless, the reactions of the other people to the white spot disease for those affected often burdening. Greater education about the symptoms could potentially increase public understanding here, especially since nobody needs to be afraid of infection because the disease is not transmissible. (Fp)