Vitiligo is a disease of the epidermis that is characterized by white patches (depigmentation) that appear and spread over any part of the skin. This pigmentary defect mainly affects the face, extremities, joints and areas of friction.
Its frequency is estimated at 1% of the general population with no predominance of sex or race.
Its origin remains poorly known even if it is now said that a combination of several factors is necessary to develop the disease, including a risk of family transmission clearly identified in recent studies.
WHAT SUPPORT AT BORDEAUX UNIVERSITY HOSPITAL ?
The Department of Dermatology and Pediatric Dermatology of the University Hospital of Bordeaux supports many years patients with vitiligo and follows to this day a cohort of over 1500 patients.
Currently, vitiligo is included in the pathologies identified as a priority within the Reference Center for Rare Skin Diseases (CRMRP) coordinated by Professor Alain Taieb , head of the dermatology and pediatric dermatology department at the CHUfrom Bordeaux. This priority appears necessary because of the few services in France or abroad offering complete medical and surgical care (melanocyte transplant) as well as make-up workshops to explain camouflage techniques. “The consultation with a patient suffering from vitiligo is a long consultation which is a time of listening, discussion, explanations about the disease. This time is necessary for the good understanding of the interlocutors, understanding of the disease by the patient which is a guarantee of the correct application of advice and treatment, but also understanding by the doctor of the moral pain of patients in the face of the difficulties caused by their disease. . » Dr Khaled Ezzedine , head of the referral center for rare skin diseases at the CHU
ORIGIN OF THE DISEASE
Vitiligo is preferentially associated with certain autoimmune diseases, the most frequent of which is represented by thyroid diseases. The extent of the disease is very variable, from localized forms of very small extent (the most frequent) to larger forms in which the whole of the skin can be depigmented.
The dermatological community separates this disease into 2 entities:
generalized or non-segmental vitiligo
This distinction is important because the treatment of either form is not the same. Vitiligo has long been confused in India or Africa with leprosy. In addition, some studies in Middle Eastern populations showed the stigmatization of patients with vitiligo with a definite impact on sexuality.
STUDY IN PROGRESS
Vitiligo can be a real handicap socially and professionally. For this reason, the service has conducted a very large study, in conjunction with the Association Française du Vitiligo , on the burden of the disease which involved more than 300 patients. The results of this study will probably be published during the year 2015.
In addition, the Reference Center for Rare Skin Diseases consists of a fundamental research unit with a strong theme on vitiligo ( INSERM U1035).
The dermatology department of Bordeaux University Hospital works in close collaboration with the Association Française du Vitiligo and other patient associations around the world which are partners of the Special Interest group on Vitiligo of the International Federation of Pigment Cell Societies (IFPCS) .
This group organizes international meetings (Washington 2005, Sapporo 2008, Bordeaux 2011, Singapore 2014) to compare the experiences of researchers, dermatologists and patients, with the aim of improving understanding of the disease and, in parallel, its treatments.
Two clinical trials are planned in the reference center in 2015 and advances in understanding the mechanisms of vitiligo have been made by the department’s research team.
AN INTERNATIONAL PUBLICATION
Recently, best skin doctor in south delhi, responsible for the treatment of vitiligo in the dermatology department of the Bordeaux University Hospital , published a general review taking stock of the disease in the Lancet, a journal with an international audience. This publication was commissioned directly by the Lancet, which wanted to better inform the medical community about vitiligo, which is still little known and poorly taken care of by physicians, and to highlight new avenues of therapeutic research resulting from fundamental research
A CULTURAL PROJECT AROUND VITILIGO
An artist residency will take place in 2015 within the dermatology department of the Bordeaux University Hospital in conjunction with the communication and culture department. This research and creation project around Vitiligo disease is designed in collaboration with patients and nursing staff. This project, designed by the visual artist Sarah Connay, is carried out in partnership with the Creative Agency for Contemporary Art.
If vitiligo cannot be cured, there are effective tools to fight it. “You can’t prevent relapses, but some treatments block them. We can thus stabilize the disease thanks to corticosteroids. And the sooner you treat vitiligo, the better the treatment works. ” Then, light therapy is used to re-pigment areas with bleaching. The light makes it possible to restart the production of melanin from the reserves of melanocytes contained in the hairs. A recognized method (except on the hands and feet, hairless areas poor in melanocyte reserves) but which requires patience. It takes at least a year of treatment. Although the disease is still little known and sometimes poorly managed by doctors, the treatment options are changing. “Treatments dedicated to this disease, immunosuppressants, are about to emerge,” says Khaled Ezzedine. No reason, therefore, to lose hope for the sick.
Vitiligo is not painful, but neither is it mild. “In 25% of cases, it is associated with autoimmune diseases (diabetes or thyroid problems), explains Professor Ezzedine. And even if the vital prognosis is not engaged, for those affected, it is a tragedy to lose the color of their skin, especially during adolescence. ” The psychological consequences are real. “A lady thanked me after a treatment because her son was no longer ashamed to walk with her,” says the specialist.