Major Disputable Issues on Vitiligo - Book Report/Review Example

Vitiligo Health sciences and medicine Vitiligo is a type of disease which develops when a person loses control of the functional melanocytes. It is a skin disease, whose cause or origin have still not been discovered properly, and it is recognized or diagnosed by the appearance of white mascules on the skin, which develop due to the loss of melanocytes, as mentioned earlier. This diseases is still, fortunately, not very common in America or Europe with the percentage of people being affected is at around one percent. But the overall occurrence of this disease worldwide is about eight percent, which is a matter of concern. The people being affected by this disease suffer not only from aesthetic problems, but their social life is damaged as well. Some people suffering from this disease feel uncomfortable while appearing in public due to their appearance. This is very unfortunate because usually this disease appears before the age of twenty and can ruinous, cosmetically and socially. Introduction Vitiligo is most likely to appear on the face or the various limb regions. The way in which this disease proceeds is still unknown and the treatment varies from case to case. Depigmentation in this process is mainly due to psychological problems, such as stress and a low quality of life. Vitiligo can appear at any age. Even babies, who were six weeks old, have been diagnosed with this disease. About one percent of the world population has been affected by Vitiligo, with most cases being under the age of twenty. It can occur in men and women, and does not vary from skin type or race; anyone can be a victim to this disease. Vitiligo, as mentioned earlier, can be very damaging to a person’s self-esteem and he or she feels do not feel like going out in public. People with darker skin become more distressed, because discoloration and appearance of white mascules, are more visible on their skin. Vitiligo can be divided into two parts: nonsegmental, which is more common, and segmental. Non-segmental Vitiligo is described as a discoloration of the skin, which is portrayed by white patches on the skin, which are symmetrical in nature, and their sizes increase with time. While segmental Vitiligo appears with a more one sided distribution, and take the shape of a branch on nerves coming from a single spinal nerve. Discoloration or the white patches due to Vitiligo tend to itch and get sunburnt easily. (1). Etiology Vitiligo is a disease which has various and complicated causes. The discoloration and the emergence of white patches can be brought about a variety of causes. Many people have reported that their Vitiligo struck when they were under a stressful or critical situation. This disease is reported to have three main causes, but these causes are still in theory. The first theory declares that the nerve endings in the skin that discharge a chemical that is lethal to the melanocytes. While, the second theory states that the melanocytes tend to get destroyed by themselves. And the third theory says that Vitiligo starts as an autoimmune disease, and the body ends up destroying its own cells and tissues. (2) The theory which supports the autoimmune cause of the disease is the most popular of all. This is because of the large number of cases which have been associated with genetic linkages, and combined with humoral and cellular immune aberrancies. Epidemiology Vitiligo has been said to occur at about one percent around the world, but the percentage differs across various regions. The province of Gujrat in India, is reported to have had the highest cases of Vitiligo, at around 8.8 percent. The men and women are equally prone to this disease, but the women tend to be a victim to it earlier in age and are also the ones who seek major and early treatment. People with a family history of Vitiligo, are prone to this disease and even suffer from it a much earlier stage than the ones without a positive family history. It has also been observed that this disease more frequently occurs in young women than young men. Vitiligo is said to occur in females usually in the first ten years of their lives and the occurrence in males is usually in the fifth of their lives. Also Vitiligo is mostly diagnosed in the seasons of spring and summer. (1) In the progress of finding the cause of this disease, scientists have discovered the possibility of vitamin D in the cause of the autoimmune disease. The relation between vitamin D plasma levels and the occurrence of autoimmune diseases have been studied in around two potential cases of RA and MS, but in other autoimmune diseases. (3) Low levels of vitamin D have been found in the blood of those patients, with autoimmune diseases. Many people who have low levels of vitamin D are usually suffering from some autoimmune disease. But the possible link between deficiency of vitamin D