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Vitiligo [EN]

Our department has a long lasting clinical experience with vitiligo. Currently, vitiligo is a target disease within the Reference Center for Rare (and Orphan) Diseases of the Skin (CRMRP) of Bordeaux. This priority was deemed necessary because of the very  limited number of departments in France or abroad offering a comprehensive platform for clinical services and research in this field. Under the leadership of Dr Yvon Gauthier since the 1980s, our department has developed a comprehensive management approach, including surgical procedures and therapeutic education (camouflage techniques, prevention of the Koebner’s phenomenon).

Vitiligo is a dermatosis which is associated with a variable but sometimes considerable social and professional burden. The practice of the vitiligo clinic requires a good clinical judgement for making appropriate management choices considering also associated psychosocial difficulties. The initial consultation with a vitiligo patient needs enough time to listen to the patient's major complaints and to explain what is known on the disease and its management (around 40 minutes). This amount of time is necessary for a good understanding of the basics of treatment principles, and helps to reach a good compliance around well-defined objectives.

Our laboratory is situated within INSERM U1035 at University Bordeaux Segalen. We have developped a pigmented skin equivalent which serves as an in vitro model for vitiligo (Cario-André et al, 2007). Current research focuses on detachment of melanocytes and inflammatory pathomechanisms.


Some background about the disease.

Vitiligo is a depigmenting dermatological disease with an incidence estimated 0,5 to 1% of the general population without predominance of sex or race. This disease is generally acquired, i.e. not transmitted genetically, although a familial inherited risk is clearly identified. Various theories have been proposed immune, neural, toxic. Indeed a subset of  generalized vitiligo patients experience autoimmune or autoinflammatory diseases such as thyroiditis, pernicious anemia, Addison’s disease, alopecia areata… The progression of the disease is very variable, from localized mild forms to extensive forms in which depigmentation can involve the majority of the skin surface. Dermatologists use to distinguish segmental vitiligo and generalized or nonsegmental vitiligo. This distinction is important because counselling and treatment options are somewhat different.


Generalized  non-segmental vitiligo.

nonsegmental vitiligoGeneralized vitiligo is the most frequent presentation of the disease The extension of the disease is variable and “generalized” does not mean widespead. Lesions manifest as hypochromic patches, bilateral, sometimes symmetrical. The age and mode of onset is very variable. The extension is unforeseeable, thus an attack can remain localised during many years or extend more or less quickly to various areas of the body. The examination of the lesions using the  ultra-violet emitting lamp named Wood’s lamp is an invaluable tool for the assessment  of t he stage and evolution of the disease. Frictions are a factor of worsening now well-recognized. Prevention of  repeated skin trauma is thus important and must be well understood by  the patient.

The currently available treatments for this form of vitiligo have a variable effectiveness.  A most used approach is natural or artificial phototherapy.  It consists on the exposure of the lesions to gradually increasing amounts of natural ultra-violets or of UV  emitted by medical lamps cabins or devices. Exposure must be controlled and adapted according to the clinical response. Many other treatments exist with variable and generally poor medical validation., i.e. without controlled studies of good quality.  In this respect, the antioxidant and vitamin or trace elements treatments are very popular (incl B12 Vitamin, folic acid, manganese, magnesium, selenium). Narrow band ultra-violets B  can be administered as a targeted therapy directly to the lesions, tacrolimus ointment associated with phototherapy or occlusive foils are promising therapies. In some cases, a surgical treatment can be indicated but only when the disease is stabilized for at least 6 to 12 months in disfiguring areas  without too much extension (<50cm ²).


Segmental vitiligo.

segmental vitiligoSegmental vitiligo is a localised form of vitiligo developing usually  in the child or the young adult. The disease  involves only  a limited zone of the integument, which may follow the territory of a cutaneous sensory nerve. This distribution supports the neural theory advanced by some. Indeed, a history of trauma affecting the nerves in the territory in which the vitiligo appears secondarily may be found. However, other hypotheses have been suggested. Segmental vitiligo develops quickly in a few weeks or month, then remains stable without reaching other territories. Very often, the loss of pigment cells is complete and final explaining the failure of  usual medical treatments noted above for generalized vitiligo. On the other hand, this form is a good indication of surgical treatment when the aesthetic embarrassment is important (Taïeb et Gauthier, 2006). Treatments with Excimer or helium-neon lasers or lamps seem promising.


Treatment

Autologous grafts with epidermal suspensions
UV irradiation and vitiligo


Links

Our department is working in close association with the Association Française du Vitiligo and other patient’s support groups worldwide, which are partners of the special interest group on Vitiligo of the International Federation of Pigment Cell Societies (IFPCS). This group organizes international meetings during international pigment cell conferences (Washington 2005, Sapporo 2008, Bordeaux 2011) which confront the experiences of scientists, physicians and patients. The aim of these meetings is to stimulate research to help improving disease understanding and treatment. Reports can be found on the VETF website.

Vitiligo European Task Force (VETF)  
Association Française du Vitiligo (F)
Vitiligo Support International (USA)
The Vitiligo Society (UK)
Association des Pays Nordiques
Pigment Cell and Melanoma Research virtual issue on vitiligo (Blackwell)


Publications

Ezzedine K, Lim HW, Suzuki T, Katayama I, Hamzavi I, Lan CC, Goh BK, Anbar T, Silva de Castro C, Lee AY, Parsad D, van Geel N, Le Poole IC, Oiso N, Benzekri L, Spritz R, Gauthier Y, Hann SK, Picardo M, Taieb A ; on behalf of the Vitiligo Global Issue Consensus Conference panelists. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res. 2012 May;25(3):E1-E13.

Picardo, Mauro; Taïeb, Alain (Eds.) Vitiligo. 2010, XVIII, 486 p. 161 illus., 144 in color., Hardcover

Taïeb A, Picardo M. Clinical practice. Vitiligo.N Engl J Med. 2009 Jan 8;360(2):160-9.

Taieb A, Picardo M ; VETF Members. The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force. Pigment Cell Res. 2007 Feb;20(1):27-35.

 
 
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