Vitiligo is a disease that affects all systems, but because it is only seen on the skin, all other causes and our ability to treat it are well hidden from us physicians for many years.
Its true face is now being revealed. In our recent studies, we have seen that focusing on the skin and giving localized treatments only for the skin does not cure the disease. It is now clear that the disease is strengthened and originated from other causes inside, that no matter what cream we use, which light therapy we give, we can treat these patients to a certain extent, and the disease either returns more rapidly or does not go away at all. It remains unanswered. Or we can get limited response in very few cases. We too are helpless.
General statements of the physicians we went to:
“Vitiligo is an incurable disease, you’ll get used to living with it anyway, look, it’s just a cosmetic disease on your skin”
Or This disease is neuropsychological Don’t disturb psychology, don’t stress, etc.
Yes, psychology is important because with stress, cortisol, adrenaline and many hormones that affect our immunity are secreted from our adrenal glands, which have an immunosuppressive effect, that is, suppresses our immunity.
However, in recent years, many studies conducted by medical authorities have shown that this is not the case, and that our immunity plays a fundamental role in this disease and it can be associated with many diseases.
E. Helen Kemp (Department of Dermatology, Royal Hallamshire Hospital, Sheffield, United Kingdom ) et al. The Autoimmunity in Vitiligo study is a very comprehensive study. proved to be dominant. (1)
DRB1*03, DRB1*04, DRB1*07 These alleles were found to be dominant in Turks by Taştan et al. Germans have a high A2 allele. In other words, genetic predisposition….(1)
In recent studies, many vitiligo-related antigen studies have been conducted and vitiligo-related antibodies have been detected. Melanogenic enzyme trozinaze, trozinaze related proteine2 vs…(1)
Lamin A antigen was found to be vitiligo-related antigen. (1)
All of these studies show that vitiligo is an immune disease. It develops with the triggering of our immunity. Stress can affect our immunity, but if we do not have genetic predispositions or vulnerabilities and our immunity is not weak, we will never have vitiligo. Or we can get rid of vitiligo if we fix them.
Why does our vitiligo sometimes remain sporadic for years? Why does the spike spread show? Let’s be careful, the periods when the increase spreads are the periods when the body is heavily traumatized in women, such as breastfeeding and breastfeeding. It occurs more frequently in men during periods such as military service, when immunity can deteriorate. Before that, it’s just quiet and well, and we may not even notice it. Our immunity is already weak that we have vitiligo, it gets weaker and the amount of vitiligo increases…
Immunotherapy in vitiligo is a form of treatment based on these principles. We understand this now. I would like to expand on the subject of genetic predisposition, because it has been somewhat misunderstood or misunderstood until now.
So having vitiligo in the family YES it’s a genetic predisposition, but one in 5 people have it, why don’t the other four people have vitiligo? I think they all have a genetic predisposition! I bet how?
Because family history of diabetes, HT, heart disease, allergy, asthma, bowel diseases, inflammatory rheumatism, psoriasis, eczema, goiter, thyroiditis and cancer are considered genetic predispositions because all of these impair immunity.
If you say that there is nothing in my family, you know it is incomplete or wrong, I say examine it better…. Uncles, aunts, ancestors are important.
By the way, 2.5-year-old babies also have vitiligo WHY? Of course, genetic cofactors that are heavier from both the mother and the father overlap in the child, but of course it is not psychological. These are completely immunocompromised children and need to be treated very well. Because they have a very long life ahead of them and they have faced many heavy life stresses throughout their lives and they have already started life with a 1-0 defeat. Protecting these children and the immunity of our society is actually one of our preventive medicine duties.
In summary; Vitiligo is completely an immune system disease. It progresses within the framework of genetic predispositions. Scientists devote years to proving them.
The essence of immunotherapy is to find and treat risk factors in immunity and genetics.
Response to treatment varies from person to person.
