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Leukoderma: causes, symptoms, treatment
Medical expert of the article
Last reviewed: 23.04.2024
Leukoderma - like leukocytes, leukemia and plaster - the term of Greek etiology, and leukos means "white". Although, you will agree, if you do not know what is the essence of leukoderma, then the name of this skin disease (according to the consonance with blood cancer - leukemia) looks ominous.
Perhaps that is why dermatologists often use such names as hypopigmentation, hypochromia or hypomelanosis in cases with leukoderma .
In the color of the skin - pigmentation - involved four pigment, but the main role played by all of us known melanin. Its synthesis and accumulation occurs in special cells - melanocytes. The initial "material" of melanogenesis is the indispensable amino acid tyrosine. Tyrosine enters the body from the outside, but under the influence of pituitary hormones and the enzyme phenylalanine-4-hydroxylase can be formed from the muscle proteins of the amino acid L-phenylalanine present in proteins. When there is any failure in this complicated biochemical process, keratinocytes (the main cells of the epidermis) cease to receive melanin, and dyschromia occurs, a violation of cutaneous pigmentation. One of these disorders is a decrease in the amount of melanin or its complete absence in the skin - leukoderma.
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Causes of leukoderma
In spite of the fact that the biochemical mechanism of skin pigmentation disturbance - the disturbance of amino acid metabolism - is known to science, the causes of leukoderma remain unclear in many cases.
According to some experts, hypomelanosis is a secondary dyschromia. Others distinguish between hypochromia primary, secondary, and also acquired and congenital. And to date, the causes of this disease, most of them consider various dermatological inflammations, as well as disorders of the nervous or endocrine systems of the body. Some doctors, dermatologists, all the causes of leukoderma are divided into two groups. The first group includes all infections, and to the second - unknown causes ...
The primary form of hypomelanosis is chemical hypochromia and drug leukoderma. Chemical leukoderma, also called professional, is the diagnosis of those who are constantly in the process of production to deal with chemicals that have a negative effect on the skin. For example, hydroquinone and its derivatives can cause hypopigmentation, which are used in the production of rubber, plastics and dyes. And the cause of drug hypochromia is the effect of any medications.
Primary leukoderma is a common dermatological pathology, like vitiligo. The specialists are engaged in studying the exact causes of vitiligo until now, but for now two versions of the etiology of this form of hypochromia have been adopted: congenital (that is, genetic) and autoimmune.
Among the congenital forms of leukoderma, which manifests itself in childhood, and disappears in adults, is the achromatic incontinence of the pigment or Ito hypomelanosis. This pathology reveals itself as colorless spots of various shapes that are scattered throughout the body and form all kinds of "drawings" that have clear boundaries. To a fairly rare autosomal dominant forms of primary hypomelanosis also include incomplete albinism (piebaldism) and complete albinism, which people have to live with all their lives.
Secondary leukoderma is not an independent disease, but only one of the symptoms or consequences of another pathology. Here, for example, syphilitic leukoderma, which, as a rule, manifests itself six months after infection with this venereal disease, refers specifically to secondary hypochromia. And the loss of melanin pigment by skin rashes when the body is infected with a syphilis pathogen by pale treponema is a key sign of secondary syphilis.
A similar situation with leprosy leukoderma. Symptom lepra (leprosy) - pink and red spots with a "rim", which with the course of this infectious disease pale, and then lose color and atrophy. And pigmented leproids (spots on the skin) with tuberculoid leprosy since the beginning of the disease are much lighter than the rest of the skin.
Fortunately, the cause of secondary hypochromia in most cases is more prosaic. The discolored spots on the skin surface appear where there were various types of eruptions in people suffering from dermatological diseases such as keratomycosis (lichen scaly, colorful, pink), seborrhoeic eczema, trichophytosis, psoriasis, parapsoriasis, focal neurodermatitis, etc. That is, the loss of melanin in certain areas of the skin - the result of their primary lesions.
Typical symptoms of the so-called solar leukoderma, etiologically related to other skin diseases (most often with lichens), are manifested by depigmented spots that replace the various rashes caused by sunlight. By the way, many dermatologists are convinced that ultraviolet rays contribute to the regression of skin rashes, although discolored spots remain on the skin for a very long time, but they no longer worry patients with scaling and itching.
Symptoms of leukoderma
The main symptom of leukoderma is the appearance on the skin of discolored spots of various shapes, sizes, shades and localization. In some cases, the edges of melanin-deprived areas of the skin are framed by a more intensely colored "fringe".
Symptoms of syphilitic leukoderma include such varieties as lacy (net), marble and spotted. In the first case, small depigmented spots merge into a net that is located on the neck and is called "Venus's necklace". With marble syphilitic hypomelanosis, whitish spots do not have clear boundaries and, as it were, "spread out". A spotty syphilitic leukoderm is manifested in the form of a large number of practically identical in size light spots of round or oval shape against the background of a skin of a darker color. These spots can be both in the neck area and on the skin of other parts of the body.
