Vita fläckar, fjärilar och PSEUDOCATALASE

Vitiligo är en kronisk hudsjukdom som kännetecknas av depigmenterade (vita) hudområden på kroppen. Sjukdomen är vanlig och drabbar 1–2 procent av befolkningen globalt. Statistiskt sett kan det finnas många fler eftersom de flesta inte söker vård för pigmentförändringar i huden.

There are three different types of vitiligo:

• Vitiligo vulgaris (generalised vitiligo) is the most common form of vitiligo. Vitiligo vulgaris is characterised by white patches that appear symmetrically on both halves of the body.
• Vitiligo segmentalis is the second variant, vitiligo segmentalis (segmental vitiligo), appearing as patches on only one side of the body.
• Vitiligo focalis is called the third variant and is characterised by small patches on one or a few parts of the body.

Scientists currently disagree on the reason why vitiligo occurs. Some say it's caused by autoimmunity, which is when your immune system attacks the pigment cells. Others claim that a high concentration of oxidative stress destroys the pigment cells. Most likely, it's a combination of both. Patients with vitiligo (especially with vitiligo vulgaris) have antibodies against the pigment cells along with a high concentration of hydrogen peroxide which is an oxidative marker. Which came first the chicken or the egg? We don't know. 

For a long time it was assumed that white patches contained no melanocytes (pigment cells), but research has now shown that melanocytes are still present in white patches, only that they have lost their ability to form pigment (1). 

As depigmentation can occur in visible areas of the skin, the disease can be socially stigmatising and cause psychosocial distress, including a decline in well-being (2).

DIAGNOS
Diagnosing vitiligo is often a simple process. However, in light-skinned patients, a so-called skin lamp (Wood's lamp) may be needed to ensure that it is vitiligo. Professor Karin Schallreuter and a team of American and German researchers discovered that substances are formed in the white skin that emit fluorescence when illuminated with the lamp. These substances belong to the family of bioterines and are also what give some butterflies their fluorescent colour (3).

The discovery of vitiligo's ability to fluoresce was published in the prestigious journal Science in 1994 (3).

A: Vitiligo on the eyelids in visual light. B: The same eyelids under Wood's lamp giving a white fluorescent light. (4).

TREATMENT OF VITILIGO
There are no uniform national guidelines for the treatment of vitiligo today. Usually, no additional medical treatment is offered and the focus is on patient education about the course of the disease.

However, some dermatologists prescribe cortisone or tacrolimus, a substance developed for the treatment of atopic eczema, which you are advised to apply to the affected areas. After 6 months, there is an evaluation. A few patients see some effect due to the immunomodulatory effect. A UVB light treatment is recommended in some regions with variable efficacy

WHAT TO AVOID IF YOU HAVE VITILIGO

• Swimming in pool water that contains chlorine - this can make vitiligo worse.
• Skin care containing the active ingredient Q10 (Inci:Ubiquinone). Studies show that applying a cream with Q10 can worsen vitiligo (5).
• Stress - this is easier said than done but it has been shown that vitiligo is greatly aggravated by psychological stress.
• Avoid getting hurt. People with vitiligo are particularly vulnerable to injury and pressure on the skin, which often produces a white patch where the wound or crust was. This is a well-known phenomenon known as the Köbner phenomenon.
• Avoid tight-fitting clothes and shoes. Vitiligo often appears around the waist, under the bra and on the feet due to constant pressure on the skin. This can trigger pigment loss.
• Avoid excessive amounts of green tea as this can have pro-oxidant effects and exacerbate vitiligo.
• Avoid smoking. Smoking has often been shown to worsen vitiligo, especially around the mouth. It is also difficult to treat vitiligo if the patient smokes, because in these cases the repigmentation occurs very slowly.

Interviews about vitiligo

Interview with Professor Karin Schallreuter Prof, MD
Professor Karin Schallreuter has been studying vitiligo for the past 25 years and has been a working dermatologist and specialist at the Mayo Clinic, Minnesota. She is one of the founders of the Center for Skin Science at the University of Bradford and founder of the Institute for Pigmentary Disorders in Greifswald, Germany. She has authored more than 170 scientific papers in experimental and clinical dermatology and has treated more than 6,000 patients with vitiligo. In this interview, she tells us more about the treatment she has developed.

Interview with Murali - about Professor Schallreuter's treatment that has helped to reduce hand vitiligo.

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Interview with Skinome's founder Johanna Gillbro, about her experience with the PC-KUS treatment

I have had vitiligo since childhood. I visited many dermatologists and tried everything from cortisone, tacrolimus and UVB treatment to transplanting healthy pigmented skin cells to the affected areas. Nothing worked and the vitiligo actually got worse from all the treatments.

I studied pharmacy in Uppsala and graduated in 2002. During my years at university, I came into contact with the German dermatologist and skin researcher Karin Schallreuter, who was a professor at the University of Bradford and an expert on vitiligo (see video clip). This contact gave me the opportunity to carry out PhD studies in clinical and experimental dermatology with Schallreuter's team.

Based on the discovery of the "butterfly bioterins" in the vitiligo patches, Karin Schallreuter and her team developed a treatment to reduce oxidative stress in the skin. When the treatment was used, the melanocytes faded and started producing pigment again. Today I use NB-UVB activated pseudocatalase PC-KUS with very good effect, my face and legs have got 90% repigmentation. However, hands and feet are still difficult to treat.

This treatment was developed by Professor Schallreuter in 1995 and has since helped thousands of patients at three different locations: the Medical Clinic-The Dead Sea, the Institute for Pigmentation Disorders of V. Greifswald, Germany and at the University of Bradford, England. In 2006 I defended my thesis on vitiligo and obtained a PhD in experimental dermatology. Today I feel happy about my vitiligo and enjoy the white patches, although several of them have now completely disappeared. If I didn't have them, I probably wouldn't have the motivation I have, nor would I have experienced everything I have or met all the amazing people and researchers I have met over the years. 

If you are interested, please read the scientific publications on the treatment here.

/Johanna Gillbro

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Do not buy Pseudocatalase online!

Karin Schallreuter has currently treated 6000 patients with vitiligo with NB-activated pseudocatalase. Several years ago, a large pharmaceutical company bought the patent. A large clinical study was done where the composition of the cream was unfortunately changed during the study. This led to the results not being as expected. Because of this, psudocatalase is not commercialized today. Therefore, patients still need to go to the Institute for Pigmentary Diseases in Greifswald to receive treatment.

Several cosmetic companies sell creams online with the name pseudocatalse. Unfortunately, this is not the same composition as in the original cream and therefore does not provide the desired effect.

Contact: Institute for Pigmentation Disorders e.V. vitiligo@biotechnikum.de