Vitiligo
All people except those born albinos have functioning skin pigment cells called melanocytes. These are cells or “cytes” with the root melas coming from the Greek word for the color black. Each individual with functioning melanocytes, whatever his arbitrarily assigned or geographically presumed race, has within himself, an assortment of pigment colors that, along with the characteristic response of those color-bearing melanocytes to sunlight, determines the appearance of one’s skin color at a given time.
We know mostly about melanocytes from their dread connection with the category of cancers known as melanomas. But a surprise best-seller that came out in mid-November 2007 may change that: Lee Thomas’ Turning White: A Memoir of Change (Momentum Books, $14.95, ISBN 13: 978-1-879094-81-9). Lee Thomas is an African-American Fox network TV entertainment reporter who has vitiligo: a disease in which some of his melanocytes are either destroyed or underperform in their role of producing skin or hair color or pigment. This has dramatically changed his facial appearance (and the appearance of his hands) into one of mixed patches of black and white skin. His forthright and stirring book is very likely to raise public awareness and demand for library information on vitiligo.
Disease Incidence, Onset, Characteristics & Course
Worldwide, while some estimates range into the higher single digits for some countries, about one or two percent of people have some degree of vitiligo on some skin surfaces. About half the cases develop before the age of twenty, and the twenties themselves seem to be the prime time for the disorder to manifest itself more fully. In most cases, patches of white or very nearly white skin develop in the place of skin that would have the ordinary tone for the patient.
The most likely sites are unfortunately the face (including the lips), the hairline (poliosis, patches of shockingly white hair, are closely related and rather common in vitiligo), arms, armpits, the backs of hands, elbows, shoulders, ankle, and groin. Vitiligo patches can be localized to one area of the body, or spread out over wide regions. A combination or compromise between these extremes is represented when the vitiligo is localized areas on both sides of the body, for example, limited to the back of both hands.
It should be noted that in a small number of cases, industrial chemicals, such as solvents, dyes, and coolants, and possibly the use of lasers for depilatory purposes, are thought to lead to a kind of environmentally-induced vitiligo.
Vitiligo patches usually begin rather small ( a few freckles worth of space) but then expand at an intermittent rate. It is not unusual for vitiligo to persist after an initial period of growth, but nonetheless not advance further along the skin’s surface. There are also cases of natural regression to normal skin tone, as the body’s remaining and better functioning melanocytes repopulate the affected skin. But cases of growth in the size of whitened areas, or the development of new unconnected white patches are more typical.
New growth in old patches or the development of new patches may be spurred by one or more implicated stressors (emotional upset is frequently & understandably mentioned often in the literature). Areas of vitiligo that undergo friction (ankles with shoes is the most cited example) or repeated rubbing with other skin surfaces (facing surfaces in the armpit or groin) tend to grow larger rather than remain stable or regress. While oral lesions related to vitiligo are known and can be uncomfortable, the vast majority of patients report no pain.
Adverse Social Responses to People with Vitiligo
Psychosocial discomfort is another story. Most vitiligo patients worldwide do report a variety of adverse consequences and attitudes towards their condition as expressed by others towards them or otherwise experienced.
Perhaps not too surprisingly, despite the fact that both men and women develop vitiligo at any equal rate, women report a much higher rate of negative attitudes experienced, because much more of their likelihood of dating and/or getting married seems dependent on their facial attractiveness.
Caucasians who are lightly complexioned probably experience the least detriment socially, because the contrast in skin tones is not as severe. However, even light skinned Near & Middle Eastern women report a substantially decreased sense of being attractive and a diminished sex life. In India and Pakistan, where the disease is reported at a higher rate (3%+) than the global estimate, and where arranged marriages are overwhelmingly the norm, there are persistent folk beliefs that vitiligo is the result of multi-generationally inherited and deserved bad karma, or is the result of bad hygiene, or is somehow akin to leprosy or venereal disease. (The latter misattribution may also be connected with the fact that the pubic area is a common site for vitiligo, and that in India the medical specialty that is most responsible for managing vitiligo cases, retains the words venereology & leprology in its organizational title and journal name.) Among some African-Americans, the notion of “going white” is seen as a kind of involuntary but nonetheless shameful rejection of their being born black.