and Vitiligo is still not known. The treatment of inducing vitamin D analogs has proved to benefit the patient suffering from Vitiligo and other autoimmune diseases. Therefore, it is related to the development of Vitiligo and other autoimmune diseases. But the exact mechanism by which vitamin D works in relation to these diseases is still not known. Further research in this area, can greatly help to treat different autoimmune diseases, and especially Vitiligo. Quality of life Vitiligo considerably changes the life that a person used to lead, and damages his social life to a great extent. It is also important that while diagnosing and treating Vitiligo, a person’s way of life should be checked and kept under consideration. This disease scars a person psychologically, because the white patches that appear on the skin are very visible and it lowers a person’s self-esteem greatly. In many regions, Vitiligo is considered as a sexually transmitted disease or a symptom of leprosy. As a result, in such regions women affected from Vitiligo are not just scarred emotionally and physically, but morally as well, as they have a challenging time in getting married or finding a decent job, or even establish a respectable position in a society. This more or less goes for the victimized men in the regions as well. Numerous patients suffering from Vitiligo live in a constant fear that the disease might exacerbate, and they start to avoid meeting people, and their socially life is utterly ruined. The depression and shame caused by Vitiligo lasts a long time and can be dangerous. It is advised to the doctors treating a Vitiligo patient that a quality of life test should be taken by the patient, and this test should kept under consideration during the treatment process, so that the patient remains satisfied, and comfortable. According to many reports, Vitiligo puts the person in a state of emotional and mental turmoil, as it is in the case of hand eczema or psoriasis. As mentioned earlier, the skin type or race does not matter when it comes to Vitiligo; anyone of any skin type can suffer from the disease, while people with a positive family history have greater chance of being affected. Also it has been reported that Vitiligo patients have difficulty in having sexual interactions and as a result, they suffer from severe stress and depression. (1) Vitamin D levels in the blood have been related to Vitiligo and myocardial infarction. People with low levels of vitamin D in their blood are more prone to develop myocardial infarction. This can be a direct result of suffering from Vitiligo earlier in life. Cases have been reported that people, who had suffered from Vitiligo, were advised by the doctors, to lessen their exposure to the sun. This led to a decrease in Vitamin D levels in the blood, which later resulted in the patients developing myocardial infarction. Therefore, those patients suffering from Vitiligo, were not only psychologically scarred, but later developed a cardiovascular disease as well, due to the deficiency of vitamin D in the blood. Treatment Research scientists, although, have not been able to find the definite cause or a definite treatment for Vitiligo, some progress has been made in the field. Calcipotriene, a topical vitamin D3 analog has been said to be a treatment for Vitiligo, as it helps in the development of melanocytes, which get destroyed when Vitiligo strikes. Though Calcipotriene has been mostly regarded as a drug which is added to another to increase effectiveness, it has showed to mark some progress in children suffering from Vitiligo. Among these children, around 78 percent have shown response to this treatment while repigmentation has only been seen in sixteen percent of the cases. Compared to topical Corticosteroids, which is another form of treatment, the Calcipotriene has a lower response and repigmentation rate; but when these two are combined it leads to a higher repigmentation rate, and time for the repigmentation to occur also shortens, and it is also a more firm repigmentation process. (4) It has been studied that the topical vitamin D3 ligands have several different approaches in tackling Vitiligo and in treating it. The two major approaches are: regulating the activation and movement of melanocytes and adjusts the T-cell activation, which seems to be related to the loss of melanocytes in Vitiligo. (5) Another form of treatment used is the use of ultra-violet rays. This treatment is being used since the 1800s to treat Vitiligo patients. Although, how the ultra-violet rays actually help is still not known, it is reported that the rays can lead to the development of melanocytes and can have immunosuppressive effects. Studies in this area have shown that the ultra-violet rays lead to the growth of melanocytes by providing them a favorable environment to grow in, and also help in preventing autoimmunity. Another way in which Vitiligo