Problem description:
I didn't have that white one on my face before. A year ago, I grew a piece of white without knowing what happened. It doesn't hurt or itch. I've tried many drugs to treat vitiligo, and the liquid on them is of no help. I just felt itchy after using it. Is this a symptom of vitiligo? A big piece has grown, but it hasn't grown up yet. Please help me, thank you!
Analysis:
Vitiligo is a stubborn skin disease, which affects people's beauty and brings a lot of inconvenience to life and work. Many patients have been cured for a long time and have great psychological pressure. Some patients even endure troubles and pains all day long. Therefore, what people are most worried about after getting sick is the treatment, whether it can be cured, what kind of treatment is good, how to choose the right treatment, what drugs can be used to treat this disease, how long will it take, and how long will it take to be cured?
First, can vitiligo be cured?
What kind of treatment level has vitiligo reached at present? Can it be cured? There are still different understandings. We believe that there are two misconceptions that affect treatment: one is to exaggerate the curative effect and think that it can be cured regardless of the condition. This understanding often leads to patients taking drugs by mistake, which leads to poor curative effect, even promotes the development of the disease and delays the treatment opportunity. The second is to deny the curative effect. Some medical workers hold a negative attitude towards the treatment of vitiligo, thinking that it is an incurable disease. This concept has caused a certain psychological burden to patients, especially adolescent patients and parents. For some difficult diseases, modern medicine can only take symptomatic treatment. At present, the effect of western medicine in treating vitiligo is not good, and some hospitals in Europe and America refuse to treat this disease. Traditional Chinese medicine workers give full play to the unique advantages of traditional Chinese medicine and adopt the method of traditional Chinese medicine or combination of traditional Chinese and western medicine. After years of research, breakthroughs have been made in the treatment of vitiligo. The early cure rate is over 95%, the middle cure rate is over 50%, and the late cure rate is over 30%. The treatment level ranks first in the world. But at present, no matter which treatment method, the cure rate can not reach 100%, and it is unscientific to say that no matter what disease is cured. So there are still many difficulties in treatment. The reason is that TCM treatment is based on syndrome differentiation. In the process of treatment, it is necessary to formulate corresponding treatment plans according to the condition, and it is necessary to constantly adjust the treatment plans according to the changes of the condition in order to achieve the best curative effect. In addition, the responsibility of doctors and the close cooperation of patients are also important factors affecting the curative effect. Therefore, it is a comprehensive treatment process, and there is no specific medicine or secret recipe that can cure all patients, regardless of their illness. As patients, we should not only know the difficulty of this disease, but also build up the confidence to cure it. After getting sick, we should maintain a stable mentality, overcome blindness and impatience, prevent drug abuse, consult in many ways, compare repeatedly, and choose the appropriate treatment according to our own situation. If the first treatment has achieved obvious curative effect, it will lay a good foundation for recovery, especially for the initial stage of the disease, which can be recovered after timely and appropriate treatment.
Many patients are worried about recurrence after recovery. According to our clinical follow-up, the recurrence rate after recovery is only 0.5%.
Second, the introduction of common treatment methods
At present, there are many methods to treat vitiligo. The following is our experience in clinical work.
