A Handbook of Vitiligo and Color Atlas SK Punshi
INDEX
Page numbers followed by t indicate tables; numbers followed by f indicate figures.
A
Aberration of
cellular immunity 10
vitamin D3 metabolism 10
Abnormal tryptophan metabolism 35
Achromia parasitica 75
Achromotrichia 5, 8
Acrofacial 7, 22
Addison's disease 14, 44
Advantage and disadvantage of various surgical grafting techniques 66t
Albinism 20
Alopecia areata 14, 33, 45
Alpha-dendritic cells 33
Amelanosis 2
Amino acid tyrosine 34
Ammi majus 4
Amyloidosis scleroviligenous 45
Anapsos 54
Antederma 45
Antimalarials 53
Antiovulatory agent 19
Apoptosis discussion of
definition 39
explanation 39
melanocytes 39
Arsenic 47
Ashtanga Hidaya (600 BC) 3
Atopic disorders 14
Aushooryan (2200 BC) 3
Autocytotoxic hypothesis 10
Autoimmune
diseases epidemiologically associated with vitiligo 14
mechanism 35, 36
polyendocrinopathy candidiasis ectodermal dystrophy syndrome 10
vitiligo 20
Autoimmunity 23
B
Basal cells of epidermis 33
Beta-mercaptoethylamine hydrochloride 47
Bimatoprost solution local application in nonfacial vitiligo 70
Bindi leukoderma 47
Biochemical theory of vitiligo 36
Biochromes present in skin 26
Biosynthesis of
melanin 31
protein 31
Broad spectrum antibiotics 48
C
Calcipotriol 54
Canities 44
Caucasian skin 32
Celiac disease 14
Central nervous system abnormalities 33
Challenge to dermatologists 78f
Charak Samhita 3
Chediak–Higashi syndrome 44
Chemical and synthetic 44
Chemical leukoderma 42
Chemically-induced leukoderma 46
course and prognosis 48
definition 46
modes 46
selected chemicals associated 47
treatment 47
Chemistry of melanogenesis 32
Chloroquine 47
Chloroquine and hydroxychloroquine 44
Cinnamic aldehyde 47
Classification of vitiligo
based on activity of the disorder 22t
depending on the activity of disease 22t
Clinical classification of vitiligo 21
generalized 21
localized 21
universal 21
Cockade-like vitiligo 5
Collagen vascular disorders 15, 33
Color of the skin 26
Common surgical treatment of vitiligo 65
Congenital vitiligo 20, 36
Contact vitiligo 20
Copper-binding agents 29
Corticosteroids and steroids use in vitiligo 56
Cosmetic and temporary camouflage 56
Cosmetic camouflage 57
Cosmetic disorder 13
Cyclosporin 64
D
Decapeptide 71
Deficiency of protein 35
Depigmentation 59
Depigmentation therapy 53
Dermatitis herpetiformis 15
Dermatomal distribution of segmental vitiligo 8t
Dermatomal vitiligo 20
Dermoepidermal junction 27
Destruction of melonocytes 15
Development of organelle 31
Diagnosis and differential diagnosis of vitiligo 41
Disorders and factors associated with vitiligo 33
Down syndrome and uveitis 15
Drugs and chemical exposure 23
Drugs for vitiligo
antioxidants in vitiligo 52
chloroquine 52
clofazimine 52
corticosteroids 52
cyclophosphamide 52
difur (anapsos) 52
herbominerals 52
khellin, bergapten 52
levodopa 52
mechlorethamine 52
miscellaneous drugs 54
new drugs 54
nialamide 52
phenylalanine 52
placental exacts 52
pseudocatalase 52
psoralens 51
systemic therapy 54
thiambutosine 52
topical fluorouracil 52
topical minoxidil 52
topical tar 52
E
Ebers Papyrus 3
Embryology 27
Emergence of few new hypotheses 38
Emerging treatment
reducing melanocyte stress 72
regulating autoimmunity 73
Endocrinal 44
Epidermal
basal lamina 27
keratinocytes 30
melanin unit 26, 30
Eumelanin biosynthesis along with spectrums 32f
Evolution of vitiligo lesion 6
Excess of tryptophan pyrrolase 35
F
Factors regulating melanogenesis—law of six 34
Familial aggregation of vitiligo 10
Fine structure of a melanocyte 28f
Fleeting vitiligo 20
Fluorouracil in vitiligo 59
Fluphenazine 47
Focal vitiligo 21
Function of melanocytes 28
G
Gauthier formulated 39
Genetic
predisposition 36
susceptibility 10
susceptibility in vitiligo 10
Gingko biloba 72
Glycolic acid 68
Golgi vesicle 31
Grafting techniques 65