If the patient has other comorbidities, such as severe gluten intolerance, celiac disease, or Type 1 diabetes, the pigmentation rate changes depending on the response rate of the underlying severe disease such as Type 1 diabetes, severe intestinal colitis, inflammatory rheumatism, severe constipation, active hashimato. .
4 types of pigmentation response types can be seen.
All types of pigment response can be seen in the same patient.
Pigmen response usually starts at the same time in the whole body.
Interestingly, pigmentation develops more rapidly under immunotherapy in traumatic areas that have undergone the Koebner Phenomenon, such as areas of anticipated burns or severe herpes infection.
As it is known, normally the opposite is expected.
Response rate can start in 1 week and sometimes extend up to 5 months. Completion of the treatment depends on the complete recovery of immunity, which can take up to 2 years.
Early discontinuation of the treatment, not using the drugs effectively and in sufficient doses, not coming to the controls regularly, in short, patient non-compliance negatively affects the success of the treatment. So the treatment fails.
Patient compliance is one of the main factors determining the success of treatment. Other factors indicate the speed of recovery. No effects on healing types were observed.
What are these factors?
1- Severity of food intolerance in the patient: I mentioned the importance of detecting gluten sensitivity and lactose sensitivity in the patient and grading them in my previous article.
The relationship between celiac disease and vitiligo has not been demonstrated in many scientific studies. (2) However, we know today that the existence of different food sensitivities, and if there is lactose and gluten sensitivity, it is important to start a very careful diet program and follow it up.
This is the situation where patients have the most difficulty in treatment and come to the point where they stop treatment. Because nobody wants to diet. No one wants to leave their pastries for dessert. However, if we have embarked on this path, it is absolutely necessary to apply the nutrition perfectly and proceed under the supervision of a physician and/or dietitian until the recovery is completed.
With a half-baked diet, the result will be half-baked. Follow-up is therefore very important. At each control, the patient is made conscious by the healthcare team. It is trained.
Today, we know that there are 132 patients with vitiligo with food intolerance, and there are only 6 people with food intolerance. The rate of recovery is not the same in both. However, there is improvement.
2- Presence of latent diabetes or diabetes:
The presence of Type 1 diabetes and/or Type 2 DM disease together with vitiligo is another factor that slows down the rate of treatment.
Because in these patients, first of all, blood sugar must be regulated very well so that inflammation in the body can be controlled. The ideal blood glucose value in these patients, which may be valid for every patient, FASTING BLOOD SUGAR: 80mg/dl Postprandial blood glucose should not exceed 90-95mg/dl.
We want results so rigid that we can restore immunity. These blood sugar levels are valid for all our patients, and we try to achieve this ideal for diabetic patients.
Every situation in which blood sugar rises (dietary disruption, infection, etc.) affects the flow of treatment and our speed of recovery.
3- Presence of cancer:
We observe a slower recovery rate in vitiligo patients with cancer disease and/or previous cancer history. This is very normal because they are more immunocompromised cases. Even if it is late, a response is received in these cases.
4- Hashimoto’s thyroiditis and/or Graves’ disease or other thyroiditis
The presence of aggressive thyroid diseases in patients slows down our response rate, because it is necessary to intensify immunotherapy for this problem first so that we can achieve success in other treatments. However, the responses are excellent in all thyroiditis. Another advantage of thyroiditis is that we can control the immunotherapy responses by monitoring the autoantibody level, especially in those with hashimato and markers. In these patients, thyroid autoantibodies generally decrease and sometimes disappear.
5- High level of allergy
This is an indication of both intestinal flora disorders and an important indicator that food intolerance is at a very bad level in the blood. It is a good follow-up criterion. Therefore, it should be followed. Make sure it’s fixed.
6- Organ failures, Other endocrine (hormonal) disorders, Obesity, Metabolic syndrome, Psoriasis, Rheumatic diseases, Psychiatric diseases etc:
As it is known, vitiligo is not a skin disease alone. There must be other accompanying systemic disorders. It is essential to detect the presence of these disorders, to understand their severity and to apply their treatment. If these are not done, no results will be obtained.
