Vitiligo – this is a violation of skin pigmentation, which has been known since ancient times, however, the attitude to this condition even now remains controversial. Society still often refuses to accept people with different skin pigmentation. Therefore, patients with vitiligo seek medical help, while ignoring any possible consequences of therapy. Doctor of Medical Sciences, Head of the Department of Dermatology and Venereology of the Azerbaijan State Institute for Advanced Training of Doctors, a member of the Society of Dermatovenereologists of Moscow, Turkey, Georgia, spoke about modern protocols for the treatment of vitiligo, as well as about the psychological aspects of working with patients with vitiligo, especially for estet-portal.com and the Eurasian Dermatological Society, member of the International Society of Dermatology, Doctor of Dermatovenereology Sanan Kerimov.
What social problems do people with vitiligo have to face?
Most often, such patients go to the doctor during the transitional periods of life: when the child goes to kindergarten, school, during puberty, when the children themselves demand to be taken to the doctor, before starting their studies at the university, or before marriage . Thus, we see that it is not the disease itself that causes anxiety for patients, but the psychological tension provoked by society.
It is very important to do social work, letting people know that vitiligo – this is absolutely normal.
Vitiligo has been known since ancient times, the first descriptions of it can be seen on papyri and in the Koran. And despite all this, there are still restrictions regarding people with vitiligo both in the East and in Europe.
Tell us what is the 2014 Vitiligo Treatment Guideline?
This guideline was an attempt to create some kind of algorithm for the treatment of vitiligo. Practitioners, especially younger ones, often find themselves unable to choose which treatment to give to a patient with vitiligo. They immediately go to extremes, prescribing biologics or stem cell therapy. We must understand that there are many other methods that will provide the patient with the same effect, but with fewer complications. Complex methods – it's always more side effects. Personally, when there is no medical necessity, I always try to get patients away from therapy. You need to try to psychologically adjust the person, explain that he will live another 100 years with vitiligo, however, treatment in the form of photo- or photochemotherapy can harm him. To be treated or not – the patient decides but our task is to notify him of all possible side effects.
How do you feel about the use of retinoids for the treatment of vitiligo?
Retinoids are good drugs for the treatment of vitiligo. I have nothing against their local use, but systemic use, which has recently become more popular – raises a lot of questions and concerns. I suggest everyone give up our medical ambitions: I must cure. First ask yourself - should I? At the same time, damaging the patient's liver, his kidneys and other organs. When prescribing retinoids, immunosuppressors, glucocorticoids, we always run the risk of unexpected liver destruction, hepatitis with cirrhosis. We must warn a person about these risks, but whether the game is worth the candle is up to the patient to decide. I do not refuse the treatment of vitiligo, however, I demand that the choice "to be" or "not to be" man did it himself
What other diseases are most commonly associated with vitiligo?
Vitiligo – it really is a marker. People with this disease should definitely be examined, since more than 30 other pathologies are combined with vitiligo. Most often, these are autoimmune diseases, for example, autoimmune thyroiditis, scleroderma, systemic lupus erythematosus, psoriasis, atopic dermatitis. When a patient with vitiligo turns to a doctor, it is extremely important, first of all, to conduct a full examination of this person, and if there are medical indications – be sure to treat. But in this case, we are no longer treating vitiligo itself, but a much more serious disease.
How do you personally prefer to work with patients with vitiligo?
Personally, I am in favor of a longer chronic treatment of these patients with antioxidants and trace elements, the deficiency of which is almost always observed in people with vitiligo.
I prefer long-term therapy with topical corticosteroids and topical biologics such as calcineurin inhibitors.
The main principle in the treatment of vitiligo is to do no harm. I do not think that any doctor will be happy to provide a patient with good pigmentation, while rewarding him with cirrhosis of the liver.
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