(a) ultraviolet (including sunlight) irradiation method
Ultraviolet light is located outside the purple light in the spectrum, also called ultraviolet light. Sunlight contains a lot of ultraviolet rays. Theoretically, ultraviolet radiation can increase the photosensitive reaction of pigment cells and promote them to produce more melanin, which is a traditional treatment. There are still books and periodicals. According to our clinical observation, this method is not conducive to the treatment of this disease, for two reasons: (1) too much ultraviolet light will cause damage to human body; (2) The human body's ability to resist ultraviolet rays decreases after illness. Therefore, we believe that patients with vitiligo should reduce or avoid ultraviolet radiation. The human body receives more or less a certain amount of solar ultraviolet radiation every day, which has no harm to normal tissues of the human body. This is because the human body surface has a complete protection mechanism, in which pigment cells produce and secrete melanin to resist ultraviolet radiation and protect the body from harm is an important self-protection function. When the illumination time is prolonged and the illumination is enhanced, the pigment cells appear compensatory physiological response. According to the time and intensity of light, the production of melanin increases correspondingly, and the skin darkens obviously, thus blocking and weakening the ultraviolet radiation on the body surface and protecting the body tissue (and also protecting the pigment cells themselves) from damage. The sick body is completely different from the normal body. Most of the pigment cells on the body surface are damaged to varying degrees, their functions are weakened or even lost, and their protective functions are destroyed. However, ultraviolet therapy will not reduce but increase the amount of light, which will inevitably increase the workload of pigment cells and aggravate the damage of pigment cells, and will also cause serious damage to other tissues and cells. Clinically, after ultraviolet irradiation, local skin redness and blistering reaction are the manifestations of serious damage to skin and subcutaneous tissue. Clinically, sometimes we can see that the skin around the white spot darkens after brightening, or a small number of pigment islands appear in the center of the white spot. This is because some pigment cells still have a certain compensatory function, showing a temporary compensatory reaction. However, with the extension of light time and intensity, the damage of pigment cells is aggravated and the function of producing melanin is lost. The melanin around and in the center of leukoplakia gradually subsided, the area of leukoplakia expanded, the whiteness deepened, and even the disease spread rapidly. Some people think that "the fading of black spots and the exposure of white spots are the manifestations of the improvement of the disease", which is debatable. We think that the discoloration of pigment and the expansion of skin lesions indicate that more and more pigment cells are lost after being damaged, and the amount of pigment produced is less and less, which is a manifestation of the aggravation of the disease. In addition, the treatment of vitiligo is a long-term process, and long-term ultraviolet irradiation will also induce cell distortion, leading to the occurrence of tumors. Therefore, we think that ultraviolet therapy is not suitable for the treatment of vitiligo.
(2) Immunomodulatory therapy
Medical research and clinical observation have proved that the occurrence and development of the disease are related to immune dysfunction, but clinical treatment with immunomodulators has no obvious effect. Immune dysfunction is a very complicated physiological and pathological process. Immune deficiency, low immune function and strong immune response will all lead to the occurrence of corresponding diseases. It is not clear which immune factors are related to this disease. At present, the commonly used immunomodulators (such as transfer factors and calf thymosin) are usually used for infectious diseases caused by low immunity, and the curative effect is remarkable. The treatment of this disease is still in the stage of observation and research. Although oral steroid hormones have a certain curative effect, long-term use has great side effects, and it is easy to appear "rebound phenomenon" after stopping taking drugs, which accelerates the development of the disease and is generally not used for routine treatment in clinic.
(3) Supplementing trace elements
Some researchers believe that the lack or imbalance of trace elements is the cause of the disease. The physiological activities of human body need the participation of various trace elements, and it is not completely clear which element is lacking or which element is disproportionate to this disease. Therefore, there is no exact theoretical basis for the supplementary treatment of trace elements, and the clinical trials of supplementary treatment of copper, zinc and other elements have no obvious effect. However, according to our clinical observation, the incidence of children with partial eclipse is high, and the treatment effect is poor compared with children with the same condition. Correcting the partial eclipse can improve the therapeutic effect, indicating that the disease is related to nutrient deficiency (including micronutrients)
Lack of quantization elements).
(4) patulin and psoralea tincture therapy
Stataxin injection is extracted from Psoralea corylifolia and used for intramuscular injection. The cure rate of patients with early onset is about 1~2%, and the effective rate is above 30%. Psoralea corylifolia tincture is made by soaking Psoralea corylifolia in alcohol, which has a certain curative effect for external use, but it rarely heals when used alone.
