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 Human skin color vary. Different races have different skin color. The same race in different shades of skin color is not the same individual, even the same individual, different parts of the skin there are differences.
---- These differences is Those factors determine it? Vitiligo Vitiligo Vitiligo Hospital
---- the color of the skin under normal conditions is mainly determined by two factors:
----( 1) the content of the skin pigment :
---- There are 4 kinds of biological skin pigment melanin is brown, red, oxygenated hemoglobin, deoxygenated hemoglobin blue and yellow carotene. carotene can not be synthesized by the body's own needs from the diet intake, referred to as exogenous pigment, and the remaining 3 synthesized by the body itself, said endogenous pigment.
---- were from outside to inside the skin epidermis, dermis and subcutaneous tissue (subcutaneous fat layer). The four kinds of biological pigments in different parts of the skin, melanin distributed in the epidermal keratinocytes, the carotenoids found in the stratum corneum and the subcutaneous fat layer, hemoglobin is distributed in the dermis. (Figure 1-1)
---- which melanin is the main determinant of skin color. melanocytes mainly depends on the amount of melanocytes in the strength of tyrosinase activity, tyrosinase activity is stronger, the synthesis of black the amount of the more factors.
----( 2) differences in skin anatomy:
---- mainly refers to the terms of the thickness of the skin. light in the skin of varying thickness and scattering, skin color to change. how much the number of skin blood vessels, the amount of blood flow, and whether there telangiectasia also affect skin color.
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2. melanin formation and how metabolism? it what function?
---- the surface of the skin by the two types of cells. One is the keratinocytes and keratinocytes, in its evolution to the skin cells can generally be divided for the four layers: basal layer, spinous cells layer, granular layer and stratum corneum (in the palm of your hand and paw, the stratum corneum and the granular layer there between the transparent layer); the other is the dendritic cell.
- - dendritic melanocytes is a cell. It embedded in the epidermal basal cells, with an average of every 10 cells in a basal melanocytes, it is a highly differentiated cell, the cytoplasm have special organelles called melanosomes. melanocyte melanin is synthesized in the body.
---- melanin is a polymer of biological pigments. The formation process is as follows: in the melanocytes in vivo, by tyrosinase acts on tyrosine to form dopa, dopa to form dopamine quinone dehydrogenase, and re-arranged in 5,6 - quinone indole, aggregated melanosomes in vivo with the combination of the structural proteins to form melanin protein that melanosomes.
---- distributed to the epidermal layers of melanin cells, is to determine the skin color of the main factors. melanocytes more undoubtedly to prevent ultraviolet damage to skin the main barrier. folate and also protect melanocytes important material from a similar decomposition of the light. In addition, melanin is a stable free radical, may participate in a number of redox reactions in the body.
3. The formation of melanin which factors affected?
---- In the process of melanin formation plays a crucial role of tyrosinase, which is a copper-bearing aerobic activity, who can affect the activity of tyrosinase factors affect the formation of melanin. which is more clear and important factors are the following:
---- (1) genetic factors: The most important factor.
---- (2) endocrine factors: a variety of endocrine factors can affect the formation of melanin.
---- (3) Neural factors: nerve impulses on the formation of melanin also have some impact. Some animals (such as certain fish, frogs, lizards, etc.) have been rapid changes in skin color confirmed with the neural control of the.
---- (4) mercapto factors: thiol biochemical reactions in the melanogenesis inhibitory factor is a.
---- (5) trace elements: trace elements in black metabolic factors play a major role in promoting enzymes, especially copper ions, the higher its content, the stronger the activity of tyrosinase, melanin synthesis of the more.
---- (6) amino acids and vitamins: Animal experiments show that tyrosine, tryptophan and lysine in the formation of melanin is required. pantothenic acid, folic acid, biotin, on the ammonia acid, also can participate in the formation of melanin. But note that vitamin C as a reducing agent, make color fades, and less.
---- (7) UV: Ultraviolet radiation in the glutathione content of the skin by reducing the activation of tyrosinase activity ultimately increase the formation of melanin.