Theories of Vitiligo Causation
Forschner, Buchholtz and Stockfleth (2007), dermatological researchers in Berlin, have written one of several recent reviews of the literature, and arguably provide the best capsule summary of competing hypotheses of vitiligo etiology. It should be noted that few researchers believe that all cases of vitiligo result from any single one of the proposed causes, and many believe that combinations of causes are common even within a single individual. The main theories are:
· Vitiligo is primarily an autoimmune disorder, possibly with a genetic predisposition. Evidence includes co-occurrence with many well-known autoimmune disorders (particularly thyroid disorders and Sjogren’s Syndromes), and a modest familial propensity (about 6% family member co-incidence in having vitiligo vs. the 1%-2% global average). Although it is an occasional rather than predictable complication, some cases of AIDS and some treatments for AIDS seem to promote vitiligo inpatients who did not have it before----reinforcing the immunological dysfunction theory.
· Vitiligo is caused by an abnormally close arrangement of melanocytes with nerve endings. While all skin tissue has some innervation, and the nervous system plays a vital role in processing sensory input from the skin and triggering skin responses such as sweating, vitiligo patients seem to have overactive and over-plenty nerve-to-skin connections. In a sense, the melanocytes and the nerve endings burn each other out. Evidence includes the debris of both depleted melanocytes and nerve fibers in vitiligo biopsy samples.
· Biochemistry One: Vitiligo is caused by toxic melanin precursors. The biosynthesis of the differing melanins from more fundamental chemical building blocks within the body has been found to be quite complicated. While the finished product, some version of melanin, is not toxic to the cell, any missteps that end up with excess ingredients or toxic byproducts that linger in the melanocyte beyond its tolerance will cause cell death. Laboratory cultures of cells of people with vitiligo have been shown to have less ability to shed these remants.
· Biochemistry Two: Vitiligo is caused by free radicals (“oxidants”) which multiply beyond the capacity of the cell to sustain them. Biopsies of vitiligo patients have demonstrated cells with ongoing processes that would contribute to excess oxidant production.
Of these, the autoimmune hypothesis has, by far, the greatest amount of support in the literature.
Vitiligo Treatments: Phototherapies
One of the most frequently sought goals of vitiligo treatment is RP: repigmentation. The main categories of treatment appear to be phototherapy (exposure of the skin to various wavelengths of light), topical lotions, and skin surgery.
The goal of all the variants of phototherapies are similar : to stimulate inactive melanocytes and more importantly encourages the migration of melanocytes from healthy areas into the depigmented area.
· The most common phototherapy treatment is called PUVA (Psoralen plus Ultra Violet Light in the A spectrum range). The psoralens are a family of ringed compounds found in plants that, sometimes spread on the skin, but usually now taken in advance of the treatment by mouth, have the ability to enhance the skins absorption of ultraviolet light. Khellin, another plant derivative with similar UV-penetrance-enhancing effects is sometimes used instead of psoralen, yielding KUVA as an acronym. .
· Ultraviolet light in the B spectrum (UVB) is generally used without sensitizing pretreatment, and is sometimes seen as more effective for more active cases of vitiligo that cover broad areas of the body.
· Excimer laser treatment may provide finer tuning of wavelength, intensity, and penetrance. It can be focused on small spots on the face much better than the other two phototherapy modalities.
Vitiligo Treatments: Topical Ointments
Topical creams seem to function on one of two theories: Promote skin cell health by restoring chemical imbalances (harkening to the last two, more biochemical, of the four theories of vitiligo causation) , or, suppressing autoimmune responses (arguably working with the prevailing hypothesis).
· Calcipotriol is related to vitamin D, and aims to promote healthy calcium balance in the skin.
