Vitiligo

1. Vitiligo Ali Rahall Arvr

2. What is Vitiligo? • 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 VisualDxHealth.com

3. Symptoms & Signs • 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 Revolution Health

4. White Vitiligo Spots • Chalk white color • Convex margins • 5mm to 5cm or more in diameter • Round, oval, or elongated in shape • AVRF

5. 3 patterns: • 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

6. Facts: • 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

7. Causes: • 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

8. 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)

9. Treatment 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)

10. Topical steroid therapy • 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 psoralenphotochemotherapy • 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.

11. ELIDEL • Topical Calcineurin Inhibitors RDNL

12. AVRF

13. Psoralenphotochemotherapy(Psorglen & Ultraviolet A Therapy & PUVA therapy) • 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

14. TREATMENTS Topical psoralenphotochemotherapy • 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. • SIDE EFFECTS include: • Sunburn, nausea and vomiting, itching, abnormal hair growth, and hyperpigmentation. • May also increase the risk of skin cancer, Oral psoralenphotochemotherapy

15. Surgical Therapies Autologous skin grafts • 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. Skin grafts using blisters

16. Surgical Therapies Micropigmentation (tattooing) • 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 • 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. Autologousmelanocyte transplants

17. Prevention: Sunscreen • Helps protect the skin from sunburn and long-term damage • Minimizes tanning, which makes the contrast between normal and depigmented skin less noticeable • Blue Lizard Baby& Sensitive Sunscreen AVRF

18. Cosmetics • 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

19. April AVRF

20. SUPPORT organizations • National Vitiligo Foundation • Vitiligo Support International • American Vitiligo Research Foundation Inc.

21. By Sharon & Jess 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.

22. Related links: • 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)

23. Related Links:images were taken from… • National Vitiligo Foundation • American Vitiligo Research Foundation Inc. • Visualdxhealth • Revolution Health • WWHT Dermatology • Elidel • National Vitiligo Foundation • Vitiligo Support International

24. Videos Kids coping with Vitiligo Lee Thomas Elizabeth Vargas Interview