Kena

Roots

Chronic skin disease

Other name = Leukoderma
White spots occur when the skin
no longer forms melanin
(pigment that determines the
color of your skin, hair, and eyes)
The white patches of irregular
shapes begin to appear on your
skin

White patches of skin

Whitening or graying of the hair on your
scalp, eyelashes, eyebrows or beard
Loss of color in the tissues that line the
inside of your mouth
Loss or change in color of the inner layer of
your eye

Chalk white color

Convex margins
5mm to 5cm or
more in diameter
Round, oval, or
elongated in shape

AVRF

Focal patternthe depigmentation is limited

to one or only a few areas
Segmental patterndepigmented patches
develop on only one side of the body
Generalized pattern(most common)
depigmentation occurs symmetrically on both
sides of the body
Focal and segmental patterns do not spread.
The generalized pattern is hard to predict and
can randomly stop

Can appear at any age, usually first appears

between the ages of 20 and 30
White patches may begin on your face above
your eyes or on your neck, armpits, elbows,
genitals, hands or knees
1-100 of the world population develops
Affects both genders and all races equally

When no melanin is
produced, the involved patch
of skin becomes white
When a white patch grows or
spreads the cause may be
Vitiligo
Exact cause is unknown
May be due to an immune
disorder, heredity, or
environmental causes like
sunburn or emotional
distress that trigger the
condition

A family history of
vitiligo
Look to see if there is a
rash, sunburn, or other
skin trauma that has
occurred within 2 or 3
months after
pigmentation was
discovered

Premature graying of
the hair (before age 35)
Stress or physical
illness

Also they may ask for

an eye examination
(inflammation of your
eye) and/or blood test
(autoimmune disease)

Vitiligo

is difficult to treat
Early treatment options include:
Exposure to intense ultraviolet light, such as narrow-band

UVB therapy
Medicines taken by mouth such as trimethylpsoralen
(Trisoralen)
Medicines:

Corticosteroid creams
Immunosuppressants such as pimecrolimus (Elidel)

and tacrolimus (Protopic)

Repigmenting agents such as methoxsalen (
Oxsoralen)

The use of steroid creams may be helpful in returning the

color to the white patches
Doctors often prescribe a mild topical corticosteroid cream
for children under 10 years old and a stronger one for
adults
Cream must be applied to the white patches on the skin for
at least 3 months before seeing any results
Corticosteriod creams are the simplest and safest
treatment for vitiligo, but are not as effective as psoralen
photochemotherapy
SIDE EFFECTS occur in areas where the skin is thin, such
as on the face and armpits, or in the genital region
They can be minimized by using weaker formulations of steroid

creams in these areas.

 Topical

Calcineurin Inhibitors

RDNL

AVRF

Most effective treatment

available in the United States.
PUVA therapy is to repigment the
white patches
time-consuming, and care must
be taken to avoid side effects
Psoralen is a drug that contains
chemicals that react with
ultraviolet light to cause
darkening of the skin.
Psoralen is injected orally or is
applied to the skin
Then skin is carefully timed
exposure to sunlight or to
ultraviolet A (UVA) light that
comes from a special lamp.

WWHT Dermatology

Used for children 2 years old and older who have small number white spots in
a few areas
Treatments are done under an artificial UVA light once or twice a week.
Psoralen is applied to your depigmented patches about 30 minutes before
exposing you to enough UVA light to turn the affected area pink.
The doctor usually increases the dose of UVA light slowly over many weeks.
Eventually, the pink areas fade and a more normal skin color appears.
SIDE EFFECTS:
(1) severe sunburn and blistering
(2) too much repigmentation or darkening (hyperpigmentation) of the
treated patches or the normal skin surrounding the vitiligo.

For people with extensive vitiligo (affecting more than 20 percent of the body)
or for people who do not respond to topical PUVA therapy
Not recommended for children under 10 years of age because it increases the
risk of damage to the eyes caused by conditions such as cataracts.
You take a prescribed dose of psoralen by mouth about 2 hours before
exposure to artificial UVA light or sunlight.
Treatments are usually given 2 or 3 times a week, but never 2 days in a row.

For patients who cannot go to a facility to receive PUVA therapy, the doctor
may prescribe psoralen that can be used with natural sunlight exposure.
SIDE EFFECTS include:

Sunburn, nausea and vomiting, itching, abnormal hair growth, and

hyperpigmentation.

May also increase the risk of skin cancer,

Used for people with small patches of vitiligo

The doctor removes sections of the normal, pigmented
skin and places them on the depigmented areas
Infections may occur at the donor or recipient sites
The recipient and donor sites may develop scarring, a
cobblestone appearance, or a spotty pigmentation, or
may fail to cure the white spot area
Takes time and is very costly
Doctor creates blisters on your pigmented skin by
using heat, suction, or freezing cold
The tops of the blisters are then cut out and
transplanted to a depigmented skin area
SIDE EFFECTS: scarring and lack of repigmentation
Less risk of scarring with this procedure than with
other types of grafting.

Implanting pigment into the skin with a special surgical instrument

Works best for the lip area, particularly in people with dark skin
Difficult to match perfectly the color of the skin of the surrounding
area
The tattooed area will not change in color when exposed to sun, while
the surrounding normal skin will.
Tattooing tends to fade over time
Also tattooing of the lips may lead to episodes of blister outbreaks
caused by the herpes simplex virus

Takes a sample of your normal pigmented skin and places it

in a laboratory dish containing a special cell-culture solution
to grow melanocytes.
When the melanocytes in the culture solution have
multiplied, the doctor transplants them to your depigmented
skin patches
Currently experimental and is impractical for the routine care
of people with vitiligo
Very expensive and its side effects are not known.

