I. What is vitiligo?

Vitiligo is a kind of local white plaque caused by acquired depigmentation of skin. So what is skin pigment? What about depigmentation? The so-called skin pigment is skin melanin. Skin melanin exists in melanocytes of skin and hair follicles. Melanin produced by melanocytes is converted into dopa by tyrosinase under the action of tyrosinase, and then it is produced through a series of complex biochemical processes. When there are obstacles in this process (such as the decrease of copper (cu++) or the increase of sulfhydryl (-SH) of tyrosinase in melanocytes), tyrosinase activity decreases or even disappears, and then melanin production decreases or disappears. This disease is usually called depigmentation in medicine, and the result of depigmentation is to make local skin look like white spots.

So why is this disease called vitiligo? It turns out that this disease was called vitiligo in ancient China, and it was named "vitiligo" because of its "no fixed place to live" and the characteristics of wind evil, which parts were popular and which parts were white.

Second, is vitiligo a chronic skin disease worldwide?

Yes, vitiligo is one of the three chronic diseases of skin diseases in the world. It harms not only the people of China, but also people all over the world. It is a common and frequently-occurring disease. All races and nations on the earth may get sick. The incidence rate of the world population is about 1-2%. If the world population is 5 billion and the incidence rate is 1%, then the number of patients will be as high as 50 million. More than120,000 people in China suffer from this disease, which is an amazing number! In addition, it is reported that the incidence rate continues to rise in various places.

Through the investigation of medical scientists, it is found that the incidence of yellow people, blacks and whites with darker skin color seems to be higher than that of people with lighter skin color. The incidence of vitiligo among Caucasians in the United States and France is below 1%, while it can reach 4% in southern India, 2% in Japan and about 1% in China. Some scholars believe that the reason for the difference in the incidence of ethnic groups is that once white spots appear, people with darker pigments are easier to identify than whites.

3. What is the cause of vitiligo?

The etiology of vitiligo is still unclear, which can be summarized into nine factors: genetic factors; Psycho-neurological factors; Chemical factors; Tyrosinase and copper ions are relatively lacking; Infection factors; Traumatic factors and so on. It can be seen that the pathogenic factors of vitiligo are various, but a considerable number of patients can not find any inducing factors. Our study found that vitiligo patients are related to microcirculation disturbance no matter where they occur. We study therapeutic drugs, focusing on improving microcirculation.

4. Is vitiligo related to mental factors?

The answer is yes. Spirit plays a vital role in people's health. Have you ever heard the allusion of "the shadow of a cup bow snake"? This allusion fully illustrates the influence of mental and neurological factors on people's mood and health.

"Cup bow and snake shadow" comes from the book of Jin. Le guangchuan Once, Leguang invited a guest to bring wine. He hung a bow on the wall. Due to the light, the shadow of the bow is reflected on the glass and swayed inside. At that time, a guest mistook the bow shadow in the glass for a snake. After drinking, Gongying disappeared. The guest thought he had swallowed the snake, so he went into shock and got sick, and he couldn't recover for a long time. Yue Guang told him that the "snake" in the cup is the projection of the bow hanging on the wall, and you didn't swallow any snakes. Hearing this, the guest's doubts disappeared and he recovered.

In medicine, the disease caused by "the shadow of a cup bow and snake" is called the role of mental factors, that is, people's emotions. People's emotions are varied, and Chinese medicine divides them into seven types: joy, anger, worry, thinking, sadness, fear and shock, which are referred to as "seven emotions" and are important factors causing diseases. Such as "happiness and sadness", "anger hurts the liver", "thinking hurts the spleen", "lung sadness" and "fear hurts the kidney".

Among thousands of cases of vitiligo diagnosed and treated by us, about 35% are caused by mental factors, some are mental stimulation, some are mental stress, and some are excessive depression.

Let's take a true story from real life.

1994, a woman in Henan brought her son to our department for treatment, but a beautiful young man had a white spot the size of a walnut on his face. We learned from the consultation that women live in rural areas, and their academic performance has always been among the best in order to let their sons jump out of the "agriculture" door and want them to go to college. However, fate can really play tricks on people. He failed in the college entrance examination in Sun Shan by only six points, so he failed to enter the university. From then on, he was sad and ill. One day, when he looked in the mirror, he suddenly found a white spot on his face, the size of millet. Later, it gradually expanded into what it is now. This is a typical case of vitiligo induced by mental factors.

