How is vitiligo classified?

What are the clinical types of vitiligo? Many patients asked via email: How to treat vitiligo? Will your medication work for me? How long does it take to cure vitiligo? Questions like these are difficult to answer simply. In fact, due to the different causes, pathological mechanisms, white spot distribution, area size, and duration of the disease, vitiligo has different treatment methods, and the treatment effects are also very different. Clinical treatment requires a clear diagnosis first, and further distinguishes between different types. It serves as the basis for formulating treatment plans, selecting treatment methods and drugs. So, how is vitiligo clinically classified? So far, there is no unified classification standard at home and abroad. Domestic scholars currently mostly follow the classification method determined by the Pigment Disease Group of the National Society of Dermatology and Venereology of Integrated Traditional Chinese and Western Medicine in 1994, which divides vitiligo into type II, category II, and stage II. Types 1 and 2: (1) Ordinary type 1. Limitations: Single or clustered white spots, varying in size, limited to a certain part. 2. Sporadic: scattered and multiple white spots, often symmetrically distributed, with the total area of ??white spots not exceeding 50% of the body surface area. 3． Generalized: Mostly developed from the sporadic type, the white spots often merge into large irregular patches involving more than 50% of the body surface area, and sometimes only small islands of normal skin color remain. 4. Acral: vitiligo initially occurs on the extremities of the human body, such as the face, hands, feet, and other parts, and is mainly distributed in these parts. A few may be accompanied by generalized vitiligo on the body. Localized, sporadic, generalized, acral (2) Segmental type: one or several white spots, distributed along the skin area innervated by a certain cutaneous nerve segment, usually unilateral. 2. Category 2: (1) Complete vitiligo. The vitiligo is pure white or porcelain white. There is no pigment regeneration in the vitiligo. The melanocytes in the vitiligo tissue disappear and the reaction to dihydroxyphenylalanine (Dopa) is negative. (2) Incomplete vitiligo: The depigmentation of vitiligo is incomplete, pigment spots can be seen in the vitiligo, the number of melanocytes in the vitiligo tissue has been reduced, and the reaction to dihydroxyphenylalanine is positive. 3. Phase 2: (1) Progressive phase: The number of white spots increases, and the original white spots gradually migrate and expand toward normal skin, and the boundaries are blurred. (2) Stable period: The white spots have stopped developing and the boundaries are clear. The classification method of the pigment on the edge of the white spots is based on the possible causes of vitiligo, relevant (part) laboratory indicators, and comprehensive consideration of the clinical shape, distribution location and scope of the white spots, and treatment response. It is generally believed that the pathogenesis of vitiligo vulgaris is caused by the autoimmune mechanism, and the patient's disease activity can last for life, and the treatment is effective with immunomodulatory drugs. Segmental vitiligo may be related to local sympathetic nerve dysfunction. Vitiligo usually stops after one year of development and rarely recurs after cure. However, in terms of treatment, the response to various drug therapies such as corticosteroids and photochemotherapy is poor. We recommend that segmental cases be treated with autologous epidermal transplantation after their condition stabilizes. The therapeutic effect is quite reliable. Incomplete and incomplete white spots differ in the degree of pigmentation loss and the number of melanocytes destroyed, and the difficulty of treating the white spots is also different. Incomplete vitiligo, the degree of depigmentation is mild, and the melanocytes have not completely disappeared, so it is easier to treat, responds better to drug treatment, and has a greater chance of cure. On the contrary, complete vitiligo has a severe degree of depigmentation. , the melanocytes have completely disappeared, so treatment is more difficult, the response to drug treatment is poor, and the chance of cure is small. However, this type of white spots can still achieve the purpose of treatment through the proliferation of melanocytes in the normal skin around the white spots and migrating to the white spot area, or the proliferation of melanocytes in the hair follicles in the white spot area and migrating to the hair follicle opening and the skin around the hair follicle opening. If the white spot area is large and the melanocytes in the hair follicles have completely disappeared, treatment will be more difficult. But despite this, the purpose of cure can still be achieved through surgical treatment, such as melanocyte transplantation. As far as melanocyte transplantation is concerned, no matter it is complete or incomplete white spots, no matter whether the melanocytes in the hair follicles have completely disappeared. , regardless of the duration of vitiligo, the treatment effect is the same, there is no big difference.

