Vitiligo

VITILIGO, one of the types of skin discoloration; characterized by the development on one or several areas of the skin of achromatic spots of various shapes, sharply outlined and surrounded by a zone of hyperpigmentation, imperceptibly transitioning into normal skin [see separate table (Vol. IV, p. 759-760), Fig. 4]. The number of spots varies greatly and can reach many dozens, often located approximately symmetrically. Usually the development of V. spots occurs slowly and imperceptibly; cases of their rapid onset are also known. Usually V. spots grow slowly and may merge into wide fields, more rarely remain in statu, and even more rarely disappear spontaneously. Subjective sensations are absent. Sometimes along the edges of a large spot there are small, pinhead-sized depigmented specks within a hyperpigmented field; due to their growth and merging, the V. spot expands. Sometimes the development of achromia is preceded by persistent spotted erythema, and as it regresses, depigmentation forms - 'pink V.'. The hair within the V. spot either loses its color or retains its pigmentation. In summer, V. spots do not tan, making their outlines even more pronounced. The sensory and secretory functions of the skin usually do not suffer; less frequently, hypesthesia of the center and hyperesthesia of the periphery are observed (Konigstein). Histologically, within V. spots the skin is normal, only the pigment is absent in the cells of the basal layer. V. is observed in people of various races, sexes, and ages (more frequently in brunettes). V., undoubtedly, is only a symptom of skin disorders of various etiologies. V. can arise from local causes - injury, trauma, friction and pressure from bandages and corsets, resolution of a long-existing infiltrate of any etiology, such as papular or tuberculous syphilide, neurodermatitis, lichen planus, etc. In such cases, V. is persistent and purely local in nature. It is possible that 'pink V.' is the result of the regression of late persistent syphilitic erythema. More frequently V. is a consequence of disorders of the nervous system, either peripheral (as polyneuritis from intoxications or infections like leprosy), or central (in pachymeningitis, radiculitis, tabes, tumors of the spinal cord, etc.). Therefore, sometimes V. is located radicular and is accompanied by changes in the spinal fluid. Apparently, more frequently V. depends on endocrine-vegetative disorders, especially dysfunction of the thyroid gland. Proof of this is the frequent development of V. in patients with Basedow's disease, sometimes many years before the symptoms of Basedow's disease, the intensification of V. in proportion to the severity of the latter, the disappearance of V. with improvement of these symptoms, and its coincidence with alopecia areata, etc. Treatment is successful only in cases of proven syphilis or thyroid dysfunction in the patient. Local treatment is futile. A cosmetic effect can possibly be obtained by taking adrenaline internally and using the Kromayer lamp (Highmann). Lit.: Thibierge G., Sur les relations du vitiligo et de la syphilis, Annales de dermatologie et de syphiligraphie, v. VI, 1905: T o u r a i n e A., La ponction lombaire dans le vitiligo (Socifite francaise de dermatologie et de syphiligraphie, 13 Mars, 1919), Presse mfidicale, 1919, № 17; Peynet J., Dystro-pliie et dyschromie des formations fepidermoidales au cours du syndrome de Basedow, P., 1926; Lane .T., Vitiligo a. syphilis, Journal of the American med. association, v. LXXIII, № 1, 1919. G. Meshchersky. VI TIUM, VITIOSUS (Lat.-vice, vicious), a term used in pathology to denote various congenital and acquired pathological conditions with different natures, etiologies, and pathogenesis. Thus, one speaks of v. cordis, of circulus vitiosus, of developmental defects, etc. The common feature for these conditions is their relative stability, immutability in anatomical and functional relationships; however, often there is progression of the phenomenon, for example, of heart defects after endocarditis; more rarely - regression to complete loss of pathological significance (self-healing of cases of circulus vitiosus after gastro-enterostomy operation). The term 'developmental defect' (which means 'deformity') is not used in Latin transcription; only in relation to the heart is it also customary to speak of congenital defects of it (v. cordis congenitum). Under circulus vitiosus is meant a chain of causes and effects, mutually acting on each other and closing into some 'vicious circle'; thus, emphysema of the lungs leads to circulatory disorders in the small circle, which among other things causes strong hyperemia and hypersecretion of the bronchi; this hypersecretion, combined with infection, creates a picture of chronic bronchial catarrh; catarrh is accompanied by coughing jolts, and these latter increase the intra-alveolar pressure, and consequently the primary process, i.e., emphysema.