So why do mental factors induce vitiligo?

We know that melanocytes originate from the neural crest of the embryo, and it has been found that there is a substance in the central nervous system (mainly the pineal gland) that can inhibit the formation of melanin-melatonin. Under normal circumstances, it is in dynamic balance with melanotropin (MSH) secreted by pituitary gland. When melatonin is excessive, it can inhibit the formation of melanin. Obviously, Myra Downing will increase when people's spirit is subjected to vicious stimulation, high emotional tension and excessive depression, which will lead to vitiligo.

At present, there are several views on neurogenic vitiligo caused by neurological factors:

1, ganglion segment theory. Clinically, we have also observed that many patients' skin lesions are distributed according to ganglion segments, that is, they occur one by one according to the direction of nerves, some along the corners of the mouth to the mandible, some from the corner of the eye to the mandible, and some from the mandible to the neck. A patient with transverse myelitis was observed to lose sensation below the waist, but white spots appeared on his face and upper body above the waist, indicating that white spots were closely related to local nerves.

2. Peripheral nerve theory. Some people have done experiments: melatonin acetylcholine, norepinephrine and epinephrine can whiten the pigment cells of amphibians and fish in vitro. Although this person suggested that the ability of melanocytes to produce melanin decreased because of the increase of peripheral neurochemicals, which interfered with the activity of tyrosinase. Under normal circumstances, peripheral nerves are inhibited, so the skin pigment has not changed. The peripheral nerve endings of patients with vitiligo are active, which increases the release of melatonin and other substances, leading to the decline of melanocyte's ability to synthesize melanin, thus causing diseases. ]

3. Local neurology. Some people think that vitiligo is caused by local nerve injury and is directly caused by various local stimuli.

4. Mechanical stimulation theory. Vitiligo often occurs in the face and parts that are easy to rub (such as lumbosacral part, bra, belt, button, hernia support and other directly compressed parts), which may be related to the long-term mechanical stimulation of skin and nerve channels in these parts.

5. Plant Neurology. Many vitiligo patients are often accompanied by autonomic nervous dysfunction, such as abnormal sweating at white spots, alopecia areata and skin scratches.

5. Can vitiligo be inherited?

Vitiligo has a certain relationship with heredity. Father and daughter, mother and child, mother and daughter, twin brothers and sisters are sick, which is not uncommon in clinic.

According to domestic and foreign reports, about 3.9-4% patients have family history. It has been reported abroad that 18 of 96 patients had family history (QR Tone, 1976). Among 5230 cases reported by dermatology department of Linfen District Hospital (1978), 200 cases have family history, accounting for 4%. Among the patients we observed, 7.20% had family history, among which 55.4% had first-degree relatives, indicating that the disease was related to heredity.

This involves a serious problem: can vitiligo have children and carry on the family line? This is a problem that many patients and their relatives and friends are very concerned about, especially young men and women in adolescence. Because of people's prejudice and discrimination against vitiligo, many young patients have a heavy burden.

Although vitiligo has a certain relationship with heredity, and there are reports that monozygotic twins develop at the same time, suggesting that vitiligo may be caused by an autosomal dominant gene abnormality, from the perspective of cluster inheritance, heredity is only one factor of vitiligo. In addition, environmental factors, such as lifestyle, working and living environment, eating habits, mental state, etc. , also plays an important role. Generally, it is necessary to have both genetic factors and environmental factors to get sick. Therefore, even if there are genetic factors, as long as the influence of environmental factors is excluded, it will not necessarily happen. Moreover, genetic factors and environmental factors vary from person to person. From this point of view, the probability of vitiligo being passed on to the next generation is far less than other genetic diseases. So vitiligo patients can get married and have children.

It should be noted that patients with vitiligo should not find the same vitiligo object. If parents have a history of vitiligo, children should pay attention to the influence of environmental factors, the law of life, avoid sun exposure, avoid mental stimulation, and actively participate in physical exercise. If you find abnormal white spots on the skin, you should seek medical attention immediately to achieve early prevention, early treatment and early recovery.

6. Is vitiligo related to autoimmune function?

At present, the etiology of the disease tends to autoimmune theory. According to our research in recent years, the positive rate of autoantibodies in patients' serum is higher than that of normal people, mainly anti-thyroid antibodies, anti-gastric parietal cell antibodies and anti-nuclear antibodies. T cells in peripheral blood decreased significantly, and Langerhans cells in the epidermis of the skin lesions were increased significantly, with abnormal morphology.