Guanosine triphosphate 11
H
Hair follicles 27
Halo nevi 15
Halo nevus 44
Hepatic dysfunction 35
Histochemical observations on vitiliginous skin 33
Hormonal factors 28
Horner's syndrome 45
Human
leucocyte antigens 11
melanocyte 28f
skin color 32
Humoral and cellular immunity 37
Hydroquine and monobenzyl ether of hydroquinone 44
Hydroquinone 47
Hypomelanosis 2
Hypopituitarism 44
Hypothesis in the causation of vitiligo 35
Hypothetical melanoma destructive toxin 35
I
Idiopathic guttate hypomelanosis 42
Immune checkpoints 73
Immune deficiency virus 33
Immune hypothesis 37
Incidence of vitiligo in
India as seen in skin camps 18t
various countries 17t
Incontinentia pigmenti achromians 41
Infantile Fanconi's syndrome 44
Infections and toxic productions 23
Inflammatory vitiligo 29, 50
Inhibitors and melanin synthesis 29
Initial sites and progression rates of nonsegmental vitiligo 7
Intercellular adhesive molecule 1 30
Intermediate vesicle 31
Intralesional 52
Irradiation or solar exposure 62
Isoprinosine 54
J
Janus Kinase-signal transducer and activator of transcription signaling 73
K
Keratinocytes 28, 30, 49
Kilas 3
Koebner's phenomenon 7
Kumkum leukoderma 47
Kwashiorkor syndrome 44
L
Langerhans cells 36
Lepra 1
Leprotic leukoderma 43
Leptomeninges 27
Leukemia 14
Leukoderma 2
acquisitum centrifugum 20
types of
condom leukoderma 46
leukoderma medicamentosa 47
nylon leukoderma 46
occupation leukoderma 46
Leukotrichia 5
Leukotrichia-depigmented hair 8
Lichen planus 15
Lichen sclerosus et atrophicus 75
Lichen striatus 75
Linear vitiligo 20
Liver function tests 49
Liver stimulants 51
Local basic fibroblast growth factors in vitiligo 70
Local therapeutic measures 52, 59
Lower extremity 7
Lupus erythematosus lesions 42
M
Makatominoharai 3
Mala-absorption syndrome 44
Mammalian melanogenesis 32
Manu Smirti 3
Melanin pigments
classification of 26
pathway 26
pathway 27
Melanin synthesis and its control 32
Melanization of melanosome 28
Melanocyte 27
repopulation in vitiligo 65f
morphology 31
Melanocytic tyrosinase inactivity 35
Melanocytopenic leukoderma 20
Melanocytorrhagy 39
Melanogenesis 10, 28, 30
Melanopenic leukoderma 20
Melanosome 31, 32
production 34
Mephenesin carbamate 44
Mercurials 47
Metabolic toxin 35
Minigrafts 66
Mixed 7, 21
Molecular oxygen 34
Monobenzyl ether of hydroquinone 46, 47
Monozygotic twin pair 10
Monozygotic twins 10
Mucosal 7, 20
Mucous membranes 27
N
Nail abnormalities 33
NALP1 inflammasome 10
Negroid skin 32
Neural
hypothesis 38
mechanism 35
Neurocutaneous syndrome 41
Neuroendocrinal field 35
Neurogenic factors 36
Neuromelanocyte interface 38
Neurotoxin 35
Nevus depigmentosus 20
Nevus depigmentosus tuberous sclerosis 41
Newer knowledge 71
basic fibroblast factors 72
decapeptide 71
pseudocatalase 72
tacrolimus 72
topical prostaglandin 72
Non-dermatomal and dermatomal type of vitiligo 7
Nuclei of basal cells 33
Nutritional and metabolic defects 35
O
Object of therapy 52
Ocular vitiligo 36
Oculocutaneous albinism 43
Ointment 64
Oral antiovulatory agent 19
Oral phenylalanine 64
Origin of the word vitiligo 1
P
Para aminobenzoic acid 23, 63
Pentachrome 5
Perifollicular macules of repigmentation 60
Pernicious anemia 14, 30
Phenol or carbolic acid 68
Phenylketonuria 44
Pheomalanin granules 32
Phrynoderma, chronic protein deficiency 44
Physically attractive people 12
Piebaldism 43
Pigmentary dystrophy 2
Ping-yuan-hon-lun 4
Pityriasis alba 75
Pityriasis versicolor 42
Placenta extract mode of 58
Placental extract 57, 58
Poliopsis 2
Polyglandular dysfunction 14, 33
Polypodium leucotomos 64
Possible clinical causative factors in vitiligo 24
Posterior trunk 7
Post-inflammatory hypomelanosis 42
Premelanosome 31
Progressive vitiligo 20
Prostaglandins 28
Protozoal 45
Pseudo-albinos 5
Psoralea corylifolia 3
Psoralen and UVA 64
Psoralen lotions 68
Psoralens 51
