vitiligo.pptx psychiatric patients have already

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1. Vitiligo M.K.WASANA PRASADI GROUP 9A NO.8

2. Introduction Vitiligo is the most common pigmentary disorder, with a reported prevalence of 0.1–4% worlwide  Vitiligo has been associated with multiple endocrine and immune conditions, such us diabetes, thyroid disease or pernicious anemia (Its etiology is still unknown, although multiple hypotheses have been considered. Three main pathogenesis mechanisms have been purposed: self-destruction, neural and autoimmune.  Nevertheless, vitiligo is nowadays widely considered as an autoimmune disorder. However, mechanism of melanocyte disappearance has never been clearly understood and cellular and humoral autoimmune phenomena as primary events remains still unproven .

3.   Subtype of vitiligo Frequency Non-segmental (97%) Vulgaris/Generalized 78.6% (n = 154)   Lip-tip/Achrofacial 11.7% (n = 23)   Focal 4.1% (n = 8)   Universal 2.5% (n = 5) Segmental Segmental 3.0% (n = 6) clinical subtypes of vitiligo in the sample

4. Laboratory Studies Although the diagnosis of vitiligo generally is made on the basis of clinical findings, biopsy is occasionally helpful for differentiating vitiligo from other hypopigmentary disorders. Because of the association with other autoimmune diseases and endocrinopathies, further testing may be necessary in patients with suggestive signs or symptoms to rule out an underlying condition. Vitiligo may be associated with thyroid disease, diabetes mellitus, pernicious anemia, Addison disease, and alopecia areata. Appropriate tests should be performed only in the presence of signs or symptoms of associated disease.   Laboratory work for vitiligo may include the following: Thyroid panel consisting of thyroid-stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4) levels Antinuclear antibody Antithyroid peroxidase antibody CBC count with differential

5. Blood Tests Roughly 15%–25% of vitiligo patients have at least one other autoimmune disease. 11  Your doctor may order  blood tests  to evaluate your overall health and specific areas of concern, such as your thyroid function. The specific blood tests may include a  complete blood count  (CBC) and an antinuclear antibody test ( ANA test ).

6. if doctors need more information before making a diagnosis, they may want to do a skin biopsy or blood tests to check for any underlying autoimmune disease or other skin conditions. Skin Biopsy A skin biopsy involves removing a small portion of the affected skin tissue to check whether there are pigment cells ( melanocytes ) in the skin. The skin sample will be evaluated under a microscope in the lab. If it shows that there are no pigment cells present, a diagnosis of vitiligo will likely be confirmed. Very rarely, a form of skin cancer called hypopigmented  cutaneous T-cell lymphoma  may cause white patches that look similar to vitiligo patches. The discoloration happens because of malfunctioning pigment cells. A skin biopsy can rule out this possibility.

7. L-17A and IL-17RA are found on vitiligo skin biopsies. Immunohistochemistry and immunofluorescence staining of IL-17A and IL- 17 receptor A on vitiligo skin biopsies. (A)&(B) In immunohistochemistry, IL-17A and IL-17RA showed strong staining on the upper dermis of leading edge vitiligo skin when compared to non-lesional/pigmented vitiligo skin. (C) Double immunofluorescence staining of IL-17A and IL-17RA, areas of orange shows receptor bound IL-17A molecules. 50–60% of IL-17RA positive cells are also IL-17A positive in leading edge vitiligo biopsies. In comparison, only 20–30% of IL-17RA positive cells are IL-17A positive in non-lesional and lesional skin. Bar = 100 mm, applies to 5A, B&C. doi:10.1371/journal.pone.0018907.g00

8. a high frequency of thyroid disease, diabetes, psoriasis, alopecia  areata  and  pernicious anemia  was found in our patientsThis finding may support an immunological basis for vitiligo. Several reports showing an increased frequency of organ-specific antibodies in vitiligo patients when compared with controls have been reported.  Although relationship between vitiligo and thyroid autoimmunity has already been studied, there still exists a debate about this association.  Consistent with literature, thyroid alterations were more frequently seen in our patients than in controls. However no significant difference was observed. Very few studies evaluating blood levels of folic acid and vitamin B12 in patients with vitiligo have been reported.  In this study, no differences in vitamin levels between patients and controls could be found. Relationship between basal glucose levels, thyroid function, vitamin B12 and folic acid and the severity of vitiligo (measured by BSA) was not significant in our study (p > 0.05). However, thyroid function screening has been recommended in vitiligo patients in recent studies

9. The pathophysiology of vitiligo is complex although recent research has discovered several markers which are linked to vitiligo and associated with disease activity. Besides providing insights into the driving mechanisms of vitiligo, these findings could reveal potential biomarkers. Activity markers can be used to monitor disease activity in clinical trials and may also be useful in daily practice. The aim of this systematic review was to document which factors have been associated with vitiligo activity in skin and blood. A second goal was to determine how well these factors are validated in terms of sensitivity and specificity as biomarkers to determine vitiligo activity. Both in skin (n=43) as in blood (n=66) an adequate number of studies fulfilled the predefined inclusion criteria.

10. These studies used diverse methods and investigated a broad range of plausible biomarkers. Unfortunately, sensitivity and specificity analyses were scarce. In skin, simple histopathology with or without supplemental CD4 and CD8 stainings can still be considered as the gold standard, although more recently chemokine (C-X-C motif) ligand (CXCL) 9 and NLRP1 have demonstrated a good and possibly even better association with progressive disease. Regarding circulating biomarkers, cytokines (IL-1β, IL-17, IFN-γ, TGF-β), autoantibodies, oxidative stress markers, immune cells (Tregs), soluble CDs (sCD25, sCD27) and chemokines (CXCL9, CXCL10) are still competing. However, the two latter may be preferable as both chemokines and soluble CDs are easy to measure and the available studies display promising results. A large multicenter study could make more definitive statements regarding their sensitivity and specificity.

11. aboratory findings No significant difference in thyroid hormones between patients and controls could be found thyroid alterations were more frequently seen among patients compared with controls ( Figs. 1  and  ​and2 2 ).

12. Differential Diagnosis Whenever there is more than one possible condition that could be causing your skin symptoms, your dermatologist will use the process of differential diagnosis to confirm the cause. Other skin pigment disorders include: Tinea versicolor :  This common fungal infection (pityriasis versicolor) is caused by an overgrowth of yeast that occurs naturally on the skin. A primary sign of tinea versicolor is distinct patches of discolored skin and sometimes mild itching. Albinism :  The main symptom of albinism is a lack of color in the hair, skin, or eyes. This genetic disorder happens because the body is unable to produce melanin (the pigment that gives your skin color). Albinism can affect the entire body, smaller patches of skin, and the hair and eyes. Hypopigmentation:  This condition is when the skin is lighter in color because there is a decreased amount of melanin. It can be prompted by past skin injuries, chemical exposure, infection, and sometimes  inflammatory skin conditions  like  psoriasis  or  eczema  (atopic dermatitis). Pityriasis alba:  This common, benign skin disorder typically affects children up to age 12. It's characterized by raised, round patches of lighter skin, usually seen on the face, though it can happen on other areas of the body.  Chemical leukoderma:  Exposure to certain heavy-duty chemicals can damage the skin and cause white or lightened patches.