4. melanocyte skin barriers What?
---- black skin disease is the prime obstacle to melanocytes and melanin quantity and quality differences, or function caused by skin disorders.
---- (1) Class hyperpigmentation (dark spots of): is hyperpigmentation of the skin contains more melanin. black pigmentation of the skin, as in the skin layers of different shades, it will cause visual differences, such as melasma.
---- (2) reduce pigment class (white of): The decrease of the skin pigment melanin contained less white color or more normal color is light (white light). skin was completely white, who often lack the melanocytes, or melanin metabolic process of a part of the defect, so that the black pigment melanin formation ability of cells affected, mostly hereditary diseases such as vitiligo and albinism.
---- Vitiligo and skin beauty is closely related, will patients with serious psychological burden and great mental pressure, and even affect people's normal life, work and study .
5. What causes vitiligo?
---- 1, .2 genetic factors, immune factors .3 .4 neuropsychiatric factors, self-destruction of melanocytes in trace elements and radical elements .5 change.
---- several aspects of the above scholars have put forward different theories, known as genetics, immune abnormalities theory, neurochemistry factor theory of self-destruction of the melanin theory, theory of trace elements and free radicals, etc. . but each theory can not fully explain vitiligo, but not mutually exclusive, it could be a combination of many factors.
6. vitiligo hereditary you?
---- Many studies have attention to a number of vitiligo have a family history and family aggregation, and gradually formed a vitiligo genetics, genetic factors can be said that the occurrence of vitiligo has a certain role.
7. How to treat vitiligo?
---- Vitiligo occurs in face and other exposed, the disease clearly marked, noticeable, especially in underdeveloped areas of science and culture often criticized by some people, and even discriminated against in society, coupled with vitiligo treatment difficult, once the risk of vitiligo patients will cause great mental pain, many patients end sleepless nights, depression, even suicidal thoughts. The recovery of the disease is detrimental. In addition, vitiligo is a chronic disease, treatment should be patient, should not have impatience, in fact, most patients through the correct treatment of the disease can be controlled, and with varying degrees of efficacy, is still very large chance of cure.
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8. Why should prompt treatment of vitiligo?
---- Vitiligo course of varying lengths, often in the exposure, trauma, acute illness or surgery, the rapid spread under severe stress. Progress can be slow or intermittent development can also be long-term stability remain unchanged, although now off to see the individual pigment patch small spontaneous regression of the patients, but more is to see a white tend to expand, increase, develop into a pan-hair, so that vitiligo is a chronic progressive disease, therefore, requires the discovery of vitiligo patients with vitiligo after timely treatment for early control of the disease.
9. Why should adhere to the treatment of vitiligo?
---- number of vitiligo patients, especially some course long, stable condition, skin lesions in patients with non-exposed parts of their spot in the winter since that will not stop the development of the treatment, in fact, this is their kind of illusion. in winter because of less exposure by the Yang Guan and normal skin color will be smeared out, and the white of the color reduction, improved easily mistaken for white; to the spring and early summer, the sun strong, the chance of receiving more sunlight, and with normal skin color deepened, and the white color difference also increased, in addition to dress less hot days, easy to make clothes sheltered spot originally exposed, which in turn is easily mistaken for exacerbations. Therefore, winter casual interruption of treatment approach is not hate appropriate. not only delay the recovery of damaged melanin cells, but also may cause the spot into a full-type, so the more the more white, increasing the difficulty of treatment. the correct approach is to treat not subject to seasonal factors, both seasons are a result of the acceptance treatment, and because of the perseverance, not free to terminate treatment or to abandon the treatment.
10, what is vitiligo? how its incidence?
---- Vitiligo is a common multiple of the acquired pigmented skin, showed local or generalized pigment loss. is generally believed that the disease was mainly due to the skin and hair follicles caused by melanin depigmentation.
---- but in recent years some studies have shown that vitiligo is not just skin depigmentation disease, other parts of the body such as eyes, ears pigment cells could change, combined with the existence of the disease changes in immunological abnormalities, indicating that vitiligo is a skin pigment-based violations, but also may invade the body systems other pigment cells disease.
