Vitiligo: those white spots on the skin

This skin disease has had great social significance throughout history. There are references to it in Indian holy books, 1,400 years BC. The stigma associated with vitiligo, in some cultures, dates back to those times, when it was mistaken for leprosy or other contagious or disfiguring disorders. It causes a great aesthetic and psychological repercussion for people who suffer from it.

Vitiligo is a disease of unknown cause, with a certain genetic predisposition, which appears in all races. It affects between 1 and 2% of the population and both sexes equally; and, although it can occur at any age, it is more frequent between 10 and 30 years, explains the dermatologist in Rajouri Garden.

Despite the great scientific advances, it has not yet been possible to elucidate the reason why melanocytes (melanin-producing cells) are not present in white spots. However, various factors are postulated, such as genetic, autoimmune, and neurogenic mechanisms (nearby nerve endings release a neurochemical mediator toxic to melanocytes). According to the skin specialist in Rajouri Garden, many patients attribute the onset of the disease to some specific circumstance in their lives, a crisis or a certain illness: the loss of a job, the death of a close relative, an accident or a serious systemic pathology.

Clinical picture

The clinical manifestations of vitiligo are very specific and, in general, asymptomatic. The characteristic lesion is a chalk or milky white spot with well-defined boundaries, ranging in size from pinpoint to large spots, in different ways. Their number is variable, since it can present as a single injury or in such a quantity that it is uncountable, explains the dermatologist in Shastri Nagar.

Types of vitiligo

a) Focal: isolated spot or a few scattered spots.

b) Segmental: unilateral spots with distribution of a metamera (field or area associated with a nerve that leaves the spinal cord). It tends to be of an early start and more stable than the generalized one. It usually appears in the area of ​​the trigeminal nerve, neck and trunk.

c) Generalized: it is the most common type and is characterized by scattered spots. It is usual for these spots to be arranged symmetrically on the extensor surfaces of the extremities, mainly in the joints of the fingers, elbows and knees. Other involved surfaces are the wrist, the navel, the lumbosacral zone, the anterior tibia and the armpit. They can be periorificiales, being located around the eyes, the nose, the ears, the mouth and the anus. It can also affect the mucosa (lips, distal part of the penis and nipples). It can be associated with premature gray hair, says the skin specialist in Shastri Nagar.

d) Universal: it affects practically the entire body surface.

Associations

As per the dermatologist in Vishnu Garden, it can be associated with alopecia areata, pigmentary abnormalities of the iris and retina, thyroid diseases (hyperthyroidism, hypothyroidism, toxic goiter and thyroiditis), diabetes mellitus, diseases of the adrenal glands (Addison) and pernicious anemia (due to vitamin B12 deficiency).

Diagnosis

It is easy, although in light-skinned people the exploration with Wood's light can be useful.

Treatment

Four aspects of the disease should be considered:

1) Protect the pigment-free areas with clothing or sunscreen to avoid sunburn, frequent due to the absence of melanin.

2) Try the repigmentation of the white areas, from the regeneration of the surrounding healthy skin melanocytes or the healthy hair follicles of the affected area. This is a difficult task that can be used for: powerful topical corticosteroids when the lesions are small, topical immunomodulators (tacrolimus), and photochemotherapy (PUVA). Healthy skin grafts or melanocyte cultures can also be performed on the affected skin areas, says the skin specialist in Vishnu Garden.

3) Try depigmentation of healthy pigmented areas with 20% hydroquinone monobenzyl ether. It is used if repigmentation fails.

4) Conceal injuries with makeup.

Spots on the Skin: what can I do?

There are multiple and diverse causes that can cause the appearance of spots on the skin, but if something is clear it is that while age is one of the least important factors, the sun is the true enemy of the skin, so learn to protect yourself. They can properly stop these spots from appearing.

According to dermatologist in Rajouri Garden, "the main cause of the appearance of spots on the skin is exposure to solar radiation." The expert explains that this is because " prolonged exposure to ultraviolet (UV) rays causes the skin to generate a greater amount of melanin, the natural pigment that protects against solar radiation, so that in those areas of our skin where melanin accumulates, a stain will finally appear”.

These spots, says dermatologist in Rajouri Garden, "are known as solar lentigo and usually appear in frequently photo-exposed areas, such as the face, back and décolleté, in both men and women." Other additional factors that can influence the appearance of skin spots are hormonal changes, such as those that occur during pregnancy or with the use of contraceptives, which give rise to other types of spots known as melasma and that usually appear in areas like cheeks, forehead and mustache.

The role that age fulfills in this aspect, affirms the skin specialist in Rajouri Garden, is due to the fact that " with the years the possibilities of developing this type of spots increase ", since there is a longer time of exposure to the sun and the skin becomes drier and less elastic. Although there is no specific age from which these lesions begin to appear, as it depends on the time and degree of sun exposure, they are generally more frequent between the ages of 30 and 40.