Psoralia corylifolia 4
Psoriasis 15, 33
Psychologic trauma 13
Punshi's sign 5
Q
Quadrichrome 5
vitiligo 8
Quality of life 13
Queer and unpredictable vitiligo activity 22
Quiescent 20, 22
Quinoid substances 44
R
Reactive oxygen species 40
Recent knowledge 71
Recurrent vitiligo 20
Ribosome 31
Role of genetic predisposition 29
Role of vitamin C 23
S
Segmental vitiligo 8, 21, 48
Selective sunscreen 74
Self-destruct hypothesis 38
Self-destruction of melanocyte 35
Semecarpus anacardium 53, 54
Size of melanin granule 31
Skin disfigurement 13
Skin grafting for vitiligo 65
Skin scrappening 49
Social attitude towards skin appearance 12
Social counseling 13
Special presentation of vitiligo lesions 6
Split thickness grafts 66
Spontaneous repigmentation 48
Squamous epithelium 27
Stages in the development of melanin granules 31
Stimulating melanocyte regeneration 73
Suction blister grafts 65, 66
Sulfhydryls 47
Superficial thermal burns pressure 44
Symptoms and reactions 64
T
Tattoo pigments used in vitiligo 67
Tetradecanoylphorbal-31 acetale 64
Thyroid disorder 14
Thyroid function test 49
Thyroid-stimulating hormone 42
Tinea versicolor 45
Toxic theory 35
Toxicity 63
Trace elements
copper 28
iron 28
manganese 28
nickel 28
zinc 28
Tranquilizers in vitiligo 52
Transepidermal elimination 40
Transporter associated with antigen processing protein-1 10
Trichloroacetic acid 68
Trichrome vitiligo 20
Tyrocine 23
Tyrosinase 34
Tyrosinase biosynthesis 31
U
Ulcerative colitis 44
Ultraviolet radiation 28
Upper extremity 7
Urticaria 15
V
Veloce vitiligo 37
Vitamin B complex 51
Vitamin C 29
Vitiligo
acro-orificialis 20
behaviorism of 9
characteristics of vitiligo lesions 5
classification
Behl's classification 20
clinicopathological classification 20
Dutta ak feels inclined to suggest different subsets of 21
Elmofty's classification 20
etiological classification 20
etiopathological classification 20
histological classification 21
Koga's classification 21
Punshi's classification 20
clinical aspects of 5
clinical manifestations 8
clinical types 6
generalized 7
localized 6
universal 7
course of 7
definition of 1
diagnosis
dermatopathology 42
laboratory studies 42
segmental vitiligo 41
solitary vitiligo lesions 42
tuberous sclerosis 41
differential diagnosis of
achromia parasitica 44
leprosy 43
nevus anemicus or achromicus 43
phrynoderma 44
pityriasis alba 44
tinea versicolor 44
disfigurement 13
endocrine dysfunction 14
epidemiology 17
etiology of 23, 24
factors affecting progression of 8, 9
finding out and the assessment and measuring the severity of 12
genetics and familial inheritance prevalence 17
historical background 3
HIV infection 33
in children 75
differential diagnosis 75
treatment 75
corticosteroid 76
PUVA 76
therapy 75
incidence of 16
interaction of doctor and patient of 13
investigations for 49
electron microscopy 49
histology 49
immunocytochemistry 49
routine investigations 49
special investigations 49
pathogenesis 39
adaptive immunity 40
environment 40
genetics 40
innate immunity 40
oxidative stress 40
precipitating factors 28
process of treatment of 55
psychological counseling 13
psychosocial impacts of 12
repigmentation with anapsos 64
stage of 22t
sun protection measures 57
surgery 64
treatment of
alternatives 68
counter irritations 68
cyclophosphamide 69
dermabrasion in vitiligo 67
general consideration 55
general measure 51
laser therapy 67
levamisole 69
local chemical irritation 68
local photosensitizers in 68
medical 51
mini pulse therapy 69
options for ultraviolet-based therapy 64
oral treatment 62
photochemotherapy 60
placental extracts 68
psychology counseling 68
PUVA therapy 60
puvasol 62
rational and scientific approach 69
social aspects in vitiligo 68
specific instruction for local/topical treatment 63
surgical 64
tattooing in vitiligo 67
topical PUVA 59