---- Vitiligo is a common disease. it the world's incidence rate 0.5% m4%. in the pathogenesis of age, vitiligo can occur at any age, but young adults as much. 95% of patients recorded before the age of onset 40, age of onset account for about one 11m30 60% of the total number of patients.
11, clinical symptoms vitiligo what?
---- Vitiligo skin damage is occurring the day after tomorrow, the typical damage is scattered, the realm of white or clear patches. leukoplakia can was gray, white or milky white porcelain, of various shapes can be round, fan-shaped, line-shaped or irregular shaped, jagged edges from mild to quite clear, from a few millimeters to several centimeters in diameter or even tens of centimeters, the surface generally smooth, without shrinking or scaling and other changes.
---- When the initial issuance of hypopigmentation mostly pale white spots, one or a few pieces, pigment is not completely disappear, it is unclear demarcation with normal skin, and some when the disease began to decline as the point-like pigment spots.
---- expanding the progressive development of skin lesions can be integrated with each other, stable spot to stop development, resulting in complete depigmentation of the white pigment spots, and its borders become more clear, and white pigmentation often better edge. leukoplakia of the number of variable. the size of its distribution range, that is, can be a focal piece or a few small areas of skin lesions, but also extensive involvement of almost the whole body while the remaining part of the normal skin.
---- The disease of the skin in any part of the body occurs, but good hair susceptible to drying in the sun and the friction damage and other parts, especially the facial (eg, glabella, medial eyebrows, nose bridge and associated parts of the medial cheek, upper part of the preauricular and forehead hairline and the vermilion border) , neck, waist and abdomen (waist belt Department), President chest, sacral, forearm and hand side of the back stretch and so on. torso perineum will be involved. leukoplakia most symmetrical distribution. The disease usually no symptoms. lesions is limited spots of depigmentation, milky white, circular, elliptical or irregular in shape, white spot at the hair can also be white, white hair is often refractory to extensive signs. some cases, the onset can be mixed with the hair follicles of the points like pigment proliferation.
---- premature gray hair is considered a harbinger of occurrence of vitiligo.
12, how to diagnose vitiligo?
---- typical vitiligo is based on their clinical manifestations usually can be diagnosed, patients often symmetrical limbs occurred, back and facial depigmentation. If the simultaneous observation of the lips, buccal mucosa, palms and soles, and scalp depigmentation spots will further support the diagnosis.
---- Check filtration ultraviolet (Wood lamp examination) can be used as auxiliary diagnostic methods. for unilateral asymmetry in the diagnosis of segmental vitiligo usually more easily, the patient usually presents the face, trunk or limbs of the unilateral depigmentation spots, skin lesions the occurrence and development dominated by nerve segment. However, patients are often clinically mild hypopigmentation emerging spots that come to treatment, early diagnosis and treatment by doctors. this time is often difficult to diagnose, in addition to the early stages of vitiligo hypopigmentation often spots, other skin diseases can also occur so many of the performance, it requires careful differential diagnosis to rule out these diseases before making the diagnosis of vitiligo.
---- Even so there are some patients can not be confirmed, and this requires further observed the development of the disease, but if the lesion area appeared follicles, hair, white pigment loss, vitiligo is more likely to suggest. In addition, if a child appears gray hair, hair, often prompt-based disease (except adults) .
---- First Affiliated Hospital of Nanjing Medical University, one of Professor Zhu Wenyuan propose a clinical diagnostic points:
---- �� acquired depigmentation occurred hypopigmentation spots or patches.
--- - �� circumscribed lesions and irregular.
---- �� edge of pigment skin lesions better.
---- �� lesions seen within the hair follicle can be white or color around the mouth complex phenomenon. < br >---- �� Wood lamp white porcelain was white.
---- if the above five in the establishment of three diagnosed with vitiligo can, if two set up as vitiligo is suspected, should be further excluded Other white skin disease. but as a necessary condition for the first �� article.