(5) People's Bailing
Minbailing originated in France, and there are oral tablets and tincture for external use, which can be used at the same time or alone, and the effect is better than that of single use. The cure rate is about1.5%; The effective rate is about 30%. The drug has great side effects, which can cause adverse reactions in the liver, kidney and digestive system, and will rebound after stopping the drug. This medicine for external use has a great local reaction. Most patients have local redness and blisters after application, and some patients are cured after blisters, but most patients have enlarged skin lesions after blisters, which leads to the development of the disease. If used improperly, it will cause different degrees of damage to the skin after half a month, and skin "aging and fibrosis" will occur after more than two months. Once skin aging and fibrosis occur, it is difficult to treat it by other methods. Therefore, this medicine should be used with caution, and do not touch ultraviolet rays after application, otherwise it will aggravate skin damage.
(6) Other imported drugs.
In recent years, some patients have used drugs imported from the United States and Japan (such as berberine injection). According to the introduction of foreign patients such as the United States, Japan and France, there is no good treatment for vitiligo abroad at present, and most hospitals refuse to treat patients, so some patients come to China for medical treatment. There was an advertisement that berberine injection was "effective in three stitches and cured in seven stitches". Some hospitals use berberine.
At the same time, acupuncture combined with Baibaijing external application, some patients can get better therapeutic effect by using Baibaijing external application alone.
[1] Appendix II Health Knowledge
Effective. Therefore, it is difficult to compare and observe the curative effects of the two drugs. According to many users, berberine alone has not been cured. If there are special effects, why don't the United States sell them to China and American patients come to China for treatment? Therefore, before choosing, we should consult the imported drugs repeatedly and carefully observe and compare them.
(7) Acupuncture therapy
Theoretically speaking, acupuncture can regulate endocrine function and enhance immunity. But the clinical observation of its curative effect is not completely consistent with the theory. Some patients actually promote the development of the disease after receiving acupuncture treatment. The reason may be that patients are afraid of acupuncture, which leads to mental tension. Therefore, acupuncture treatment can not be the same, but should be used according to the patient's situation. Patients who are afraid of acupuncture, especially children, should not choose acupuncture treatment. In addition, you must not use some therapies that directly damage the skin, such as plum blossom needles, fire needles or direct burns with firearms. Because of this disease, "isomorphic reaction [1]" will occur after skin damage, which will lead to the development of the disease. In severe cases, scar tissue is formed locally and becomes permanent injury.
(8) Autologous epidermal cell transplantation
This method is aimed at the pathological changes that the number of pigment cells in vitiligo lesions is reduced or even completely lost. The epidermal layer of normal skin was removed by instruments, and then transplanted to the lesion (leukoplakia) to increase the number of melanocytes in the lesion and promote the recovery of melanocytes in the lesion. This method was first reported by Kiistala in the United States in 1964, and the transplantation method is simply negative pressure suction foaming. In 1980s, China began clinical trials in Shanghai Medical University and China Medical University. Simple negative pressure suction foaming takes a long time and the peeling area is small, which is not conducive to the popularization of this method. From 65438 to 0995, vitiligo research institute of Shandong University and Shandong Polytechnic University jointly developed PFJ- 1A autologous epidermal cell transplantation therapeutic instrument, and later improved PFJ-I and BLY-II were developed by Shandong Polytechnic University. This machine is characterized by applying negative pressure to the transplanted epidermis to attract foam and heat at the same time, and separating the epidermis under the dual biophysical effects of negative pressure and heating. Self-control of pressure and temperature, good stability, fast separation speed (60-90 minutes), accurate separation level, uniform foam skin, no scar and large separation area. The maximum separation area is 15.7cm2 ... The operation is simple and easy to popularize, which has promoted the application of autologous epidermal cell transplantation in China so far, and the autologous epidermal cell transplantation in China has reached the world leading level. On the basis of traditional Chinese medicine treatment and autologous epidermal cell transplantation, the total cure rate increased from 35.8% to 57%. Among the cured patients, only the patient with the smallest lesion area underwent 1 operation, and 5 blisters (0.5 cm2) were transplanted. Each). The largest operation was 22 times, and 602 blisters were transplanted, accounting for about110 of the body surface area. The maximum area of each transplant is 64 blisters. According to our clinical experience, drug therapy is effective, the survival rate of skin grafting is high, drug therapy is ineffective, and the transplantation effect is not significant. Patients with sporadic, systemic and acromegaly must be treated with drugs first, and surgery can only be performed after the condition improves and the area of skin lesions shrinks, otherwise the treatment will be ineffective and even "isomorphic reaction" will appear. Usually, 3~6 months of drug treatment is the best time to choose surgery. The survival rate of pigment cells in premature operation is low, and the treatment time is prolonged in late operation. The operation of "skin aging and fibrosis" is not suitable because of improper application method and poor effect. In addition, those who are located in the sternum, fingers, eyes and scars should be careful when grinding and strictly control the depth to avoid injury, scar tissue formation and physiological dysfunction.
