Vitiligo

Vitiligo has been, until recently, a rather neglected area in dermatology and medicine. Patients complain about this situation, which has offered avenues to quacks, and has led to the near orphan status of the disease. The apparently, simple and poorly symptomatic presentation of the disease has been a strong disadvantage to its study, as compared to other common chronic skin disorders such as psoriasis and atopic dermatitis. Vitiligo is still considered by doctors as a non disease, a simple aesthetic problem. A good skin-based angle of attack is also lacking because generalized vi- ligo is clearly epitomizing the view of skin diseases as simple targets of a systemic unknown dysregulation (diathesis), re? ecting the Hippocratic doctrine. This view has mostly restricted vitiligo to the manifestation of an auto-immune diathesis in the past 30 years. Thus, skin events, which are easily detected using skin biospies in most other situations, have not been precisely recorded, with the argument that a clinical diagnosis was suf? cient for the management (or most commonly absence of mana- ment) of the patient. This book is an international effort to summarize the information gathered about this disorder at the clinical, pathophysiological and therapeutic levels. Its primary aim is to bridge current knowledge at the clinical and investigative level, to point to the many unsolved issues, and to delineate future priorities for research. Front Matter....Pages i-xvii Front Matter....Pages 1-1 Historical Aspects....Pages 3-9 Evaluation, Assessment and Scoring....Pages 127-134 Quality of Life....Pages 135-137 Natural History and Prognosis....Pages 139-142 Defining the Disease: Editor's Synthesis....Pages 143-146 Epidemiology, Definitions and Classification....Pages 13-24 Histopathology....Pages 25-32 Generalized Vitiligo....Pages 35-39 Segmental Vitiligo....Pages 41-49 Vitiligo Universalis....Pages 51-56 Mucosal Vitiligo....Pages 57-59 Halo Nevi and Vitiligo....Pages 61-64 Hair Involvement in Vitiligo....Pages 65-71 Non-Skin Melanocytes in Vitiligo....Pages 73-78 Autoimmune/Inflammatory and Other Diseases Associated with Vitiligo....Pages 79-90 Vitiligo and Immunodeficiencies....Pages 91-97 Inflammatory Vitiligo....Pages 99-105 Rare Inherited Diseases and Vitiligo....Pages 107-115 Vitiligo in Childhood....Pages 117-122 Late-Onset Vitiligo....Pages 123-125 Front Matter....Pages 148-148 Pathophysiology Overview....Pages 149-152 Editor’s Synthesis....Pages 311-315 Genetics....Pages 155-163 Environmental Factors....Pages 166-180 In Vivo Data....Pages 182-203 Animal Models....Pages 205-218 In Vitro Approaches....Pages 219-230 Oxidative Stress....Pages 231-237 Immune/Inflammatory Aspects....Pages 239-267 Cytokines and Growth Factors....Pages 269-282 Proopiomelanocortin and Related Hormones....Pages 283-290 Other Hypotheses....Pages 291-293 Particular Clinical Characteristics of Segmental Vitiligo....Pages 296-298 The Concept of Mosaicism Applied to SV....Pages 298-302 The Neurogenic Hypothesis in Segmental Vitiligo....Pages 302-305 Segmental Vitiligo: A Model for Understanding the Recapitulation of Repigmentation....Pages 306-310 Front Matter....Pages 318-318 Management Overview....Pages 319-323 Topical Corticosteroids....Pages 327-330 Calcineurin Inhibitors....Pages 331-338 Vitamin D Analogues....Pages 339-342 Front Matter....Pages 318-318 Vitamins and Antioxidants: Topical and Systemic....Pages 369-374 Empirical, Traditional, and Alternative Treatments....Pages 387-391 Combined Therapies for Vitiligo....Pages 417-421 Camouflage....Pages 423-429 Photoprotection Issues....Pages 431-437 Depigmenting Agents....Pages 439-442 Therapy Adapted for Age, Gender, and Specific Locations....Pages 443-446 Psychological Interventions....Pages 447-449 The Patient Perspective....Pages 451-459 Evidence-Based Medicine Perspective....Pages 461-469 Editor's Synthesis and Perspectives....Pages 471-473 PUVA and Related Treatments....Pages 345-352 UVB Total Body and Targeted Phototherapies....Pages 353-368 Corticosteroid Minipulses....Pages 377-379 Other Immunosuppressive Regimen....Pages 381-385 Background and Techniques....Pages 395-407 The Outcomes: Lessons About Surgical Therapy for Vitiligo in the Past Two Decades....Pages 409-415 Back Matter....Pages 475-483 Vitiligo is one of the most common cutaneous disorders. Great numbers of affected patients suffer from the high stigmatizing impact of this disease. Up to now, clinical guidelines for the treatment of vitiligo were non-existent. In order to fill this void, this textbook defines and gives a complete overview of the disease, both regarding the classification of differential diagnosis as well as the treatment. Written by the most authoritative experts in the field, all therapy recommendations are based on new evidence-based guidelines. It includes case studies with illustrations before and after the treatment in order to demonstrate the treatment success. This textbook will be a valuable resource for all physicians who are seeing patients with this disease. Springer,2010,ISBN 978-3-540-69360-4,Compiled by MP@GP