Local skin injury plays an important role in the pathogenesis, 15.5% patients are homomorphic (white spot injury occurs in normal skin trauma); 1 1.9% patients have other autoimmune diseases, which is significantly higher than that of normal skin patients (3.6%). Fundus examination found that nearly half (48.65438 0%) patients were abnormal. This proves that vitiligo is closely related to autoimmune function.

7. Will vitiligo recur after being cured?

The recurrence rate of vitiligo after cure is about 15-35%, and it usually recurs within one year after cure. The recurrence site can also be at the primary site, close to the primary site, or far away from the primary lesion. Recurrent leukoplakia may be 1-2 or several, and the leukoplakia may be large or small.

Therefore, after vitiligo is cured, we must not treat it lightly and continue to treat it for a period of time. If it is cured for more than one year, it will not recur.

Eight, what is microcirculation? Is there a relationship between microcirculation and vitiligo?

1, the blood vessels of the human body are the pipes that transport blood. Like the same big river, they gradually branch, irrigate the surrounding land and nourish the tissues and cells around blood vessels. When the blood reaches the tiny arterioles through the big blood vessels, it flows through the widely distributed capillary network and then flows into the venules. Because the diameter of this part of the blood vessel is very small, it can't be seen by the naked eye, and it can only be seen under the microscope, so it is called microcirculation.

In recent years, some people put forward the concept of generalized microcirculation, which includes not only blood microcirculation, but also lymph and tissue fluid microcirculation. But microcirculation usually refers to the microcirculation that has been deeply studied.

The study of microcirculation began in the 1920s, but the formal definition and use of the word microcirculation was at 1954, the first American Microcirculation Conference. For more than half a century, five worldwide conferences on microcirculation have been held. At present, the study of microcirculation has been directly observed under the microscope, and has gone deep into the cellular and molecular level.

The basic function of microcirculation is to deliver oxygen and nutrients to tissues and take away metabolites. The tiny blood vessels in microcirculation have only one layer of endothelial cells, and the tubes are very thin, allowing small molecules to enter and exit freely. In addition, the capillaries are interwoven into a network, which has enough space and area for material exchange. In this way, the higher oxygen and nutrients in the blood will permeate from the capillaries and be sent to the surrounding tissues and cells; Carbon dioxide and other wastes produced by tissue and cell metabolism will be taken away by blood and excreted from the excretory organs of the body. Therefore, microcirculation plays an important role in human life activities.

2. Above we know about microcirculation, which is closely related to vitiligo. Clinically, we have observed through advanced means that there is microcirculation disturbance in the affected part of vitiligo, which prevents nutrients from being delivered to all parts of the skin, and melanocytes can not get nutrition normally, thus affecting their growth, development and metabolism. Over time, the loss of melanin makes the local skin discolored and white, resulting in vitiligo. The determination of trace elements in vitiligo patients will find that most patients do not lack trace elements, but only in local leukoplakia; The microcirculation measurement of leukoplakia also shows that the number of capillaries in vitiligo area is far less than that in normal skin area. This also proves from one side that vitiligo and microcirculation have some inevitable connection.

3. It is precisely because we have grasped the inevitable connection between microcirculation and vitiligo, started with improving and regulating microcirculation, combined TCM syndrome differentiation with modern medical syndrome differentiation theory, combined TCM traditional knowledge with modern pharmacology, selected natural and precious Chinese herbal medicines, and processed them with modern advanced preparation technology, and made the special internal medicine "Li Qiang Xiaobaisan" and external medicine "Vitiligo Tincture" for treating vitiligo, giving consideration to both internal and external factors, treating both the symptoms and root causes, and achieved high curative effect.

Nine, vitiligo on the face or exposed parts affects the appearance and is difficult to cure for a while. Is there any way to hide white spots?

In the long-term medical practice of treating vitiligo, someone has successfully developed a covering product-gold makeup beauty cream, which is specially designed for vitiligo patients. This product has no therapeutic effect on vitiligo, but only cosmetic effect. DHA, its main component, has artificial tanning effect and can combine with free radicals on amino acids of vitiligo surface protein. After polycondensation, protein melanin, which is deeper than leukoplakia and similar to normal skin color, is formed, which can cover the leukoplakia skin evenly and effectively cover the leukoplakia. If you stop moving, with the metabolism of the skin surface, the pigment in the affected area will fall off. Therefore, this product has no therapeutic and control effect on vitiligo, and it is only a "stopgap measure".