Localization of symptoms of leprosy leukoderma - hips, lower back, buttocks, hands. This hypochromia behaves differently: it can remain for years without any changes, it can seize new areas of the body, or it can disappear by itself with the possibility of distant relapses.
The symptom of leukoderma in chronic systemic lupus erythematosus is inherent in the discoid form of this autoimmune disease. In the third stage of lupus dermatosis, white spots with characteristic cicatricial atrophy appear at the center of the rashes.
Leukoderma scleroderma (sclero-atrophic leuchen) is a secondary dyschromia and manifests itself in the form of small light spots localized mainly on the neck, shoulders and upper chest. Spots of white color can occur at the site of rashes and scratching with neurodermatitis (atopic dermatitis). And this, perhaps, is one of the few cases when, after the successful treatment of this neurogenic allergic skin disease, its normal color is restored - gradually and without any medication.
But the restoration of normal pigmentation of discolored areas of the skin with vitiligo - a rare case. With this hypomelanose, which does not cause any other symptoms, colorless areas of the skin have clearly defined boundaries, and the typical places of their localization are the upper part of the chest, the face, hands on the back, feet, elbows and knee joints. With the progression of the disease, the area of hypopigmentation increases, involving the pathological process of hair growing on the affected areas of the skin.
Among the symptoms of such a rare type of leukoderma, as piebaldism, that is, incomplete albinism - the presence on the parietal part of the head of a strand of completely white hair, whitish spots on the forehead, chest, in the knee and elbow joints, as well as dark spots in areas of discolored skin stomach, shoulders and forearms.
Probably everyone knows the external symptoms of albinism, which is closer to anomalies than to illnesses. But in addition to obvious signs, albinos have nystagmus (involuntary rhythmic movements of the eyeballs), photophobia, and functional impairment of one or both eyes (amblyopia) due to congenital underdevelopment of the optic nerve. According to scientists, the incidence of albinism in the world is about one person per 17 thousand. And most people with this congenital form of leukoderma are born in Africa - south of the Sahara desert.
Diagnosis of leukoderma
In the definition of dermatological pathology with syphilis or lupus the main thing is the diagnosis of these diseases. Diagnosis of leukoderma is based on a comprehensive examination of patients, which includes a thorough examination of the skin, a detailed biochemical blood test, dermatoscopy, differentiation of the clinical picture of the disease, the collection of anamnesis, including the next of kin. Also, the doctor must find out what medicines the person was taking, and the connection of his work with chemicals.
Examination of the skin at primary or secondary leukoderma allows the dermatologist to determine the nature of hypomelanosis and to reveal its etiology.
An auxiliary method in the diagnosis of leukoderma is luminescent diagnostics with the aid of the Wood lamp, which makes it possible to detect invisible lesions. However, according to the doctors themselves, luminescence diagnostics is only applicable when suspected of lichen, and it can not guarantee a correct diagnosis with hypochromia.
Treatment of leukoderma
In cases of solar leukoderma or drug-induced hypochromia, no treatment is performed, since the depigmentation of the skin on the damaged areas eventually passes.
Treatment of chemical leukoderma, as such, also does not exist, and the main thing here is to remove the provoking factor, that is, to stop contact with chemicals that caused pigmentation disorders.
Treatment of syphilitic hypochromia or leukoderma in lupus is associated with the overall treatment of the underlying disease with the help of appropriate medications.
Therapy of the secondary leukoderm is determined by a specific dermatological disease that causes hypochromia and is prescribed exclusively by the doctor - using various medications for internal and external use: glucocorticosteroid and furocoumarin preparations, synthetic substitutes for natural amino acids of tyrosine and phenylalanine, etc. The intake of vitamins of group B, A , C and PP. In the treatment of vitiligo, a special PUVA therapy is widely practiced : the application of photoactive drugs-psoralens to the skin with irradiation with soft long-wave ultraviolet rays. However, not all patients this method of treatment helps get rid of leukoderma.
Prophylaxis of leukoderma
Since tyrosine is necessary for the synthesis of melanin, it is recommended to eat foods that contain this amino acid for the prevention of leukoderma. Namely:
- cereals (especially millet, oatmeal, buckwheat);
- meat, liver, eggs;
- Milk and dairy products (butter, cheese);
- sea fish and seafood;
- vegetable oils;
- pumpkin, carrots, beets, tomatoes, radish, cauliflower, spinach;
- beans (beans, soy, lentils, chickpeas);
- raisins, dates, bananas, avocados, blueberries;
- walnuts, hazelnuts, peanuts, pistachios, almonds, sesame and flaxseed, pumpkin and sunflower seeds