The dermatologist in Shastri Nagar, defends in this sense that "there are many types of spots, therefore it cannot be generalized when we talk about them, since there may be other types of injuries that are due to other causes”.

Faced with this problem, dermatologist in Shastri Nagar assures that "the only thing in our hands is to protect ourselves from the sun, because the other factors do not depend on us." In this sense, dermatologist declares that "the use of daily sunscreens on commonly exposed skin, such as that of the face, neck and hands, is essential."

The skin specialist in Shastri Nagar denounces that "there is an erroneous belief that we should use these creams only in the summer months, however, UV radiation is present throughout the year, to a greater or lesser extent, so it is necessary to maintain continuous protection”. In addition, the use of these protective creams, he declares, "not only prevents the appearance of solar lentigo, but also prevents the appearance of skin cancer."

How to treat Spots?

In the event that they have appeared, there are numerous topical products and chemical and physical techniques to eliminate these injuries, although it is important, before taking any action, to contact a professional who confirms the diagnosis and can give a specific solution for the type spot in question. Among the available treatments, says dermatologist in Vishnu Garden, "we found depigmenting agents, peels and treatments with lasers and light sources":

• Depigmenting agents: The skin specialist in Vishnu Garden highlights hydroquinone and its derivatives, kojiko acid, azelaic acid and retinol.
• Peeling: Combinations of different types of acids and depigmenting agents are used in different concentrations, depending on the pathology to be treated.
• Lasers and light sources: The expert states that among the options with the highest effectiveness rate are pulsed light and Q-Switched lasers, which are used for spots of the solar lentigo type. The possibility of carrying out cryotherapy treatment in certain more localized lesions also stands out as an alternative.

How to care for your skin at home?

The fundamental pillars for skin care are hydration and photoprotection, since both measures aim to avoid skin photoaging, and with it the appearance of spots and the possibility of developing cancer.

Dermatologist in Delhi also advises a diet rich in antioxidants, such as vitamin E, vitamin C, carotenoids and lycopene, since "they have shown to have a protective role against aging." Tobacco causes premature aging of the skin, hinders wound healing and favors the appearance of skin cancer, so avoiding it also falls within the recommendations for healthy, blemish-free skin.

Acne and its Treatment: Everything you need to know

 

Acne is a condition that usually begins in adolescence, although there are cases, especially women, in which it persists or appears for the first time during the adult stage. There are two reasons why we should treat acne on time: because if it continues to evolve it can leave marks and because it causes, in many cases, great discomfort in who suffers it. There are studies that show that acne patients have lower self-esteem, are not happy with their image, their social relationships are affected, both with people of the same sex and the opposite sex and have more difficulty finding employment. The anxiety and depression rate is higher in people with acne and even 6% have had suicidal thoughts. For all this, it is very clear that acne treatment must be correct and on time, says the dermatologist in Rajouri Garden.

What anti-acne treatment should you choose?

Having made it clear that acne is always worth treating, the skin specialist in Rajouri Garden will have to decide which acne treatment to perform. For this, once in consultation, they will assess your specific case: type of acne, severity, evolution, previous treatments carried out, factors that may be aggravating it ... Sometimes analytical studies must be requested to rule out a basic hormonal alteration. And with all this information, they will propose the different acne treatment options and then they will choose the most appropriate option for you.

Topical treatments

We can try both creams or gels with medication and cosmetics suitable for acne-prone oily skin. In any acne you will have to use a topical treatment, it is actually the basis of any anti-acne treatment. In mild cases topical treatment will suffice, but in moderate and severe cases we will probably need to associate it with another therapy, explains the dermatologist in Shastri Nagar.

Oral antibiotics

Certain antibiotics, such as tetracyclines, are used for the treatment of acne due to their anti-inflammatory effect. They are therefore effective in cases of inflammatory acne, where red pimples predominate more than black points. Its main drawbacks : they are not usually effective enough in more severe acnes, when the treatment ends, acne may reappear, they cannot be used during pregnancy or children under 8 years of age, they can make the stomach feel bad and you have to protect yourself well from the sun because they are phototoxic, says the skin specialist in Shastri Nagar.

Antiandrogenic therapies

Women are sometimes recommended to use antiandrogenic therapies (oral contraceptives, spironolactone, metformin) especially if acne is linked to other problems, such as irregular menstruation, alopecia or hirsutism (appearance of exaggerated hair on the face, alba line, mammary areola ...). Although, although it is true that, the most modern contraceptives give much less side effects than the old ones, we should always take into account the thrombotic risk, which is the most relevant, states the skin specialist in Vishnu Garden.

Isotretinoin (Roactutan®)

The isotretinoin is, in many cases, the most effective drug for treating acne. Despite its potential side effects, the dermatologist in Vishnu Garden consider that, with adequate control tests, it is a very safe drug. We cannot use it in pregnant women or those who want to get pregnant soon and drinking alcohol is not recommended during therapy.