Generally, beauty cream is used twice every morning and evening, and the effect will appear in a few days. If it is used continuously for 2-3 months, it can achieve satisfactory covering and beauty effect.

X. What is melanin? How is it formed?

Melanin is widely found in human skin, mucosa, retina, pia mater, gallbladder and ovary. Melanin is synthesized by melanocytes. Skin melanocytes are mainly distributed in the basal layer of epidermis, but also in hair roots and outer hair sheaths. There are about 2 billion melanocytes in human epidermis, weighing about one gram, with an average of 65,438+0,560 melanocytes distributed symmetrically throughout the body.

Melanocytes can synthesize and secrete melanin, so they are gland cells. However, the biosynthesis of melanin is very complicated, which is formed by tyrosine-tyrosinase reaction in chromosomes (immature melanin).

XI。 What are the factors that affect melanin synthesis and metabolism?

In the process of melanin production, transfer and degradation, any obstacle in any link may affect its metabolism and lead to skin discoloration. According to our research, there are mainly the following situations:

1, tyrosine-tyrosinase reaction was disturbed. Take ascorbic acid (vitamin C) as an example, if ascorbic acid and dopa are added in this reaction.

2. The migration of melanosome from melanocytes to distant cells near the corner was blocked. Through our observation for many years, it is found that the skin color of human body is mainly due to the difference of melanocyte activity, but the skin color does not necessarily deepen with the increase of melanosome in melanocytes, but mainly depends on whether the process of melanosome migrating from melanocytes to adjacent keratinocytes is smooth. For example, the depigmentation after skin inflammation is due to the damage of epidermal cells, and melanosome can not be excreted smoothly through epidermal cells, resulting in the inhibition of melanosome in melanocytes and the decline of secondary melanocytes.

3. The formation and degradation of blackbody is slow. Clinical cyanogen abnormalities such as green nevus, Mongolian spot, Ota nevus and Eton nevus are all caused by the slow formation and degradation of melanosome in dermal melanocytes.

It should be understood that tyrosinase plays an extremely important role in the formation of melanosome and its melanogenesis, and the activity of tyrosinase is influenced by many factors, so it is necessary for patients to understand:

(1), ultraviolet. Under normal circumstances, ultraviolet rays can enhance the activity of tyrosinase in melanocytes, increase melanocytes, produce energetic melanosome and accelerate its movement.

2. Base. There is an organic compound in human epidermis-amino compound, especially glutathione, which inhibits tyrosinase activity by complexing copper ions. Someone measured the content of amino groups in skin, and found that the content of amino groups in damaged skin of vitiligo patients (157 mg molecular weight/100 g wet weight) was higher than that of normal people (1.55x0.0 1 mg molecular weight).

(3) Tryptophan pyrrolase. The increase of tryptophan pyrrolase activity will inhibit tyrosinase activity.

(4), copper ions. Tyrosinase is based on copper ion and its activity is closely related to copper ion. Studies have shown that the values of copper or ceruloplasmin in blood and skin of patients with vitiligo are lower than those of healthy controls. The reasons for the decrease of copper and ceruloplasmin may be related to nutritional disorders, copper metabolism disorders in vivo and genetic defects.

Twelve, why is vitiligo prone to occur after sun exposure?

We statistically analyzed 830 cases of vitiligo, and found that 95.54% of them were related to seasonal factors, especially in late spring and early summer, white spots or new white spots were more likely to appear. Among them, 6.8% people got sick after exposure. What is the reason?

We believe that, firstly, after sun exposure, melanocytes are overactive, and their tyrosinase and dopa oxidation intermediates are destroyed. Intermediates are an important protection mechanism. Once this protective mechanism is exhausted, melanin may be destroyed. Second, it is possible that melanocytes are damaged by excessive production or accumulation of intermediate substances of melanin that can be synthesized by the cells themselves, thus producing white spots.

Is vitiligo related to endocrine?

Vitiligo is closely related to endocrine. According to our statistical analysis of 2060 clinical data, 23.6% of them have endocrine factors. These include hyperthyroidism, diabetes, menstrual disorder in women of childbearing age, lobular hyperplasia of breast or fibroma of breast. ...