Third, how to choose a treatment plan
(1) Repeated consultation
1, consult the patient being treated.
As the saying goes, "We are in the same boat", and the communication between patients can best reflect the real situation. Don't rush to seek success after the onset, consult the patients receiving treatment first, and the patients receiving treatment should carefully introduce their treatment experience to the consultants to help them choose treatment methods.
2. Consult the recovered patients.
In the early stage of the disease, it is very important to choose the appropriate treatment scheme, so as to obtain the best curative effect after the first treatment. If the treatment fails many times, it may become a chronic disease. After getting sick, we should face the reality, keep a normal state of mind and actively look for patients who have recovered. Grasp all kinds of information about treatment, consider and compare it repeatedly, and then choose the treatment plan according to your own situation to avoid blind treatment without consultation. In clinical work, we often encounter two strange phenomena: First, parents are afraid of being known and do "confidential treatment" after their children get sick. Second, when the patient visited the cured patient and consulted him, the cured patient denied that he had suffered from the disease and refused to provide treatment information. As a result, many patients blindly use drugs because of improper selection methods, which leads to the development of the disease. After getting sick, you should seek advice from many parties, get timely and appropriate treatment, and make yourself responsible for the early recovery of the disease. All the patients who have recovered have been ill, so we should have empathy for new patients and give enthusiastic help. It is known that the reason why patients are unwilling to communicate with each other is that a few people are biased against the disease and mistakenly think it is contagious or hereditary, afraid of affecting their reputation and being known. This disease is not contagious and the genetic probability is very low, so we should eliminate our concerns. Don't delay the treatment opportunity because of vanity, and you will regret it for the rest of your life.
3. Consult a hospital for treatment.
At present, besides western medicine, there are many kinds of Chinese patent medicines circulating in the market, such as vitiligo pill, Baishi Pill and Vitiligo Capsule. The therapeutic effect of single drug is not significant. Most specialized hospitals use self-made empirical prescriptions, and the approval number is "non-standard preparation number". This preparation was originally approved by cities, but now it is approved by provincial and municipal drug supervision departments. Provincial and municipal food and drug administration officials are close to and understand the actual clinical situation, with short approval period and low cost. The hospital used self-made experience flexibly and cured many difficult diseases. At present, the deficiency is that comprehensive treatment measures still need to be taken according to different conditions. Doctors need to formulate treatment plans based on syndrome differentiation according to all aspects of patients, and they need to constantly adjust the treatment plans according to the changes of their conditions during the treatment. So the curative effect of the hospital is different. Patients can consult several hospitals before treatment, and the focus of consultation is on curative effect, such as effective rate and cure rate, consulting medical records and observing and comparing photos before and after treatment. However, it should be noted that the real photos can be clearly imaged, and the skin texture, hair (hair), pores and other fine hooks can be clearly observed, and the edges of skin lesions are polymorphic and irregular. The color edge, shape and structure of the altered picture are dim, stiff or unclear, and traces after alteration can be seen. According to the above method, no matter how it is modified, it can be distinguished from the original picture. Written information should record the patient's name, sex, age, onset time, diagnosis and treatment process, address and contact telephone number.
After many consultations and repeated comparative analysis of various information and treatment methods, we can select a more suitable treatment method according to our own situation.