Sunscree
n

Blue Lizard Baby&

Sensitive Sunscreen

Helps protect the skin

from sunburn and longterm damage
Minimizes tanning,
which makes the
contrast between normal
and depigmented skin
less noticeable
AVRF

Some vitiligo patients cover depigmented patches with stains, makeup, or self-tanning
lotions.
Dermablend, Lydia OLeary, Clinique, Fashion Flair, Vitadye, and Chromelin offer makeup or
dyes that you may find helpful for covering up depigmented patches
Self tanning lotions have an advantage over makeup in that the color will last for several
days and will not come off with washing.

AVRF

April

AVRF

SUPPORT

organizations
1)National Vitiligo Foundation
2)Vitiligo Support International
3)American Vitiligo Research Fo
undation Inc.

Nation Library of Medicine (Medicine Plus)

American Vitiligo Research Foundation
National Institutes of Health, Department of Health an
d Human Services
: National Institute of Arthritis and Musculoskeletal
and Skin Diseases
Drugs.com (Treatments)
youtube.com (Lee Thomas- Turning White 20/20
Interview)
National Vitiligo Foundation (video gallery-Elizabeth
Vargas Interview)

National Vitiligo Foundation

2) American Vitiligo Research Foundation Inc.
3) Visualdxhealth
4) Revolution Health
5) WWHT Dermatology
6) Elidel
7) National Vitiligo Foundation
8) Vitiligo Support International
1)

Kids coping with

Vitiligo
Lee Thomas
Elizabeth Vargas
Interview

Ingredient

Cocos nucifera oil

Main active
substance

Coconut oil
contains essential
saturated and
unsaturated fatty
acids, High
concentration of
Vitamin E and K,
high concentration
.of Zinc and Iron

Action
Coconut oil is the
only type of oil that
one should use on
ones skin for it is
absorbed easily
and keeps the skin
soft. Coconut oil
contains Vitamin E
Alpha Tocopherol.
This kind of
Vitamin is a wellknown potent
antioxidant and is
beneficial to the
.skin

Ingredient
Psoralea
corylifolia extract

Main active
substance
Psoralea
corylifolia contains
flavons,
isoflavons,
furanocoumarins,
chalcones and
coumesterol group
of compounds
which includes
psoralen,
isopsoralen and
.bavichinin2

Action
Psoralea corylifolia appears to
have a purely local action with a
specific effect on the arterioles of
the subcapillary plexuses, which
are dilated so that the plasma is
increased in this area. The skin
becomes red and the
melanoblasts (pigment-forming
cells) are stimulated. In
leukoderma, melanoblasts do not
function properly and their
stimulation by the drug leads
them to form and exudate
pigments, which gradually diffuse
into the white leukodermic
patches.[ Also, the
phytochemically induced covalent
binding of the drug to pyrimidine
bases is responsible for its
therapeutic effect. The
photoconjunction involves thymine
dimer adducts on the opposite
strands of DNA. Psoralen has been
found to intercalate into DNA,
where they form mono- and diadducts in the presence of long
wavelength UV light and thus are
used for the treatment of hypopigmented lesions of the skin,
.such as leukoderma

Ingredient

Berberis vulgaris
root extract

Main active
substance
Barberry includes
such alkaloids as
berbamine, berberine,
oxyacanthine, resin
and tannins, and
chelidonic acid.
Barberry Root also
constituents the Bvitamin thiamine,
vitamin C, lutein,
zeaxanthin, the
carotenoids betacarotene, chromium,
. zinc, and cobalt

Action

Barberry root has

antioxidant and
cytoprotective
.properties

Ingredient

Picrorhiza kurroa
root extract

Main active
substance

Picrorhiza kurroa root

extract contains
Kutkin, D-Mannitol
and Vanillic acid

Action
Picrorhiza kurroa was
found to be a potent
immunostimulant of
both cell-mediated
and humoral
immunity. picrorhiza
was reported to
stimulate cell
mediated and
humoral components
of the immune
system including
stimulation of
.phagocytosis

Ingredient

Melaleuca
Alternifolia
(TeaTree) Leaf Oil

Main active
substance

Terpineol, Cineol,
Pinene, Terpinenes

Action
Powerful and broad
spectrum antimicrobial agent
(Anti-bacterial,
anti-fungal and
anti-mycotic
agent), and it has
an immune system
stimulant effect

Ingredient

Emu oil

Main active
substance

Linolinic acis and

Oleic acid

Action
Used by the
Aboriginal people of
Australia for the
treatment of muscle
and joint pain,
contains a variety of
fatty acids. Modern
research into the
properties of emu oil
has found that this is
the greatest skin
emollient in the
world, with deep skin
penetration
properties better than
.any other natural oil

Ingredient
Vitamin E
(Tocopherol)

Main active
substance
Alpha-tocopherol

Action
Powerful antioxidant agent

Natural pathway for PUVA therapy.

Rich source of natural powerful antioxidants.
Rich source of essential minerals and
vitamins for vitiligo patients.
Safe with minor side effects.
Cost effective.

Great thanks for your

listening
Kena Roots for therapeutic
cosmetics
Dr. Hani Malkawi