Leucoderma: what is it, causes, symptoms, treatment,

What is Leukoderma?

Leucoderma - This is not an independent disease, but a characteristic symptom of several disorders, which are accompanied by a violation of skin pigmentation. The term leukoderma comes from two Greek words: leukos and derma (translated as white skin). It is used to indicate a violation of pigmentation, accompanied by a decrease in the level or complete disappearance melanin (coloring pigment) and the appearance on the skin of multiple white spots of various shapes and outlines. Sometimes dermatologists use the following terms to refer to such pathological changes: hypopigmentation, hypochromia, hypomelanosis, or leukopathy.

Leucoderma is observed with the same frequency in both men and women. The disorder can develop at any age, but more often the first signs appear in children under 12 years of age (sometimes already at the time of birth).

Such pigmentation disorders can appear suddenly and for no apparent reason on any part of the body. Sometimes their formation is provoked by various factors (for example, inflammatory skin diseases). In any case, such an unpleasant aesthetic skin defect always causes a person to feel awkward in front of others and a lot of inconvenience.

Causes and risk factors

Skin tone is determined by the level of melanin, which is synthesized in special skin cells called melanocytes. The starting material for the formation of this pigment is the amino acid tyrosine.

This substance enters the body with food, but under the influence of pineal gland hormones and an enzyme such as phenylalanine-4-hydroxylase can be synthesized from the amino acid L-phenylalanine found in muscle proteins fabrics.

If in this complex biochemical process, regulated by the endocrine and nervous systems, occurs any failure, then the skin cells stop accumulating melanin, and a violation of pigmentation occurs - dyschromia. One of the manifestations of such a violation is leukoderma.

There is no consensus among dermatologists in the classification of the causes of leukoderma. This is due to the fact that many of them have not yet been sufficiently studied, and research is ongoing.

Some dermatologists conditionally divide the causes of the development of leukoderma into two groups:

• unknown etiology;
• infections.

Most dermatologists identify the following main reasons for the appearance of leukoderma:

• inflammatory skin diseases;
• pathology of the nervous system;
• pathology endocrine system.

Leucoderma can accompany various infectious diseases (for example, syphilis, tuberculosis, leprosy (Hansen's disease), etc.) and becomes a consequence of skin lesions such as pityriasis versicolor, red flat, multicolored, white, scaly lichen, psoriasis, eczema, etc. Sometimes this pathology of pigmentation is inherited or caused by exposure to the body of toxic or medicinal substances.

Some experts believe that hypomelanosis is a secondary dyschromia of the skin. Others divide leukoderma into primary and secondary, congenital and acquired.

The most common types of leukoderma are:

• infectious (syphilitic leukoderma, leprosy leukoderma, leukoderma with white, red flat, multi-colored or scaly lichen) - develops in infectious diseases;
• post-inflammatory leukoderma - develops with burns and skin diseases accompanied by inflammatory processes (psoriasis, eczema, etc.);
• medicinal and professional (or toxic) leukoderma - develops as a result of exposure to the body of toxic substances (for example, at work) or certain medications;
• congenital leucoderma (10 forms of albinism, tuberous sclerosis, Bloch-Sulzberg melanoblastosis) - develops in congenital Ziprowski-Margolis syndromes, Wolfe's syndrome, Waardenburg's syndrome, pigment incontinence;
• immune leukoderma (vitiligo, Setton's nevus, systemic lupus erythematosus, scleroderma) - is caused by complex autoimmune reactions, during which the own immune system destroys melanocytes.

Special attention should be paid to the reasons for the development of such a disease, accompanied by the appearance of white spots on the skin, such as vitiligo. This pathology is observed in about 5 percent of people and can appear both from the moment of birth and at a more mature age.

Many dermatologists believe that complex autoimmune reactions are the cause of its development, but there is an assumption that the disease is congenital and is caused by a gene mutation. Scientists have not yet identified this carrier gene. The exact reasons for the development of vitiligo are still unknown, and this pathology is still referred to as immune leukoderma.

Signs and symptoms

The appearance of white (or discolored) patches, the main symptom of leukoderma, depends on the disease that caused them. They can be of various sizes, shapes, shades and are located on different parts of the body.

White patches may be flat or protruding from the surface of the skin. With age, their size can increase, they can merge with each other, forming areas of hypo- or depigmented skin.

