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Vitiligo has been, until recently, a rather neglected area in dermatology and medicine. Patients complain about this situation, which has offered avenues to quacks, and has led to the near orphan status of the disease. The apparently, simple and poorly symptomatic presentation of the disease has been a strong disadvantage to its study, as compared to other common chronic skin disorders such as psoriasis and atopic dermatitis. Vitiligo is still considered by doctors as a non disease, a simple aesthetic problem. A good skin-based angle of attack is also lacking because generalized vi- ligo is clearly epitomizing the view of skin diseases as simple targets of a systemic unknown dysregulation (diathesis), re? ecting the Hippocratic doctrine. This view has mostly restricted vitiligo to the manifestation of an auto-immune diathesis in the past 30 years. Thus, skin events, which are easily detected using skin biospies in most other situations, have not been precisely recorded, with the argument that a clinical diagnosis was suf? cient for the management (or most commonly absence of mana- ment) of the patient. This book is an international effort to summarize the information gathered about this disorder at the clinical, pathophysiological and therapeutic levels. Its primary aim is to bridge current knowledge at the clinical and investigative level, to point to the many unsolved issues, and to delineate future priorities for research.
Table des matières
Defining the Disease.- Historical Aspects.- Epidemiology, Definitions and Classification.- Histopathology.- Generalized Vitiligo.- Segmental Vitiligo.- Vitiligo Universalis.- Mucosal Vitiligo.- Halo Nevi and Vitiligo.- Hair Involvement in Vitiligo.- Non-Skin Melanocytes in Vitiligo.- Autoimmune/Inflammatory and Other Diseases Associated with Vitiligo.- Vitiligo and Immunodeficiencies.- Inflammatory Vitiligo.- Rare Inherited Diseases and Vitiligo.- Vitiligo in Childhood.- Late-Onset Vitiligo.- Evaluation, Assessment and Scoring.- Quality of Life.- Natural History and Prognosis.- Defining the Disease: Editor's Synthesis.- Understanding the Disease.- Pathophysiology Overview.- Genetics.- Environmental Factors.- In Vivo Data.- Animal Models.- In Vitro Approaches.- Oxidative Stress.- Immune/Inflammatory Aspects.- Cytokines and Growth Factors.- Proopiomelanocortin and Related Hormones.- Other Hypotheses.- Particular Clinical Characteristics of Segmental Vitiligo.- The Concept of Mosaicism Applied to SV.- The Neurogenic Hypothesis in Segmental Vitiligo.- Segmental Vitiligo: A Model for Understanding the Recapitulation of Repigmentation.- Editor's Synthesis.- Therapy.- Management Overview.- Topical Corticosteroids.- Calcineurin Inhibitors.- Vitamin D Analogues.- PUVA and Related Treatments.- UVB Total Body and Targeted Phototherapies.- Vitamins and Antioxidants: Topical and Systemic.- Corticosteroid Minipulses.- Other Immunosuppressive Regimen.- Empirical, Traditional, and Alternative Treatments.- Background and Techniques.- The Outcomes: Lessons About Surgical Therapy for Vitiligo in the Past Two Decades.- Combined Therapies for Vitiligo.- Camouflage.- Photoprotection Issues.- Depigmenting Agents.- Therapy Adapted for Age, Gender, and Specific Locations.- Psychological Interventions.- The Patient Perspective.- Evidence-Based Medicine Perspective.- Editor's Synthesis and Perspectives.
Résumé
Vitiligo has been, until recently, a rather neglected area in dermatology and medicine. Patients complain about this situation, which has offered avenues to quacks, and has led to the near orphan status of the disease. The apparently, simple and poorly symptomatic presentation of the disease has been a strong disadvantage to its study, as compared to other common chronic skin disorders such as psoriasis and atopic dermatitis. Vitiligo is still considered by doctors as a non disease, a simple aesthetic problem. A good skin-based angle of attack is also lacking because generalized vi- ligo is clearly epitomizing the view of skin diseases as simple targets of a systemic unknown dysregulation (diathesis), re? ecting the Hippocratic doctrine. This view has mostly restricted vitiligo to the manifestation of an auto-immune diathesis in the past 30 years. Thus, skin events, which are easily detected using skin biospies in most other situations, have not been precisely recorded, with the argument that a clinical diagnosis was suf? cient for the management (or most commonly absence of mana- ment) of the patient. This book is an international effort to summarize the information gathered about this disorder at the clinical, pathophysiological and therapeutic levels. Its primary aim is to bridge current knowledge at the clinical and investigative level, to point to the many unsolved issues, and to delineate future priorities for research.