· Clobetasol is designed to damp down immune activity in a manner similar to other steroid creams.
· Tacrolimus (initially tested as an antibiotic but found to be good at preventing organ rejection) & Pimecrolimus (initially used for eczema) are non-steroidal.
Vitiligo Treatments: Skin Transplants & Yes, Tattooing
Some success has been had when layers of a patient’s own healthy pigmented skin are shaved off, frozen off, or peeled off using a “suction-blister-raising & excising” technique, and then transplanted over, or in replacement of, de-pigmented areas.
While it is not being done frequently, cosmetic tattooing can often deal with the problem areas of vitiligo permanently and effectively.
Outcomes
With few exceptions, such as the complete success of a skin graft (some grafts do undergo de-pigmentation, btw) most cases of vitiligo are discussed in terms of being “clinically managed” with some greater or lesser degree of success, as opposed to being cured. Current trends in the literature suggest that progress will be incremental and most likely made in the frequency, extent, uniformity, and degree of permanence with which re-pigmentation can be induced. …..And perhaps with the success of Lee Thomas’ book, this will be matched by greater public understanding.
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Please reply back as I'm {looking to|trying to|planning to|wanting to|hoping to|attempting to} create {my own|my very own|my own personal} {blog|website|site} and {would like to|want to|would love to} {know|learn|find out} where you got this from or {what the|exactly what the|just what the} theme {is called|is named}. {Thanks|Many thanks|Thank you|Cheers|Appreciate it|Kudos}!| {Hi there|Hello there|Howdy}! This {post|article|blog post} {couldn't|could not} be written {any better|much better}! {Reading through|Looking at|Going through|Looking through} this {post|article} reminds me of my previous roommate! 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Is {going to|gonna} be {back|again} {frequently|regularly|incessantly|steadily|ceaselessly|often|continuously} {in order to|to} {check up on|check out|inspect|investigate cross-check} new posts| {I wanted|I needed|I want to|I need to} to thank you for this {great|excellent|fantastic|wonderful|good|very good} read!! I {definitely|certainly|absolutely} {enjoyed|loved} every {little bit of|bit of} it. {I have|I've got|I have got} you {bookmarked|book marked|book-marked|saved as a favorite} {to check out|to look at} new {stuff you|things you} post…| {Hi|Hello|Hi there|What's up}, just wanted to {mention|say|tell you}, I {enjoyed|liked|loved} this {article|post|blog post}. It was {inspiring|funny|practical|helpful}. Keep on posting!| I {{leave|drop|{write|create}} a {comment|leave a response}|drop a {comment|leave a response}|{comment|leave a response}} {each time|when|whenever} I {appreciate|like|especially enjoy} a {post|article} on a {site|{blog|website}|site|website} or {I have|if I have} something to {add|contribute|valuable to contribute} {to the discussion|to the conversation}. {It is|Usually it is|Usually it's|It's} {a result of|triggered by|caused by} the {passion|fire|sincerness} {communicated|displayed} in the {post|article} I {read|looked at|browsed}. And {on|after} this {post|article} SLA Biomedical & Life Sciences Division Blog: Vitiligo: Some Biomedical Literature To Back a New Book by a Popular TV Reporter with the Disease. I {{was|was actually} moved|{was|was actually} excited} enough to {drop|{leave|drop|{write|create}}|post} a {thought|{comment|{comment|leave a response}a response}} {: -P|:)|;)|;-)|:-)} I {do have|actually do have} {{some|a few} questions|a couple of questions|2 questions} for you {if you {don't|do not|usually do not|tend not to} mind|if it's {allright|okay}}. {Is it|Could it be} {just|only|simply} me or {do|does it {seem|appear|give the impression|look|look as if|look like} like} {some|a few} of {the|these} {comments|responses|remarks} {look|appear|come across} {like they are|as if they are|like} {coming from|written by|left by} brain dead {people|visitors|folks|individuals}? :-P And, if you are {posting|writing} {on|at} {other|additional} {sites|social sites|online sites|online social sites|places}, {I'd|I would} like to {follow|keep up with} {you|{anything|everything} {new|fresh} you have to post}. {Could|Would} you {list|make a list} {all|every one|the complete urls} of {your|all your} {social|communal|community|public|shared} {pages|sites} like your {twitter feed, Facebook page or linkedin profile|linkedin profile, Facebook page or twitter feed|Facebook page, twitter feed, or linkedin profile}?