If there is liver kidney failure and/or chronic hepatitis, internal measures should be taken for this. Immunotherapy cannot be applied to patients with advanced organ failure.
Those with chronic hepatitis and vitiligo have a chance to get rid of both hepatitis and vitiligo together. Vitiligo patients with hormonal disorders such as Cushing’s syndrome, acromegaly, etc. It is imperative that these diseases are primarily taken under control. Vitiligo patients with obese metabolic syndrome experience weight loss and improve their metabolism with immunotherapy. If this is not possible, our immunotherapeutic response will be slower.
Another comorbid disease that we see frequently in patients is psoriasis. This is also treated with immunotherapy. Although the relationship between psoriasis in the family and vitiligo has not been determined until now, the existence of this relationship became clear after the discovery of the intestinal flora test.
Psoriasis and vitiligo are common. The reason is the disorders in the gastrointestinal flora.
All types of inflammatory rheumatism; Although systemic lupus erythematosus and rheumatoid arthritis seem to be more prominent, rheumatism with a strong genetic background such as Ankylosing spondulitis is also seen together with vitiligo. In the presence of these, both the treatment of rheumatic disease and the treatment of vitiligo are carried out together. Very good results can be obtained from immunotherapy.
The presence and severity of psychiatric disorders are important as they impair the treatment compliance process. Conditions such as depression, panic attacks, sleep disorders, excessive excitement, anxiety disorder, and obsessions are the most common psychological problems in vitiligo patients. Monitoring their condition with immunotherapy is as important as monitoring the closure rate of the spots.
The patient’s peaceful sleep, recovery from anxiety, recovery from depression and reluctance, recovery from loss of libido, recovery from panic attacks can only be possible by repairing the damage in the body. At this stage, depending on the depth of their disease, a shoulder-to-shoulder follow-up with a psychiatrist accelerates and finalizes the response to immunotherapeutic treatment.
How can immunotherapy affect our psychology and sleep patterns?
Just as it has an effect on closing our spots, there are some basic reasons for these sensitivities in our psychology. Of course, I don’t mean major major depression, schizophrenia. Our thyroid gland and vitamin deficiencies, intestinal absorption disorders are the basis of problems such as simple panic attack anxiety disorder, insomnia and excitement. When these are repaired, we get rid of these diseases quickly and even if we experience the most severe life event, we will not develop vitiligo and similar diseases. Those who say that this disease is only due to stress should not forget that there are cases of vitiligo at the age of 2.5, even congenital cases.
CHILDREN VITILIGOLAR:
These babies do not have any psychological problems. In these babies, vitiligo develops in the first years with the combination of diabetes, hypertension, heart diseases, cancer, vitiligo, psoriasis, inflammatory rheumatic diseases, goiter histories, which are problems from both parents (because unilateral severe immunodeficiency anamnesis is not sufficient for vitiligo in the child). Their response to treatment depends on their compliance, but since they are naive stem cells, their response is fast. (as seen in the pictures www.ulkuduraksoy.com)
The Effect of Years on Vitiligo
According to generally known approaches, a vitiligo patient whose last 5-10 years is unresponsive to all treatments. Cells are destroyed or killed by autoimmune attack or direct apoptosis. Destroyed cells will never be replaced by new ones
Vitiligo treatment with immunotherapy has succeeded in destroying this understanding, foresight and belief. (as seen in the pictures)
They managed to become pigmented within 1 month with immunotherapy, including cases of 44-45 years. As well as other metabolic problems began to be treated. Here, too, patient compliance is a very important factor.
In summary; Immunotherapy treatment is promising in the treatment of vitiligo patients. Patient compliance and clinical close follow-up are very important.
All underlying genetic, metabolic and hormonal problems of the patient must be determined and treated.
References:
1- Autoimmunity in Vitiligo (review)
E. Helen Kemp1, Sherif Emhemad1, David J. Gawkrodger2 and Anthony P. Weetman1
1Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield, 2Department of Dermatology, Royal Hallamshire Hospital, Sheffield, United Kingdom