So what is the effect of endocrine on pigment metabolism? Experimental studies show that melanocyte stimulating hormone, adrenocorticotropic hormone and sex hormone can promote the anabolism of melanin, while corticosteroids, epinephrine and norepinephrine, thyroxine and melatonin can inhibit the anabolism of melanin. In order to make patients understand, we briefly introduce:

1, melanocyte stimulating hormone. Recent studies have shown that human melanin stimulating hormone may be secreted by cells secreting adrenocorticotropic hormone in the anterior pituitary. Melanocyte stimulating hormone is divided into two kinds: A and β. When patients receive a large number of melanocyte stimulating hormone treatments, local pigmentation will occur in a short time.

2, adrenocorticotropic hormone. Corticotropin is secreted by the anterior pituitary gland. Addison's disease-like pigmentation appears in many patients after clinical use of adrenocorticotropic hormone, and the color of the original pigmented nevus deepens, resulting in new pigmented nevus, which may be due to the fact that adrenocorticotropic hormone contains melanin stimulating hormone, and there are also reports that adrenocorticotropic hormone is used to treat vitiligo.

3, sex hormones. Sex hormones include male hormones and female hormones, and the representative of male hormones is testosterone, such as testosterone propionate; Female hormones such as flavonoids and estrogen. Sex hormones can deepen skin color, such as chloasma on pregnant women's faces, and blackening of nipples and areola, which is caused by the increase of female hormones in pregnant women. Another example is patients with liver disease with pigmentation on the skin and chloasma (also known as liver spot) on the face. This is because the function of inactivating hormone in patients with liver disease is reduced, which leads to the increase of estrogen concentration in the blood.

4. Corticosteroid hormones. Corticosteroid hormones: Prednisone, dexamethasone and cortisone are secreted by adrenal cortex, and their effects on melanin metabolism are mainly related to stimulating melanocytes. Under normal circumstances, the levels of melanin stimulating hormone and corticosteroids in blood are relatively balanced, and once they are out of balance, they will affect skin color. We found that leukoplakia expanded and increased in patients with vitiligo after taking cortisone to treat arthritis. From case analysis to animal experiments, skin experts speculate that the mechanism of corticosteroid whitening skin mainly lies in inhibiting the secretion of melanocyte-stimulating hormone by pituitary gland, but the direct effect on melanocytes is slight.

5. Epinephrine and norepinephrine. Adrenaline and norepinephrine are hormones secreted by adrenal medulla. They secrete very little in a quiet state. When cold, pain and emotional excitement make the body "nervous", the sympathetic nerve is excited and the secretion of adrenal medulla increases, so the two hormones increase. A small amount of adrenaline can not only inhibit the effect of melanocyte stimulation on melanocytes in frog skin in vitro.

6. Thyroxine. Thyroxine is secreted by the thyroid gland. Thyroxine and diiodothyroxine in thyroid preparations are inorganic iodide compounds, which can lighten the skin color, but have no effect on frog melanocytes. In addition, hyperthyroidism with vitiligo is not uncommon, and some patients with vitiligo will change after thyroidectomy.

7, melatonin. Melatonin is mainly secreted by the pineal gland. The secretory function of pineal gland is closely related to light, and long-term light can inhibit melatonin and secretion.

What is the relationship between immunity and vitiligo?

After years of research, it can be affirmed that vitiligo is closely related to abnormal immune function. The main performance is as follows:

1, humoral immunity changes. We measured the blood immunoglobulin of 104 patients with vitiligo, and found that the values of immunoglobulin A, G and M before treatment were significantly higher than those of the healthy control group. Complement (C3) and total complement (CH50) decreased in many patients. However, the determination of immune circulatory complex (C 1C) increased. In addition, many patients have positive serum antithyroid globulin antibodies and antithyroid granule antibodies. Some patients also have leukopenia, low hemoglobin and thrombocytopenia. We examined 22 cases of leukoplakia by direct fluorescence method, and found that 6 cases had immunoglobulin G deposition in the basement membrane.

In addition, we mentioned in the sixth question of this volume that the autoantibodies in the blood of vitiligo patients can be found to be higher than those of normal people, which is not discussed here.