| {Hi there|Hello}, I enjoy reading {all of|through} your {article|post|article post}. 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I {came across|found} this board and I {in finding|find|to find} It {truly|really} {useful|helpful} & it helped me out {a lot|much}. {I am hoping|I hope|I'm hoping} {to give|to offer|to provide|to present} {something|one thing} {back|again} and {help|aid} others {like you|such as you} {helped|aided} me.| {Hello|Hi|Hello there|Hi there|Howdy|Good day|Hey there}! {I just|I simply} {would like to|want to|wish to} {give you a|offer you a} {huge|big} thumbs up {for the|for your} {great|excellent} {info|information} {you have|you've got|you have got} {here|right here} on this post. {I will be|I'll be|I am} {coming back to|returning to} {your blog|your site|your website|your web site} for more soon.| I {always|all the time|every time} used to {read|study} {article|post|piece of writing|paragraph} in news papers but now as I am a user of {internet|web|net} {so|thus|therefore} from now I am using net for {articles|posts|articles or reviews|content}, thanks to web.| Your {way|method|means|mode} of {describing|explaining|telling} {everything|all|the whole thing} in this {article|post|piece of writing|paragraph} is {really|actually|in fact|truly|genuinely} {nice|pleasant|good|fastidious}, {all|every one} {can|be able to|be capable of} {easily|without difficulty|effortlessly|simply} {understand|know|be aware of} it, Thanks a lot.| {Hi|Hello} there, {I found|I discovered} your {blog|website|web site|site} {by means of|via|by the use of|by way of} Google {at the same time as|whilst|even as|while} {searching for|looking for} a {similar|comparable|related} {topic|matter|subject}, your {site|web site|website} {got here|came} up, it {looks|appears|seems|seems to be|appears to be like} {good|great}. {I have|I've} bookmarked it in my google bookmarks. {Hello|Hi} there, {simply|just} {turned into|became|was|become|changed into} {aware of|alert to} your {blog|weblog} {thru|through|via} Google, {and found|and located} that {it is|it's} {really|truly} informative. {I'm|I am} {gonna|going to} {watch out|be careful} for brussels. {I will|I'll} {appreciate|be grateful} {if you|should you|when you|in the event you|in case you|for those who|if you happen to} {continue|proceed} this {in future}. {A lot of|Lots of|Many|Numerous} {other folks|folks|other people|people} {will be|shall be|might be|will probably be|can be|will likely be} benefited {from your|out of your} writing. 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Is this a paid theme or did you {customize|modify} it yourself? {Either way|Anyway} keep up the {nice|excellent} quality writing, {it's|it is} rare to see a {nice|great} blog like this one {these days|nowadays|today}.| {I am|I'm} {extremely|really} {inspired|impressed} {with your|together with your|along with your} writing {talents|skills|abilities} {and also|as {smartly|well|neatly} as} with the {layout|format|structure} {for your|on your|in your|to your} {blog|weblog}. {Is this|Is that this} a paid {subject|topic|subject matter|theme} or did you {customize|modify} it {yourself|your self}? {Either way|Anyway} {stay|keep} up the {nice|excellent} {quality|high quality} writing, {it's|it is} {rare|uncommon} {to peer|to see|to look} a {nice|great} {blog|weblog} like this one {these days|nowadays|today}..| {Hi|Hello}, Neat post. {There is|There's} {a problem|an issue} {with your|together with your|along with your} {site|web site|website} in {internet|web} explorer, {may|might|could|would} {check|test} this? 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