What you didn't know about vitiligo

White spots, butterflies, and PSEUDOCATALASE
Vitiligo is a chronic skin disease characterized by depigmented (white) skin areas on the body. The disease is common and affects 1-2 percent of the population globally. Statistically, there may be many more since most people do not seek medical care for pigment changes in their skin.

There are three different types of vitiligo:
  • Vitiligo vulgaris (generalized vitiligo) is the most common form of vitiligo. Vitiligo vulgaris is characterized by white spots appearing symmetrically on both body halves.
  • The second type, vitiligo segmentalis (segmental vitiligo), appears as spots only on one side of the body.
  • The third type is called vitiligo focalis. It is characterized by small patches located on one or a few parts of the body.

The researchers are conflicted about the reason vitiligo arises. Some argue that it is caused by autoimmunity, i.e. when your immune system attacks the pigment cells. Others claim that a high concentration of oxidative stress destroys pigment cells. Most likely, it is a combination of both. Patients with vitiligo (especially with vitiligo vulgaris) have antibodies against the pigment cells together with a high concentration of hydrogen peroxide which is an oxidative marker. What came first, the chicken or the egg? We do not know.

For a long time, the assumption was that the white spots did not contain any melanocytes (pigment cells), but now research has shown that melanocytes are still present in the white spots, only they have lost their ability to form pigments (1).

Because depigmentation can occur in visible skin areas, the disease can be socially stigmatizing and cause psychosocial concerns with, among other things, impaired well-being (2).

DIAGNOSIS
Diagnosing vitiligo is often an easy process. In light-skinned patients, however, a so-called skin lamp (Wood's lamp) may be needed to ensure that it is vitiligo. Professor Karin Schallreuter and a team of American and German researchers discovered that substances form in the white skin that emits fluorescence when illuminated with the lamp. These substances belong to the biopterins family and these are also what give some butterflies its fluorescent color (3).

ButterflyThe discovery of the ability for vitiligo to fluorescent was published in the prestigious journal Science in 1994 (3).

Vitiligo eyesA: Vitiligo on eyelids in visual light. B: The same eyelid under Wood's lamp gives a white fluorescent light (4).

TREATMENT OF VITILIGO
No uniform national guidelines for the treatment of vitiligo exist today. Most often, no further medical treatment is offered, but the focus is on patient information and information on disease progression.

However, some dermatologists prescribe cortisone or tacrolimus, a substance developed for treating atopic dermatitis, which you are instructed to apply to the affected areas. Evaluation takes place after 6 months. A few patients see some effect due to the immunomodulatory effect. A light treatment with UVB light is prescribed in some regional councils with varied effects.

WHAT TO AVOID IF YOU HAVE VITILIGO

  • Bathing in pool water containing chlorine - this can aggravate vitiligo.
  • Skincare containing the active ingredient Q10 (Inci: Ubiquinone). Studies show that applying creams with Q10 can aggravate vitiligo (5).
  • Stress – this is easier said than done, but it has been shown that vitiligo is greatly aggravated by mental stress.
  • Avoid getting injured. People with vitiligo are especially vulnerable to injuries and pressure on the skin, which often elicits a new white spot where the wound or scab was. This is a well-known phenomenon that is called the Köbner phenomenon.
  • Avoid tight clothing and tight shoes. Vitiligo often manifests itself around the waist, under the bra, and on the feet due to constant pressure on the skin. This can trigger pigment loss.
  • Avoid excessive amounts of green tea since this could have prooxidative effects and exacerbate vitiligo.
  • Avoid smoking. Smoking has often been shown to aggravate vitiligo, especially around the mouth. It is also difficult to treat vitiligo if the patient smokes since the repigmentation happens very slowly in these cases.

vitiligo

Interviews about vitiligo

Interview with Professor Karin Schallreuter Prof, MD
Professor Karin Schallreuter has studied vitiligo for the past 25 years and has been a working dermatologist and specialist at the Mayo Clinic, Minnesota. She is one of the founders of the Center for Skin Science at the University of Bradford as well as the founder of the Institute for Pigmentary Disorders in Greifswald, Germany. She has authored more than 170 scientific articles in experimental and clinical dermatology and has treated more than 6,000 patients with vitiligo. In this interview, she tells us more about the treatment she has developed. 

Interview with Murali - about Professor Schallreuter's treatment that has helped reduce his vitiligo.

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Interview with Skinome Project's founder Johanna Gillbro, about her experience with the PC-KUS treatment

I've had vitiligo since my childhood. I visited numerous dermatologists and tried everything from cortisone, tacrolimus and UVB treatment to transplantation of healthy pigmented skin cells to the affected areas. Nothing worked and the vitiligo actually got worse from all the treatments.

I studied in Uppsala to become a pharmacist and graduated in 2002. During my years at the university, I got in contact with the German dermatologist and skin scientist Karin Schallreuter who was a professor at the University of Bradford and an expert on vitiligo (see video clips). This contact gave me the opportunity to conduct doctoral studies in clinical and experimental dermatology with Schallreuter's team.

Based on the discovery of the "butterfly bioterins" in the vitiligo spots, Karin Schallreuter and her team developed a treatment to reduce oxidative stress in skin. When the treatment was used, the melanocytes faded and began producing pigments again. Today I use NB-UVB-activated pseudocatalase PC-KUS with a very good effect, my face and legs have gotten 90% repigmentation. The hands and feet, however, are still difficult areas to treat.

This treatment was developed by Professor Schallreuter in 1995 and has since helped thousands of patients at three different locations: Medical Clinic- The Dead Sea, Institute for Pigmentation Disorders by V. Greifswald, Germany and at the University of Bradford, England. In 2006, I defended my thesis on vitiligo and got a Doctor’s degree in experimental dermatology. Today I feel happy about my vitiligo and enjoy the white spots, even though several of them have now completely disappeared. If I had not have had them, I probably would not have had the motivation I have, nor have I experienced everything I have experienced or met all the amazing people and researchers that I have met over the years.

If you are interested, please read the scientific publications about the treatment here.

/Johanna Gillbro

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Do not buy Pseudocatalase online!

On this day, Karin Schallreuter has treated 6,000 patients with vitiligo with NB-activated pseudocatalase. Several years ago, a large pharmaceutical company bought the patent. A large clinical study was done. Unfortunately, the composition of the cream changed during the study and the results were not as expected. This is why psudocatalase is not commercialized today. Therefore, patients still need to go to the Institute for Pigmentary Disorders in Greifswald for treatment.

Several cosmetics companies sell creams online named pseudocatalse. Unfortunately, this is not the same composition as the original cream and therefore does not give any effect. 

Contact: Institute for Pigmentation Disorders e.V. vitiligo@biotechnikum.de

Tobin DJ, Swanson NN, Pittelkow MR, Peters EM, Schallreuter KU. Melanocytes are not absent in lesional skin of long duration vitiligo. J Pathol. 2000;191:407–16.

Krüger C, Schallreuter KU. Stigmatisation, avoidance behaviour and difficulties in coping are common among adult patients with vitiligo. Acta Derm Venereol. 2015;

Schallreuter KU, Wood JM, Pittelkow MR, Gütlich M, Lemke KR, Rödl W, et al. Regulation of melanin biosynthesis in the human epidermis by tetrahydrobiopterin. Science (80- ). 1994;

Lio PA. Little white spots: An approach to hypopigmented macules. Archives of Disease in Childhood: Education and Practice Edition. 2008.

Schallreuter KU. Q10-triggered facial vitiligo. Br J Dermatol. 2013;