In the advanced stage of vitiligo, the predisposing factors may still exist, and the intrinsic pathological changes that cause white spots are still developing. Therefore, the predisposing factors should be avoided first, and the treatment should be based on drugs. Children with small areas and single white spots can try it. External medicines or corticosteroid ointments with mild effects and little irritation should be used. If the white spots are scattered in multiple places, develop and spread quickly, and have a large area, internal and external treatment must be combined, and internal treatment should be the main method. Comprehensive therapy must be adhered to, and should not be used casually. Interrupt treatment or change treatment methods to avoid delaying the condition and losing the best opportunity for treatment. Patients with vitiligo in the stable stage, those with localized type and small white spots can use more irritating external drugs, as well as sun exposure, ultraviolet irradiation or local photochemical methods. If the effect is slow, or if it is located in an exposed area and is eager to seek treatment, it can be used Autologous melanocyte transplantation surgery can eliminate white spots in the short term. If the white spot area is large, comprehensive treatment should also be adopted. Pay attention to the toxic and side effects of long-term medication. Even if the topical medication is used, the toxic and side effects of percutaneous absorption of drugs used in large areas should also be paid attention to. Whole body photochemotherapy (PUVA) may also be used. Currently, there are narrow-wave UVB therapeutic devices for treating vitiligo, which are more effective than traditional long-wave ultraviolet irradiation and have fewer side effects. Our hospital uses narrow-wave UVB to treat patients with large-area vitiligo, and has achieved very satisfactory treatment results. In addition, patients with generalized stable disease can also use autologous epidermal transplantation to first eliminate white spots on exposed parts such as face, neck, arms, etc. This can relieve patients' psychological anxiety and mental stress, and make systemic treatment more effective. . It should be noted that unless the white spots spread quickly and the condition progresses rapidly, hormones or immunosuppressive drugs must not be abused. Such drugs are by no means the first choice even for those with rapid disease progression. Practice has proved that the use of hormones Treatment with similar drugs not only has serious side effects, but also the melanin islands produced often disappear quickly after the drug is stopped. If hormone drugs are used again, or other drug treatments are used after stopping hormones, treatment resistance often occurs, making treatment more difficult. Principles of vitiligo treatment Principles of early treatment of vitiligo: A large amount of practice has proven that treatment of vitiligo is relatively easy in the initial stage. White spots that first appear for 1 to 2 months can disappear completely within half a month to two months of treatment. This is because in the initial onset of white spots, there are still incompletely destroyed melanocytes in the skin lesions. We call this "incomplete white spots". Early treatment at this time can help repair the melanocytes in the basal layer of the skin with white spots. , divide and proliferate, secrete melanin, and transport it to all layers of the epidermis through dendritic processes to achieve the best therapeutic effect. At the same time, the initial white spots are small in size, and the melanocytes of the surrounding normal skin can migrate to the white spots, which will also help the white spots disappear quickly and shorten the treatment period. If the course of the disease exceeds one year, the course of treatment will be extended accordingly. If the course of the disease lasts for several years or even decades, the melanocytes in the basal layer of the epidermis in the white spots are completely destroyed, and even the melanocytes in the hair follicles have completely disappeared, making treatment very difficult. . Therefore, early diagnosis and early treatment are an important principle in the treatment of vitiligo. It should be pointed out that the initial skin lesions of vitiligo are often punctate and small flake-shaped hypopigmented spots, which are blurred, vaguely visible, and difficult to distinguish from normal skin. They are easily misdiagnosed as white pityriasis or sweat spots, etc., due to lack of treatment. , mistreatment, causing lifelong pain to patients. On the contrary, there are also cases where white pityriasis rash, achromic nevus, anemic nevus, etc. on the face are misdiagnosed as vitiligo and long-term treatment fails, which brings heavy financial burden and mental pressure to the patients. Such examples are common in clinical practice. This is an issue that dermatology outpatient physicians should pay great attention to. Principles of staged treatment of vitiligo: The course of vitiligo can be divided into quiescent and progressive stages. During the treatment, you must not use it externally without distinguishing the stage of the disease. In the progressive stage of vitiligo, internal treatment should be mainly used to adjust the body's immune function and neuroendocrine function. Those with other systemic diseases, such as thyroid disease, diabetes, liver disease, etc., should be treated at the same time. During the ongoing period, you must not choose strong sunlight or ultraviolet rays to avoid increasing the load on melanocytes, increasing the toxic products of melanin metabolism, and aggravating the self-destruction of melanocytes. At the same time, strong irritating drugs such as 5-fluorouracil, nitrogen mustard, psoralen, etc. should not be applied externally to avoid local irritation, damage to melanocytes, aggravation of immune disorders, and the expansion and spread of white spots. Only for stable vitiligo, especially small-area stable vitiligo, external medication can be considered, combined with phototherapy.

Traditional Chinese medicine believes that the initial onset of white spots is caused by wind evil blocking the collaterals, and treatment is mainly based on dispelling wind. Over time, the damage will lead to imbalance of qi and blood, stasis of blood, and blocked collaterals. The so-called long-term disease enters the collaterals, and treatment is to activate blood circulation, remove blood stasis, regulate qi and unblock collaterals. ; Chronic disease, liver and kidney deficiency, and loss of essence and blood. The so-called "long-term disease affects the kidneys" is treated by nourishing the liver and kidneys, replenishing essence and blood. This dialectical thinking also has good reference and guiding significance in the treatment of vitiligo. . Principles of comprehensive treatment of vitiligo: Since the causes of vitiligo are complex and multifaceted, various factors influence each other and are cause and effect, and its specific mechanism is not yet fully understood. Therefore, the effect of any single treatment method or single drug is often limited, the course of treatment is long, and the recovery rate is very low. Therefore, at least at this stage, the treatment of vitiligo should adhere to comprehensive treatment. For example, in staged vitiligo, it is necessary to consider both neurochemical factors and factors that may cause immune disorders. It is necessary to formulate a systematic and comprehensive treatment plan to improve the efficacy and recovery rate. In our country, thousands of years of traditional Chinese medicine practice has accumulated rich experience and prescriptions for treating vitiligo. If traditional Chinese and Western medicine can be combined, there is no doubt that the effect will be better than using Western medicine alone. Therefore, we emphasize adhering to comprehensive treatment, that is, a combination of oral and external use, a combination of traditional Chinese and Western medicine, and a combination of drugs and physical therapy or other therapies. What are the typical lesions of vitiligo? Vitiligo can occur on the skin of any part of the body. White spots mostly occur in areas exposed to friction and sun exposure; especially on the face (such as between the eyebrows, inside the eyebrows, the connection between the root of the nose and the inside of the cheek, in front of and above the ears, the brim of the forehead, hairline, and lips). Red part), neck, waist and abdomen (corset), sacrococcygeal forearm extension surface and back of fingers, etc. Typical white spots are usually the size of a fingernail to a coin, nearly round or oval in shape. Although they later expand or merge with each other into large irregular shapes, no matter how their shape changes, the edges of the white spots are always visible, and island-like pigments are added to the white spots. dots; another typical white spot is a band-like or cord-like depigmented spot along the nerve distribution. The edge of the white spot is as neat as a knife cut.