vulgaris 20
with disorders of other systems 14
Vitilus 3
Vitix 54
Vogt-Koyanagi-Harada syndrome 37
Vulgaris 7, 21, 22
W
Washerman's nut lotion 68
Watkins 44
White spots 4
WNT signaling 74
Wood's lamp examination 49
X
Xenon-chlorine 67
Y
Yaws 45
Z
Zinc 23
Ziprkowski-margolis syndrome 41
Zosteriformis 20, 22
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Chapter Notes

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IntroductionCHAPTER 1

“Some diseases do not take life, but they just ruin it.”
—Stephen Rothman
 
DEFINITION OF VITILIGO
Vitiligo is a common pigmentary disorder of great sociomedical importance. It is defined as a circumscribed, acquired idiopathic, progressive, hypomelanosis of skin and hair, often familiar and characterized by total absence of melanocytes microscopically. This definition includes post-inflammatory, chemical-induced depigmentation, those associated with melanoma, secondary to various dermatoses and after-burns.
Vitiligo is a commonly acquired heritable melanocytopenic disorder characterized by progressive well-circumscribed, cutaneous, white macules, ocular abnormalities, autoantibodies, and a high incidence of, associated disorders, particularly thyroi-ditis, diabetes mellitus and premature leukotrichia. Of discussion, and is mainly based on clinical evidence. The cause of non-segmental vitiligo is still unknown. It seems to require following three factors: (1) a complex of vitiligo susceptibility genes that influence the autoimmune response; (2) genetically abnormal melanocytes; (3) an environmental or physiological factor(s) that activates the genetic program for melanocyte destruction. The current dogma is that there are several genes affecting the immune system and the pigment system that predisposes someone to develop vitiligo. However, a precipitating factor must elicit an interaction between the immune system and the melanocyte, resulting in the destruction of the melanocyte population in discrete areas of the skin. Regarding the segmental type, different pathogenic mechanisms have been proposed, mainly linked to mosaicism phenomenon.
Vitiligo is an acquired depigmenting disorder usually classified as non-segmental and segmental types with a higher incidence of segmental types. The definition of two forms is still a matter.
 
ORIGIN OF THE WORD VITILIGO
Vitiligo probably derived from Latin word Vitium (blemish) and the suffix-ego. Biblical references to leukoderma as leprosy date from the translations of the Hebrew word ‘Zora'at’ (Leviticus) as lepra.2
Just as the term lepra or leprosy was used casually to refer to a large cluster of cutaneous afflictions, the use of vitiligo has been used by some to refer to the leukodermas associated with melanoma, various dermatoses, senile graying of hair and chemically induced depigmentation.
Vitiligo refers to an idiopathic, acquired sometime familial, leukodermas characterized histologically by the absence of identifiable melanocytes and often by association with other abnormalities. The terms hypomelanosis, amelanosis and depigmentation are not synonymous.
Vitiligo was defined as a pigmentary dystrophy. Moreover, Louis Brocq (1856–1928) noted the lack of pigmentation (achromy) in vitiliginous lesions combined with an increase of pigmentation (hyperchromy) in the lesion's periphery which he called ‘dyschromy’ (Brocq 1892). Moritz Kaposi (1837–1902) was one of the first to describe the histopathalogical features of vitiligo.
  • Hypomelanosis—decrease in normal melanin pigmentation.
  • Amelanosis—total lack of melanin.
  • Depigmentation—loss of previously existing melanin.
  • Leukoderma is a generic name of skin relativity or absolutely lightened in color.
  • Poliopsis refers to a localized whitening of hair, whereas Lavities refers to a more generalized defect.