Vitiligo and Skincare Physicians Meetings September 15-16, 2016 Berlin, Germany

Vitiligo is a condition in which white patches develop on the skin. Any location on the body can be affected, and most people with vitiligo have white patches in many areas of the body. Vitiligo affects 1-2% of the American population, and it is estimated that 2 to 4 million Americans have the condition. In most cases, vitiligo develops early in life, between the ages of 10 and 30 years. Ninety-five percent of those affected will develop the disorder before age 40. Both men and women are equally likely to develop vitiligo. Those with a family history of vitiligo or premature graying of the hair are at increased risk for the development of vitiligo.

The body reacts in a variety of ways to autoimmune disorders, which cause a person’s immune system to attack its own tissues. An autoimmune disorder can affect a variety of organs, joints and muscles or other bodily tissues. One tissue that’s commonly affected by autoimmune disorders is the skin. Doctors usually treat vitiligo with ultraviolet (UV) light to stimulate skin depigmentation. vitiligo was “very highly associated” with a number of other autoimmune diseases, mostly thyroid disease, but also pernicious anaemia, rheumatoid arthritis, psoriasis, lupus, Addison’s disease, and adult onset autoimmune diabetes.

The precise cause of vitiligo is still unclear. Multiple theories have been proposed, including genetic, autoimmune, neural, and biochemical mechanisms. An immune mediated pathogenesis is indeed the most popular theory. The autoimmune hypothesis considers the role of toxic mediator that might cause an injury to the melanocytes with the release of an antigenic substance and subsequent autoimmunization. Histamine appears to play a significant role in the pathogenesis of a particular type of vitiligo characterized by faint hypo pigmented patches with significant itching.

Vitiligo is an acquired skin disorder caused by the disappearance of pigment cells from the epidermis that gives rise to well define white patches which are often symmetrically distributed. The lack of melanin pigment makes the lesional skin more sensitive to sunburn. Vitiligo can be cosmetically disfiguring and it is a stigmatizing condition, leading to serious psychologic problems in daily life. It occurs worldwide in about 0.5% of the population and it occurs as frequently in males as it does in females. The cause is involved genetic factors, autoimmunity, neurologic factors, toxic metabolites, and lack of melanocyte growth factors. Current modalities are directed towards stopping progression and to achieving depigmentation in order to repair the morphology and functional deficiencies of the depigmented skin areas.

 Camouflage is derived from the French word, ‘Camoufler’ which means ‘to blind’ or ‘veil’. Also known as protective concealment, it means to disguise an object in plain view, for the purpose of concealing it from something or someone. In mammals, the color of skin plays an important role in camouflage and prey-predator relationship. He BASC defined remedial cosmetic skin camouflage as being the ‘the art of concealing a discoloration, blemish or scar with the application of specialist camouflage creams that are matched to the surrounding skin tone.’

Stability may be lesion-specific in many patients. This area-based variable status of stability is neither related to the conventional refractory behaviour of vitiligo, typically seen in the so-called ‘resistant’ anatomical sites such as palms, soles, lips, nipples, areola, glans penis and bony prominences nor is it related to the type of vitiligo such as unilateral (segmental/focal) or bilateral (symmetric, vulgaris, or generalized). When the disease becomes refractory to conventional medicinal therapy, transplantation techniques are the only options left to replenish the lost melanocytes. Stability of vitiligo is considered as the most important parameter while opting for any transplantation technique to treat vitiligo.

Segmental vitiligo, a subtype of vitiligo, is characterized by its early onset, rapid stabilization and unilateral distribution. The reported prevalence of segmental vitiligo ranges from 3·5% to 20·5% of all patients with vitiligo. In generalized vitiligo there is accumulating evidence for an autoimmune response against melanocyte self-antigens. Associated autoimmune diseases in patients with segmental vitiligo and their family members are reported less frequently than in generalized vitiligo. An associated autoimmune disease was seen in 8% of all patients with unilateral isolated segmental vitiligo.

Non-segmental vitiligo is a depigmented skin disorder showing acquired, progressive, and depigmented lesions of the skin, mucosa, and hair. It is believed to be caused mainly by the autoimmune loss of melanocytes from the involved areas. This indicates the presence of genetically determined susceptibility to not only vitiligo but also to other autoimmune disorders. Nonsegmental vitiligo is acquired depigmented skin lesions mainly caused by autoimmune loss of melanocytes. Genetic and environmental factors are involved in the development.

Surgical procedures aim to replace the melanocytes with ones from a normally pigmented autologous donor site. Several melanocyte transplantation techniques can be performed under local anaesthesia in an outpatient facility.  Transplantation for extensive areas may require general anaesthesia. All methods require strict sterile conditions. Punch grafting (tissue graft) is the easiest and least expensive method, but it is not suitable for large lesions and seldom produces even depigmentation. Epidermal blister grafting gives excellent cosmetic results, but it is time-consuming, and large areas cannot be treated.

 Grafting procedures in vitiligo have become quite popular over the last one or two decades especially in India. Starting with the simplest punch grafting we have now a multitude of different grafting techniques available in vitiligo. All of these grafting procedures are associated with certain complications. In addition there are certain factors and surgical pearls that can go a long way in improving the cosmetic results achieved with any of these grafting techniques. Grafting techniques in vitiligo are divided into two main groups: Tissue grafting and cellular grafting procedures. Vitiligo is a common acquired disorder of skin pigmentation characterized by localized loss of skin pigment secondary to melanocyte damage.