13, how the course of vitiligo? affect the progression of the disease What are the factors?
---- the natural course of vitiligo is often slow, carried out. shortest number of weeks duration, the longest up to several decades. This may be associated with treatment of the age. in the disease process, may be due to exposure, trauma, acute illness or surgery, severe stress state spreading rapidly. individual cases, vitiligo rapid progress in a few days or weeks to form extensive bleaching, known as the outbreak of vitiligo. of the disease can be expanded integration of the original lesions, but also the emergence of new lesions. Some data show that about 70% of patients with vitiligo in the progression of the disease stage, that the majority of patients with active disease. On the other hand, the slow progress of vitiligo can be developed or intermittent, or long-term stability remain unchanged.
- --- Many factors can affect the development of the disease and prognosis of vitiligo, there are �� without family history. vitiligo occurrence and genetic factors, the genetic relationship between melanocytes are more susceptible due to destruction of leaving the disease tend to develop. �� lesion type. early onset of segmental vitiligo, the condition is relatively stubborn, often within two years after onset, the rapid development in the affected areas, tends to rest after, often to maintain life-long spot. a few cases can be static lesions after there development. segmental vitiligo affected skin, usually along the nerve segment development, and therefore, more predictable trends in its development. rather than segmental vitiligo can affect any part of the body, there is no specific trend, so good prediction. to hand as the primary site in patients with facial lesions prone to the development; after the back, hand or foot as the primary site were, to other parts of the development of vitiligo is easy; the primary site for the face, arm or leg who Vitiligo is not easy progress; ��, age, origin; ��, other factors. The disease developed rapidly in the general summer, and winter often slow down or stop the spread of development. In addition, emotional trauma, sun, cosmetics allergy, other diseases and pregnancy Dengjun may aggravate the disease.
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14. vitiligo and other body related diseases
----( 1) Alopecia areata: alopecia areata concurrent vitiligo is not uncommon. Some studies have shown that , vitiligo may be associated with alopecia totalis or in the scalp or beard hair of alopecia areata occurring at a single, the accompanying rate of 16%, mainly seen in the progress and the Pan onset of vitiligo, vitiligo patients in the early years of the family who has more gray hair. < br >---- (2) Psoriasis: psoriasis and vitiligo patients also occurred in the same clinical cases is not uncommon. concurrency and they are both autoimmune and genetic factors related to not unrelated.
---- (3) thyroid disease: information, vitiligo, thyroid disease, the incidence of 1.28% to 38%. For two concurrent mechanisms, most scholars believe that they share a common immunological basis of the genetic, can be reinforce each other.
---- (4) Diabetes: The incidence of vitiligo, diabetes mellitus% ~ 7.1%, mainly insulin-dependent diabetes mellitus, and vitiligo patients, islet cell antibody positive rate is higher than the general population , associated with diabetes often have vitiligo autoimmune disease susceptibility, or there is the phenomenon of familial aggregation of disease.
---- (5) Cancer: Malignant melanoma associated with vitiligo. In addition, vitiligo Concurrent squamous cell carcinoma, basal cell carcinoma and gastric cancer reported.
---- (6) Other: including Addison disease (Addison), pernicious anemia, bullous pemphigoid, scleroderma and atrophic lichen sclerosis, etc..
15. vitiligo any harm to the human body? the treatment of vitiligo to what end?
---- vitiligo patients generally will not cause any physical discomfort, not to endanger the life, it is mainly mental harm to the human body and can bring patients severe psychological stress and social problems, thus reducing the quality of life of patients.
---- Therefore, the physician, the treatment of vitiligo first To achieve the purpose is to enable patients to the disease has a more correct understanding.
---- Vitiligo is an easy to diagnose and difficult to treat skin diseases, its pathogenesis is unknown, so far, treatment is still relatively difficult to make a therapy at home and abroad there is no complete cure in all patients. physicians should recognize that patients with vitiligo do not have any impact on life, it will not infect others, to eliminate their fear of normal social activities, there is no need look around for ways to cure the so-called special effects, but rather according to their specific circumstances, a medical practitioner to develop their own viable treatment options, and actively cooperate with the physician adherence to treatment.