(2) Observe the curative effect
1. Initial effect period: The clinical manifestation of initial effect is that leukoplakia shrinks inward from the periphery, and the edge of leukoplakia gradually becomes clear (blurred edge is the manifestation of disease development), which is slightly darker than normal skin, and there are dark spots (pigment islands) in leukoplakia. If the method is proper, 65% of patients will take effect within 1 month; More than 85% take effect within 2~3 months; It is very rare that the effective time exceeds 3 months.
2. Obvious period of validity: black spots increase and merge into pieces, white spots disappear, and big white spots shrink obviously.
3. cure; The leukoplakia completely subsides, and the skin in the leukoplakia area can be slightly darker than the normal skin color, and it takes more than 3 months to completely restore the normal skin color.
4. Ineffective: the condition has not improved after treatment for more than 3 months, and it is ineffective, so the treatment plan should be adjusted.
During the treatment, the attending doctor should conduct a face-to-face consultation once a month to observe the condition in detail so as to prescribe the right medicine. If you can't see a doctor on a monthly basis because of the long distance, take photos of the affected part every1~ February for the doctor to see. It is also necessary to introduce the changes of the condition and the reaction after taking the medicine to the doctor frequently by telephone (at least once a month) or letter. If doctors and patients can cooperate closely, severe patients can sometimes have better results.
(3) Curing time
Curing time is affected by six factors:
1, onset time: early onset (within 3 months) and recovery in about 3~ 10 months, with an average of 7 months; Intermediate patients (onset time 4 months to 3 years) recovered from 6 months to 2 years, with an average of 65438 0.5 years; The recovery time of patients in the middle and late stage (more than 4 years) is 65438 0 ~ 4 years, with an average of 2 years. According to the statistics of 2597 patients in our hospital, the cure rate at different onset time is: early 95%, middle 57% and late 33%.
2. Skin lesion area: The skin lesion is distributed as a localized plaque from the rice grain to the nail, and the healing time is about 3~ 10 month; There is only one piece in the whole body, the area is the size of a palm, and the healing time is about 8~ 14 months; The healing time of 2~3 palms is about 10~ 16 months; Large area, multiple pieces distributed all over the body, cured in 2~4 years.
3, skin lesions: the face is quick and easy to cure. It is the face, head, neck, back, chest, ilium, waist, abdomen, hands, feet and mucous membranes. Mucosal treatment of joints, hands and feet and limbs has a long course of treatment and a low cure rate. Hair turns white, black and white people tend to turn black, and all white people are more difficult to cure. White eyebrows are easy to cure, while white eyelashes are more difficult to return to normal color.
4. Age: The curative effect of teenagers and children is better than that of middle-aged and elderly people, but there is no significant difference in early-onset curative effect. There is a significant difference in curative effect between middle and late stage patients because of their different ages.
5. Individual differences: the curative effect varies from individual to individual, such as living habits, mental state and physical condition. Partial eclipse, like alcohol and tobacco, children like snack drinks, slow curative effect, long course of treatment; The curative effect of those who keep comfortable and stable mood is better than those who have long-term mental stress, depression, insomnia and other neuropsychiatric disorders; It is difficult to treat obese children and fair-skinned people.
6. Skin lesion type: the cure rate can reach 96% in a limited small area; The cure rate of ganglion segment type can reach 98%, but it takes a long time to take effect, up to 9 months. Patients with large area and serious illness need 2~3 years to be cured. Because of the complete loss of pigment cells in the diseased area, this type must be cured by autologous epidermal cell transplantation. A large area of sporadic skin lesions, distributed in joints, limbs, hands and feet, is unstable and difficult to cure; Broadly speaking, it is the most difficult to cure, and the cure rate is below 5%.
(D) the sense of responsibility of doctors
Because vitiligo is caused by many and complicated factors, and the therapeutic effect is also affected by many factors, it is impossible for a drug or method to cure all patients. Therefore, the doctor's sense of responsibility is very important for achieving the best curative effect and making patients recover. Medical staff should have good medical ethics, take Dr. Bethune as an example, regard patients as relatives, carefully observe each patient's condition, accurately grasp and record the condition, so as to formulate appropriate treatment plans according to the individual differences and condition differences of patients, and try their best to get rid of the pain and troubles of patients as soon as possible.