can be treated is by using helium neon laser. This is mainly used in patients who have segmental Vitiligo and show low response to other forms of treatment. The Helium-Neon laser treatment alters the adrenergic dysregulation of cutaneous blood flow that is observed in segmental Vitiligo, and leads to an increase in melanocyte development and helps the skin to survive. (4) Another method of treatment that has been found effective to treat Vitiligo, is the combination of Calcipotriol and NB-UVB. Previous studies have established that NB-UVB phototherapy is more effective than PUVA therapy, and a few cases have suggested that the combination of NB-UVB and Calcipotriol is much safer, effective and works quicker than NB-UVB alone. It has also been said to be cheaper than some other treatments. Some patients suffering from generalized Vitiligo, experienced faster and better repigmentation and they also did not have any side effects. Also the addition of topical Calcipotriol cream to NB-UVB treatment resulted in a faster response rate and also leads to the lowering of the ultra-violet dosage. (6) . Research has been done which has provided evidence that the combination of Calcipotriol and PUVA therapy does help to treat Vitiligo, quicker and effectively. Studies were carried out among patients suffering from Vitiligo, who were not responding to PUVA therapy alone. Around 29 percent of patients were shown to respond effectively to the treatment of combining Calcipotriol and PUVA, while the rest of them showed promising results, with their quick repigmentation rates. There were no extra side effects seen, that were any different from the PUVA therapy alone, and the overall treatment provided encouraging results. (9) Diagnosis As far as diagnosis of Vitiligo is concerned, it has been divided into three categories: localized, generalized and universal. It is mainly recognized the white patches that appear on the skin, uniform in shape and have convex borders. Vitiligo mostly affects those areas of the body which are hyperpigmented, such as the face, hands, chest etc. A proper diagnosis of Vitiligo is mainly made clinically, and a lamp emitting ultra-violet rays, called the Wood’s lamp, is used as a part of this diagnosis. Vitiligo slowly starts to develop in those areas of the body, which are constantly exposed to the sun, during the summer or spring season. If the body is already sunburnt, or if someone is pregnant or under great stress, all these factors can play a role in the further development of Vitiligo. It grows gradually, which is indicated either by the increasing in size of existing white patches or lesions, or the formation of new white patches on the skin. Segmental Vitiligo usually begins at a very early age, while generalized Vitiligo begins at a later age, at places of the body which are prone to pressure or friction, and it gradually proceeds with consistent outbreaks on the skin. A complete examination or checkup of the body is essential, especially if there is a doubt of genital depigmentation and a complete blood count should also be done. Up till now, there has not been an international or universal staging system for Vitiligo, that on which stage does the disease become serious or life threatening. If stage system like that of cancer is developed, then it will be much easier to diagnose and treat Vitiligo. (1) Cited References 1. Vitiligo: A comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up (Ali Alikhan, MD,a Lesley M. Felsten, MD,a Meaghan Daly, MD,b and Vesna Petronic-Rosic, MD, MScc) 2. Current remedies for vitiligo (M. Abu Tahir a, K. Pramod a, S.H. Ansari b, Javed Ali) 3. Does Vitamin D Affect Risk of Developing Autoimmune Disease?: A Systematic Review (Martin A. Kriegel, MD, PhD,* JoAnn E. Manson, MD, DrPH,† and Karen H. Costenbader, MD, MPH) 4. Vitiligo: A comprehensive overview Part II: Treatment options and approach to treatment (Lesley M. Felsten, MD,a Ali Alikhan, MD,a and Vesna Petronic-Rosic, MD, MSc) 5. Topical vitamin D3 analogues in the treatment of vitiligo (Davinder Parsad and A.J. Kanwar) 6. New Insights onTherapy with VitaminD Analogs Targeting the Intracellular PathwaysThat Control Repigmentationin Human Vitiligo (Stanca Ariana Birlea,1,2, Gertrude-Emilia Costin3,and David Albert Norris) 7. Myocardial infarction, hypovitaminosis D and vitiligo (JOSÉ PEDRO L. NUNES1, CARLA S. MARTINS) 8. A pilot study assessing the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris (Jonathan I. Silverberg, MD, PhD, MPH,a Arnold I. Silverberg, MD,b Edmond Malka, MPH, CPH, CSci, CChem, MRSC, FAIC,c and Nanette B. Silverberg, MD). 9. Experience with calcipotriol as adjunctive treatment for vitiligo in patients who do not respond to PUVA alone: A preliminary study (Bas¸ak Yalçın, MD, Sedef S¸ahin, MD, Gül Bükülmez, MD, Ays¸en Karaduman, MD,Nilgün Atakan, MD, Tülin Akan, MD, and Fikret Kölemen, MD Ankara, Turkey) Read More