---- of treatment of this disease is generally more long, slow onset, a course of at least 2-3 months, the general courses required to adhere to treatment 2m3, so the patient should be fully aware of the difficulty of treating this disease.
---- aim is to pigment loss completely back to normal, white as possible is not obvious.
16. vitiligo, stability and progress of patients with lesions of
---- are under development or stability, can be divided into stable and advanced. In the advanced stage, off to the normal skin pigmentation development, and may appear with the form of reaction, pressure, friction, trauma, secondary vitiligo can be formed. In stable spot to stop development, state clearly that ring the edge of pigmentation, duration of chronic persistent. the right to determine the stability of vitiligo and advanced, for the clinical treatment of great significance.
17. Children What are the characteristics of treatment of vitiligo?
---- and about the same treatment in adults, its efficacy compared adults as well.
---- (a) of the children with vitiligo has the following characteristics:
---- 1, age of onset: the shortest in 3 days after birth, the average age at onset was 4.6-4.8 years; 2, girls more common; 3 to segmental more common, localized second; 4, 11.2% had a family history of -17.32%; 5, the eyes easily affected; 6, the incidence of halo nevi as high as 8.5%; 7, easy to cause injury after the reaction of the same shape; 8, gastrointestinal disorders significantly.
---- (b) the special treatment of children with vitiligo
---- not the routine treatment of children are: < br >---- 1, the system of oral corticosteroids, there will be system or local side effects; 2, the body light therapy is not appropriate for children under 12 years of age; local light therapy is not appropriate for children under 5 years of age; 3, transplant surgery, is difficult with children, not used.
---- can be used with:
---- 1, low in the efficiency of topical corticosteroids; 2, immune enhancer; 3, trace elements; 4, oral medicine, dose reduction half.
---- (c) is generally believed that the best treatment for child patients with vitiligo is a stable condition on time, which is the white area is no longer the situation continues to expand 3-6 months.
18. several common clinical classification
---- Vitiligo Vitiligo generally unified into two types, II, II:
---- (1) II: �� vulgaris. can be divided into limited, sporadic, pan-onset and limb off of 4. limitations are as single or clusters of white, sizes, restricted to a particular site; those for the scattered sporadic, multiple white patches, often symmetrical distribution; Pan-onset were more evolved from the sporadic, irregular white spots and more mutual integration into a large and involved more than 50% body surface area, sometimes only a small piece of residual islands of normal skin equipment; extremities of the initial issuance of those white spots on the body extremities, such as facial, hand, foot and other parts Zhi Zhi; �� section end type. white as a sheet or several along the broken section of a nerve to dominate the regional distribution of the skin, usually unilateral.
---- (2) Category II: 1. full of spots. white porcelain for pure white or white, there is no white pigment regeneration, vitiligo melanocytes disappear within the organization, the negative reaction of non-phenylalanine .2. is not complete leukoplakia. leukoplakia bleaching is not complete, white pigment visible point.
---- (3) Phase II: 1. Progress in period. leukoplakia increased gradually to the normal 2 original spot. stable. leukoplakia to stop development, state clear, white pigment to enhance the edge.
---- Four Mistakes treatment of vitiligo?
---- 1, becoming a sick, mistakenly believed earth, recipe, casually wiping drugs.
- - 2, find the speed, the hormone injections will be misled into believing that western medicine.
---- 3, skin grafting, a temporary solution, resulting in white spread.
---- 4, enhance the immune therapy, the use of muscle injection of a number of immunostimulants such as: thymosin, transfer factor, these pins serve water only enhance the immune effect on vitiligo is not relevant, would not achieve therapeutic effect.
---- Expert Tip: The above treatment refractory symptoms of this program are considered easy to relapse, to the majority of patients have adverse psychological pressure and severe economic burden on the patient missed the best timing of treatment.
---- white spot is not terrible, choose the right medication, to prevent recurrence is the key.
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