2. Changes in cellular immunity. We used 65,438+0: 65,438+00,000 old tuberculin to skin test 400 patients with vitiligo, and 65,438+094 cases were negative. More than 180 patients received the test of intradermal injection of phytohemagglutinin. The results showed that the skin test reaction intensity of leukoplakia before treatment was significantly lower than that of normal skin color and normal skin color, and it was significantly enhanced after treatment. In addition, the lymphocyte transformation test and natural petal formation test of vitiligo patients are low.

15. What are the typical damage characteristics of vitiligo?

Vitiligo occurs in any part of the body. White spots mostly appear in exposed parts such as friction and sunlight; Especially the face (such as the brow, the inside of the eyebrows, the junction of the nose root and the inside of the cheek, the front and upper part of the ear, the edge of the forehead hairline and the red part of the lips), the neck, the waist (waist), the sacrococcygeal region, the extension surface of the forearm and the back of the finger.

Typical white spots are mostly fingernails to the size of coins, close to round and oval. Although it will expand or merge into irregular chunks in the future, no matter how its shape changes, the edge of the white spot is always visible, and there are island pigment spots in the white spot. Another typical white spot is strip or cord-like depigmentation along the nerve, and the edge of the white spot is neat as a knife.

Is vitiligo related to environmental pollution?

Vitiligo is related to environmental pollution. It is not difficult to see from a large number of our cases that the incidence rate in rural areas is lower than that in cities, and the incidence rate in industrially weak areas is lower than that in industrially developed areas, and vice versa. Known occupational diseases prove that exposure to certain alkylphenol compounds (such as p-tert-butylphenol, etc. ) can induce vitiligo. If more and more phenolic compounds are produced and applied in industry, the incidence of vitiligo will also increase. In addition, water, air, vegetables, food and other pollution will also lead to vitiligo away from life.

Therefore, environmental protection is very important. Our government attaches great importance to environmental protection. In recent years, it has done a lot of important things to control pollution and improved our living environment to some extent. We are also glad to see that many people consciously protect the environment and learn to protect themselves. It is believed that the probability of vitiligo caused by environmental pollution will gradually decrease.

Seventeen, why do people with dark skin easily get vitiligo?

We have already talked about this problem in the second lecture of this volume, and now we will discuss it further.

According to the survey data of vitiligo in the world, the incidence of vitiligo in dark-skinned people can be as high as 4% (such as India), while the incidence of vitiligo in light-skinned people is less than 1% (such as the United States and Britain), and there is a significant difference between them. The reason is not clear. However, it may be different from the synthetic mature melanosome (that is, stage ⅳ melanin) in the following aspects.

1, the black body of light-colored leathers is relatively light, small in size, oval in shape, clustered and distributed, and several melanosome are wrapped together; On the other hand, the melanosome color of dark-skinned species is dark brown, which is large and spherical, with a single distribution type, and also exists alone in melanosome.

2. When melanosome transferred from melanocytes to adjacent keratinocytes, melanosome of light-skinned species was mainly found in basal layer and spinous layer of epidermis, while melanosome was found in all layers of epidermis of dark-skinned species.

3. The process of melanosome degradation (melting and disappearing) in keratinocytes is also different. Most of melanosome in keratinocytes of light-skinned species is directly degraded by lysosomes in keratinocytes. Among black people, the melanosome of keratinocytes is mainly the latter degradation pathway, which not only spreads to all layers of epidermis, but also separates from epidermis with the exfoliation of cuticle, so this is the reason why people with dark skin have darker skin color.

4. Melanin synthesis and metabolism of dark skin species may be relatively strong. If an activating factor similar to ultraviolet rays is given, melanin synthesis and metabolism will be extremely vigorous, thus accelerating the consumption of melanocytes; Due to the vigorous metabolism of melanin, the excessive accumulation of intermediates can in turn kill melanocytes, thus hindering the synthesis and metabolism of melanocytes and causing decoloration lesions.

What is the relationship between halo nevus and vitiligo?

The clinical manifestations of halo nevus and vitiligo are white pigment loss, and the histopathological and ultrastructural changes are similar. It can often be seen that after the central nevus of halo nevus disappears, its halo expands, and then new cases of white spots are issued in other parts of the body. Therefore, we think that halo nevus is a type of vitiligo.

In addition, halo nevus and vitiligo can occur in the same patient at the same time, which means that halo nevus patients suffer from vitiligo at the same time, and vitiligo patients suffer from halo nevus at the same time, especially generalized vitiligo patients.

