a puneet group presentation
DESCRIPTION
A Puneet Group Presentation. Vitiligo - A social stigma. Light! Did you say Light! The patch looks lovely bright Soon the white patch Grows and spreads The sun makes it A little red, how can Vitiligo Harmless, not even skin deep Can cause a trauma so deep?. VITILIGO. - PowerPoint PPT PresentationTRANSCRIPT
A Puneet Group Presentation
LIGHT! DID YOU SAY LIGHT!THE PATCH LOOKS LOVELY BRIGHT
SOON THE WHITE PATCHGROWS AND SPREADSTHE SUN MAKES ITA LITTLE RED,HOW CAN VITILIGOHARMLESS, NOT EVEN SKIN DEEPCAN CAUSE A TRAUMA SO DEEP?
Vitiligo - A social stigma
VITILIGO
Chronic skin disease occurring worldwide in about 1% of the population, mostly between the age of 10-30
White spots occur when the skin no longer forms melanin (pigment that determines the color of your skin, hair, and eyes)
White patches of irregular shapes begin to appear on skin
Total absence of melanocytes microscopically
CLINICAL FEATURES Totally amelanotic macule (patch) surrounded by
normal skin Vitiligo macules characteristically have fairly
discrete margins and they are round, oval or linear in shape
Lesions enlarge centrifugally over time, but the rate may be slow or rapid
Vitiligo macule patches ranges from millimeter to centimeter in size
DISTRIBUTION PATTERN OF VITILIGO
Focal
•a few isolated lesions
Segmental
•unilateral distribution
Vulgaris
• fingers and around mouth
Universal
• total depigmentation
SUB TYPES OF VITILIGO Differ by anatomical location, and size of lesions
Focal• A few isolated lesions, most common in children
Segmental• Unilateral distribution
Acrofacial • Fingers and periorificial areas
Universal• Almost total depigmentation
Mucosal• Depigmentation of only the mucous membrane
GENERALIZED• Most common, symmetrical distribution, occurs
symmetrically on both sides of the body
VITILIGO CAUSE- MELANOCYTE DESTRUCTION
1. Stress to the skin in form of wound, burn, excessive sun exposure or contact with bleaching phenol
2. Differential gene expression among melanocytes
3. Inflammatory infiltrate of T cells & macrophages
4. Further induce melanocyte apoptosis
WHY IS THE TREATMENT IMPORTANT??? Vitiligo - not harmful medically, but
emotional and psychological effects can be devastating.
Affects self-esteem. Women, are sometimes discriminated against
in marriage. Developing vitiligo after marriage can be
grounds for divorce. People suffering from vitiligo feel
embarrassed, depressed, or worried about other people’s reaction.
THE PRIMARY GOAL OF VITILIGO THERAPY IS TO REPIGMENT THE AFFECTED SKIN. HOWEVER, IT IS NOT ALWAYS POSSIBLE.
In such cases , depigmentation is the only available option
WHERE DE-PIGMENTATION THERAPY REQUIRED
Patients with widespread and extensive vitiligo with body surface area(BSA)>50%, who desire permanent matching of skin colour, and where the probability of achieving cosmetically significant repigmentation is low. Generally it can be considered if vitiligo involves more than 60% to 80% of BSA.
Patients with less extensive disease (30-50% BSA) who have progressive disease or have shown resistance to standard therapies for repigmentation.
Vitiligo extensively involving cosmetically sensitive areas of face and hands where covering cosmetics are ineffective, although it is unusual to treat only the exposed sites.
Vitiligo involving areas known to be resistant to treatment, e.g. hands, malar areas.
LIST OF DEPIGMENTING AGENTS
• MONOBENZONE• 88% phenol,• Laser,• cryotherapy
First line agents
• Imatinib• Imiquimod• diphencyprone
Second line agents
• Hydroquinone, 4-Ethoxyphenol,4-methylcatechol,
• Catechol, • IFN-gamma,• Busulfan,• Vaccines using melanoma associated antigens etc
Experimental agents
COMPOSITION:-MONOBENZONE USP…..20% W/W CREAM BASE…………..Q.S.