The color of the spots can be completely white (see. photo above) or approaching pale pinkish and yellowish shades. In some diseases, the edges of hypopigmentation have a darker (sometimes red) border, and in In Setton's nevus, patches of pinkish or brown pigmentation appear on the skin, surrounded by a white border.

Most often, white spots appear on the upper and lower extremities, trunk, or in the groin folds and armpits. They are sometimes scattered throughout the body and can spread to the face.

The characteristic location of depigmentation sites is observed in syphilitic leukoderma. 3-6 months after infection, a "necklace of Venus" appears on the posterolateral part of the patient's neck (less often on the back, abdomen or lateral surface of the chest), which is an accumulation of white spots.

In some diseases, in addition to white spots, the patient has leukotrichia (congenital gray hair) or leukonychia (complete or partial discoloration of the nail plates or white spots on them), and with some forms albinism a very light color of the iris is observed: it can be light blue, very light and acquire reddish or pink shades in bright light.

A disease like tuberous sclerosis, accompanied not only by the appearance of areas of depigmentation, but also leads to the growth of tumors during many internal organs (heart, kidneys, brain, retina, etc.), the development of mental backwardness and epilepsy.

With albinism, patients often have pathologies of the organs of vision:

• nystagmus;
• a sharp decrease in visual acuity;
• photophobia.

In some diseases, white spots may disappear on their own or after treatment. These types of leukoderma include depigmentation that appears after inflammatory skin diseases, leprosy, burns, scleroderma or lichaev. And with other pathologies, white spots remain for life and can progress steadily.

Diagnostics

If white or light spots appear on the skin, consult a dermatologist. The doctor will carefully examine the skin, study the medical history and family history, find out what drugs the patient was taking and whether he had contact with certain chemicals. After that, the dermatologist will conduct differential diagnostics and prescribe additional laboratory and instrumental studies. If necessary, the patient will be assigned consultations of narrow-profile specialists: genetics, ophthalmologist, cardiologist, etc.

Which doctor should I go to?

If white spots appear on the skin, see a dermatologist. After a thorough examination, the doctor can refer the patient to other specialists: infectious disease specialist, neurologist, rheumatologist, oncologist, immunologist. This happens when leukoderma is just one of the symptoms of internal diseases. A cosmetologist and a plastic surgeon can assist in the treatment of external manifestations.

Standard treatments

The tactics of treatment for leukoderma depends on the cause that caused the underlying disorder and attracted to the pigmentation disorder. With some types of lichen (white and red flat) and post-inflammatory leukoderma, treatment is not prescribed, since the depigmentation areas are eliminated on their own. If the appearance of white spots was caused by toxic substances or drugs, then the patient is recommended to completely eliminate the provoking factor that caused their appearance.

With infectious or some types of immune leukoderma, therapy is aimed at treating the underlying disease. Congenital forms of pigmentation disorders and vitiligo are much more difficult to correct. The prognosis for the treatment of such forms of leukoderma is not very encouraging, since scientists and doctors have not yet been able to find effective ways to normalize pigmentation.

The tactics of therapy in such cases is determined individually for each patient. It can include:

• drugs for internal or external use: glucorticosteroids, furocoumarin drugs, synthetic analogues of phenylalanine and tyrosine amino acids, tranquilizers, digestive enzymes, etc .;
• vitamins A, B, E, C and PP;
• zinc preparations;
• copper preparations;
• PUVA therapy.

In some cases, to eliminate leukoderma, surgery is performed to transplant autologous melanocytes and transplant one's own skin or donor samples.

Patients with leukoderma are advised to include foods rich in tyrosine in their diet. These include:

• seafood and sea fish;
• meat;
• liver;
• dairy;
• eggs;
• vegetable oils;
• cereals (especially oats, millet, buckwheat);
• legumes;
• vegetables (carrots, beets, radishes, tomatoes, pumpkin, spinach, cauliflower);
• avocado;
• parsley;
• bananas;
• blueberries;
• raisin;
• nuts (almonds, peanuts, hazelnuts, pistachios);
• seeds (sesame, flax, sunflower, pumpkin).

The appearance of white spots on the skin is a reason for contacting a dermatologist. Their occurrence always signals a malfunction in the body.

There are many reasons for the development of leukoderma, and only an experienced dermatologist can establish the correct diagnosis. The tactics of treating diseases accompanied by skin depigmentation is always determined individually.