What is the relationship between vitiligo and visceral diseases?

Many medical diseases are related to the immune system and also belong to the category of visceral diseases. Vitiligo is related to autoimmune diseases, which are mentioned in lecture 6 and lecture 37 of this book. In addition, some patients with vitiligo are accompanied by gastric ulcer, duodenal ulcer, chronic gastritis, antritis, glomerulonephritis, hepatitis, hypertension, tuberculosis, diabetes ... So it is not clear what the relationship between vitiligo and these diseases is. However, from the perspective of accompanying diseases, gastrointestinal diseases are more common, especially peptic ulcer. Ulcer is related to mental factors, which is also one of the pathogenesis of vitiligo.

Do vitiligo patients need blood tests?

In recent years, our research has found that many patients with vitiligo are accompanied by anemia, leukopenia and thrombocytopenia, and various autoantibodies can be detected in the blood of many patients (mentioned in the sixth part of this volume). These situations tell us that it is necessary to do some blood tests before or during treatment, find out abnormal or potential internal lesions, find out the causes and treat the symptoms, which can improve the cure rate and is conducive to the rehabilitation of vitiligo.

Twenty-one, how to identify white spots on middle-aged and elderly people?

Clinically, we often see that some middle-aged and elderly people over 45 years old begin to have a fading spot without conscious symptoms, which is medically called senile leukoplakia. There is no difference in incidence between men and women.

White spots often appear on the trunk, limbs, especially thighs, but not on the face.

This kind of white spot has clear boundaries, mostly from needles to beans, and some of them can reach the nail plate, which is round or oval. The number can be several, dozens or even hundreds. The skin at the white spot is slightly sunken, with clear boundaries and no pigmentation. The disease is a senile degenerative phenomenon, which is caused by the decrease of the number of dopa-positive melanocytes in the skin. Therefore, white spots on middle-aged and elderly people are not necessarily vitiligo.

Twenty-two, how to distinguish sweat spots and vitiligo?

Sweat spot, also known as tinea versicolor, is a superficial fungal disease. Skin lesions are mainly pale white, round or oval, with blurred edges and many tiny scales on the surface, which are refractive. Fungi can be found directly by microscopic examination. Sebaceous glands are more common in diseased parts, such as neck, upper chest, back and upper limbs.

Need to remind everyone that children's cases can be seen on cheeks, foreheads and eyebrows. Because of frequent scrubbing, scales are not easy to attach to the surface, so they are easily confused with early vitiligo.

The skin pigment of vitiligo patients is white, with pigmentation on the edge and no scales on the surface. Hyperhidrosis is not aggravated. Of course, fungi cannot be found under a microscope. Knowing this knowledge helps to distinguish the two diseases.

23. Are sexually transmitted diseases related to vitiligo?

It is safe to say that sexually transmitted diseases have nothing to do with vitiligo. However, some people think that the depigmented white spots on the skin of syphilis patients seem to be vitiligo. This is a wrong understanding, because syphilis leukoplakia is the characteristic of secondary syphilis rash, which is characterized by multiple spots with reduced nail size and unclear boundary; Leukoplakia is confined to the neck and shoulder nail, and its decoloration degree is not as obvious as vitiligo, and its color tone is not bright. Combined with the history of unclean sexual intercourse and other syphilis symptoms, it can be differentiated from vitiligo.

Therefore, syphilis leukoplakia and vitiligo are not necessarily related, but two different diseases.

24. What is the difference between pityriasis simplex and vitiligo?

Pityriasis simplex, commonly known as insect spot, is a common skin disease in children and can also occur in young adults. Hypopigmentation is round or oval, with clear boundary, slightly higher edge, covered with a small amount of scales, mostly characterized by unconscious symptoms. The patches vary in size, with a diameter of about 1 cm, which is reddish in the early stage and turns pale white soon. At this time, if you don't pay attention to identification, it is easy to confuse vitiligo. However, the decolorization of insect spots is incomplete, the surface is rough, and sometimes scales are attached, which is helpful to distinguish from localized vitiligo.

25. What are the effects of transfer factor, thymosin and levamisole on vitiligo?

These immunodrugs can improve the cellular immunity of patients to varying degrees. Some patients with vitiligo have low cellular immune function due to immune mechanism, so it is beneficial to use these drugs (Chapter 29 of this book).