MONOBENZONE
Monobenzyl ether of hydroquinone (MBEH) Chemical Name: P- (Benzyloxy) - Phenol Acts as a skin sensitizer Topical application decreases the excretion of
melanin from melanocytes in animal Depigmentation spreads to distant sites
unexposed to Monobenzone Progressive systemic reaction against
melanocytes
MECHANISM OF ACTION
INHIBITS
TYROSINE
MELANOCHROME
MELANIN
Tyrosinase
MONOBENZONE IS THE MOST WIDELY USED DEPIGMENTING AGENT
LIMITATIONS OF OTHER DEPIGMENTING AGENTS
• Requires longer time prior to the onset of visible depigmentation4-Methoxy Phenol
• large areas applications proved to be toxic to Liver and Kidney.
• Cardiovascular shock, cardiac arrythmias, bradycardia as well as metabolic acidosis
88% Phenol
• Painful & expensive technique• Available only at hospitals.Different type of lasers
• Hospital based treatment.• It gives edema, pain and bulla formation as
side effects.• Not suitable for extensive vitiligo
Cyro therapy
• Require further investigationTopical Imatinib, Imiquimod and Diphencyprone
EFFICACY OF MONOBENZONE THERAPY
Residual patches of vitiligo affecting more than 70% of her skin surface
Depigmentation after topical application of 20% Monobenzone daily after 8 months
Pigment Cell Melanoma Res. 22; 42-65. REVIEW ARTICLE Update on skin pigmentation therapies in vitiligo. Rafael Falabella and Maria I. Barona. Page No. 11
ADMINISTRATION: Apply a thin layer of to the normal
coloured skin area which requires depigmentation usually two to three times daily or as directed by physician. There is no recommended dose for children under 12 years of age except under the advice and supervision of a physician.
It may take up to 4 months before the full benefit of this drug takes effect. Once the desired skin colour is achieved, this medication is applied only as needed to maintain the new skin colour (usually 2 times a week).Use cream regularly to get the most benefit from it. Inform the doctor if your condition persists or worsens after 4 months.
SIDE EFFECTS OF MONOBENZONE Mild burning, Irritation, Redness, Cracking, or Peeling of the treated skin may occur. If any of these effects persist or worsen,
doctor needs to be informed.
PRECAUTIONS This medication is for use on the skin only.
cream should be applied with a patch test for 48 h to detect hypersensitivity.
Avoid application of to the eyelids and areas close to the eye.
Avoid getting this product in your eyes or on the inside of your nose or mouth. If the cream is accidentally applied in these areas, flush with plenty of water.
After using this medication, the skin will be permanently affected and sensitive to sunlight. Avoid prolonged exposure to sunlight. Always use a sunscreen of SPF 15 or greater, and wear protective clothing when outdoors.
ALBAQUIN TREATMENT EFFECTS As a depigmenting agent, Monobenzone
lightens up the pigmented areas and matches them with the white patches arisen out of Vitiligo skin disorder and can provide following effects to the patients :
Permanently depigmented skin Produce an even tone Match the skin around the vitiligo patches to a
uniform light colour Create a feeling of normalcy for the patient
BRINGS ABOUT PERMANENT DE PIGMENTATION
Only drug used worldwide as a depigmentation therapy for vitiligo
Safe and well tolerated No toxicity to liver or kidney Permanently lightens skin
IDEAL THERAPY FOR UNIFYING SKIN COLOUR
FOR FURTHER DETAILS CONTACT
PUNEET LABORATORIES PVT.LTD.605 Raheja Plaza , B wing,
LBS Road, Ghatkopar (West), Mumbai 400086, India.TEL. 91-22-61367000
Division Head : Mrs. Rashmi Jain
Customer Care : 18002096261E-MAIL : [email protected]
VISIT US AT: www.albaquin.com