 Vitiligo most often affects the face, elbows and knees, hands and feet, and genets. It affects both sides of the body equally. Vitiligo is more noticeable in darker-skinned people because of the contrast of white patches against dark skin. Skin may be moved (grafted) from normally pigmented areas and placed onto areas where there is pigment loss. Several cover-up makeups or skin dyes can mask vitiligo. When most of the body is affected, the remaining skin that still has pigment may be depigmented. It is important to remember that skin without pigment is at greater risk for sun damage. Be sure to apply a broad-spectrum (UVA and UVB), high-SPF sunscreen or sunblock and use appropriate safeguards against sun exposure.

Vitiligo is an acquired skin depigmentation occurring in approximately 1 percent of the population worldwide. It results from an autoimmune process directed against the melanocytes. The disease can be devastating psychologically; particularly in dark-skinned individuals. The pathogenesis is thought to involve an autoimmune process directed against melanocytes. Evidence of this is derived from histologic studies that have found an absence of melanocytes in the affected skin. An autoimmune process is also suggested by the concomitant occurrence of other autoimmune diseases in patients with vitiligo. 

Phototherapy is the study of the use of extracts of natural origin as medicines or health-promoting agents. Phototherapy medicines differ from plant-derived medicines in standard pharmacology. Where standard pharmacology isolates an active compound from a given plant, phototherapy aims to preserve the complexity of substances from a given plant with relatively less processing. Phototherapy is distinct from homeopathy and anthroposophy medicine, and avoids mixing plant and synthetic bioactive substances. Traditional phototherapy is a synonym for herbalism and regarded as alternative medicine by much of Western medicine.

Grafting procedures in vitiligo have become quite popular over the last one or two decades. Starting with the simplest punch grafting we have now a multitude of different grafting techniques available in vitiligo. The only possible treatment in such patients is a surgical replacement of the damaged melanocytes. These surgical techniques are collectively known as grafting procedures.  The different techniques of transferring skin tissue grafts as a whole to the involved recipient skin, the latter involves further separation of these skin grafts into cellular components. These cellular components are then applied on the derma braded recipient skin either as such or after growth and multiplication in culture media. 

Vitiligo is being tackled by multipronged attacks in the form of advancement in basic research, genetics and treatment including surgical management. Vitiligo Global Issues Consensus Conference (VGICC) recently revised the classification of the disease. Recent progress in genetics of generalized vitiligo provides insights into underlying pathogenic mechanisms and incrimination of vitiligo susceptibility genes that controls important aspects of immune regulation. Vitiligo is a T-cell mediated autoimmune disease. Heat shock protein 70 (HSP70) plays a central non redundant role in precipitating of depigmentation in vitiligo.Mosenson et al. in a very promising study recently showed that vitiligo can be reversed through immune targeting with mutant HSP70.

Dermatology is the branch of medicine dealing with the hair, nails, skin and its diseases. It is a specialty with both medical and surgical aspects. A dermatologist treats diseases, in the widest sense, and some cosmetic problems of the skin includes Acne is a long-term skin condition characterized by areas of blackheads, whiteheads, pimples, greasy skin, and possibly scarring. Skin cancer & malignancy of epithelial cells, Contact dermatitis, Kawasaki syndrome, Inflammation, scars & rashes, viral skin diseases. The global dermatology markets reached $15.8 billion in 2012. The market is expected to reach $16.1 billion in 2013 and $18.5 billion in 2018 for a CAGR of 2.8%. An overview of the global market for treatments of skin diseases, perhaps the most common of human afflictions.

This study presents the readers to most skin illnesses, and some common measures. However, as regards analysis, this study limits itself to preparation and therapeutic drugs for dermatological disorders. Cosmetic as well as aesthetic measures, aging conditions, and wound care. We were mainly interested in understanding the forthcoming market potential for the present and evolving technologies and products surrounded by the dermatological therapeutics industry. This report assesses the offered therapeutic methods for skin, along with the drugs and technologies presently being used for various skin treatments. The part of public agencies, the regulatory atmosphere, and non-governmental participants has also been detected.

Cosmetics, also known as make-up, are care substances used to enhance the appearance or odour of the human body. They are generally mixtures of chemical compounds, some being derived from natural sources (such as coconut oil) and some being synthetics. Cosmetic dermatology defined as that part of the practice of dermatology that highlights on looking good. While relating to skin - medicine as well as surgical focuses on the diagnosis, treatment, and prevention of skin disease. The Primary function of the Cosmetics is keeping up a beautiful appearance, changing the appearance, or correcting body odours. A cosmetic may clean, perfume, and guard. Acne is a long-term skin condition characterized by areas of blackheads, whiteheads, pimples, greasy skin, and probably scarring. The Dermatologists industry has increasingly expanded into cosmetic dermatology.

Skin care practices play an important role in the health of well new-borns and hospitalized neonates. Fortunately, for many aspects of neonatal skin care, there exist evidence- or consensus-based recommendations to guide best practices. Preserving the skin integrity of the neonate is important to maintain the function of the skin, protect against potential wounds and avoid skin disorders in the future. a competent epidermal barrier is necessary at the time of birth for maintaining fluid homeostasis in the extra uterine environment. The epidermal permeability barrier resides in the stratum cornea, the outermost layer of the skin. There, it is mediated by lamellar bilayers composed of hydrophobic lipids; principally fatty acids; cholesterol; and ceramides, located in extracellular spaces of multiple layers of tightly knit, anucleate corneocytes, which are girded with a protein-rich and keratin-rich cornified cell envelope.