1. Kena
Roots

2.  Chronic skin disease
 Other name = Leukoderma
 White spots occur when the skin
no longer forms melanin
(pigment that determines the
color of your skin, hair, and eyes)
 The white patches of irregular
shapes begin to appear on your
skin

3.  White patches of skin
 Whitening or graying of the hair on your
scalp, eyelashes, eyebrows or beard
 Loss of color in the tissues that line the
inside of your mouth
 Loss or change in color of the inner layer of
your eye

4.  Chalk white color
 Convex margins
 5mm to 5cm or
more in diameter
 Round, oval, or
elongated in shape
AVRF

5.  Focal pattern—the depigmentation is limited
to one or only a few areas
 Segmental pattern—depigmented patches
develop on only one side of the body
 Generalized pattern—(most common)
depigmentation occurs symmetrically on both
sides of the body
 Focal and segmental patterns do not spread.
The generalized pattern is hard to predict and
can randomly stop

6.  Can appear at any age, usually first appears
between the ages of 20 and 30
 White patches may begin on your face above
your eyes or on your neck, armpits, elbows,
genitals, hands or knees
 1-100 of the world population develops
 Affects both genders and all races equally

7.  When no melanin is
produced, the involved patch
of skin becomes white
 When a white patch grows or
spreads the cause may be
Vitiligo
 Exact cause is unknown
 May be due to an immune
disorder, heredity, or
environmental causes like
sunburn or emotional
distress that trigger the
condition

8.  A family history of  Premature graying of
vitiligo the hair (before age 35)
 Look to see if there is a  Stress or physical
rash, sunburn, or other illness
skin trauma that has
occurred within 2 or 3  Also they may ask for
months after an eye examination
pigmentation was (inflammation of your
discovered eye) and/or blood test
(autoimmune disease)

9. Vitiligois difficult to treat
Early treatment options include:
 Exposure to intense ultraviolet light, such as narrow-band
UVB therapy
 Medicines taken by mouth such as trimethylpsoralen
(Trisoralen)
Medicines:
 Corticosteroid creams
 Immunosuppressants such as pimecrolimus (Elidel)
and tacrolimus (Protopic)
 Repigmenting agents such as methoxsalen (
Oxsoralen)

10.  The use of steroid creams may be helpful in returning the
color to the white patches
 Doctors often prescribe a mild topical corticosteroid cream
for children under 10 years old and a stronger one for
adults
 Cream must be applied to the white patches on the skin for
at least 3 months before seeing any results
 Corticosteriod creams are the simplest and safest
treatment for vitiligo, but are not as effective as psoralen
photochemotherapy
 SIDE EFFECTS occur in areas where the skin is thin, such
as on the face and armpits, or in the genital region
› They can be minimized by using weaker formulations of steroid
creams in these areas.

11.  Topical
Calcineurin
Inhibitors RDNL

12. AVRF

13.  Most effective treatment
available in the United States.
 PUVA therapy is to repigment the
white patches
 time-consuming, and care must
be taken to avoid side effects
 Psoralen is a drug that contains
chemicals that react with
ultraviolet light to cause
darkening of the skin.
 Psoralen is injected orally or is
applied to the skin
 Then skin is carefully timed
exposure to sunlight or to
ultraviolet A (UVA) light that
comes from a special lamp.
WWHT Dermatology

14.  Used for children 2 years old and older who have small number white spots in
a few areas
 Treatments are done under an artificial UVA light once or twice a week.
 Psoralen is applied to your depigmented patches about 30 minutes before
exposing you to enough UVA light to turn the affected area pink.
 The doctor usually increases the dose of UVA light slowly over many weeks.
 Eventually, the pink areas fade and a more normal skin color appears.
 SIDE EFFECTS:
› (1) severe sunburn and blistering
› (2) too much repigmentation or darkening (hyperpigmentation) of the
treated patches or the normal skin surrounding the vitiligo.
 For people with extensive vitiligo (affecting more than 20 percent of the body)
or for people who do not respond to topical PUVA therapy
 Not recommended for children under 10 years of age because it increases the
risk of damage to the eyes caused by conditions such as cataracts.
 You take a prescribed dose of psoralen by mouth about 2 hours before
exposure to artificial UVA light or sunlight.
 Treatments are usually given 2 or 3 times a week, but never 2 days in a row.
For patients who cannot go to a facility to receive PUVA therapy, the doctor
may prescribe psoralen that can be used with natural sunlight exposure.
 SIDE EFFECTS include:
 Sunburn, nausea and vomiting, itching, abnormal hair growth, and
hyperpigmentation.
 May also increase the risk of skin cancer,

15.  Used for people with small patches of vitiligo
 The doctor removes sections of the normal, pigmented
skin and places them on the depigmented areas
 Infections may occur at the donor or recipient sites
 The recipient and donor sites may develop scarring, a
cobblestone appearance, or a spotty pigmentation, or
may fail to cure the white spot area
 Takes time and is very costly
 Doctor creates blisters on your pigmented skin by
using heat, suction, or freezing cold
 The tops of the blisters are then cut out and
transplanted to a depigmented skin area
 SIDE EFFECTS: scarring and lack of repigmentation
 Less risk of scarring with this procedure than with
other types of grafting.

16.  Implanting pigment into the skin with a special surgical instrument
 Works best for the lip area, particularly in people with dark skin
 Difficult to match perfectly the color of the skin of the surrounding
area
 The tattooed area will not change in color when exposed to sun, while
the surrounding normal skin will.
 Tattooing tends to fade over time
 Also tattooing of the lips may lead to episodes of blister outbreaks
caused by the herpes simplex virus
 Takes a sample of your normal pigmented skin and places it
in a laboratory dish containing a special cell-culture solution
to grow melanocytes.
 When the melanocytes in the culture solution have
multiplied, the doctor transplants them to your depigmented
skin patches
 Currently experimental and is impractical for the routine care
of people with vitiligo
 Very expensive and its side effects are not known.

17.  Blue Lizard Baby&
Sunscreen Sensitive Sunscreen
 Helps protect the skin
from sunburn and long-
term damage
 Minimizes tanning,
which makes the
contrast between normal
and depigmented skin
less noticeable
AVRF

18.  Some vitiligo patients cover depigmented patches with stains, makeup, or self-tanning
lotions.
 Dermablend, Lydia O’Leary, Clinique, Fashion Flair, Vitadye, and Chromelin offer makeup or
dyes that you may find helpful for covering up depigmented patches
 Self tanning lotions have an advantage over makeup in that the color will last for several
days and will not come off with washing.
AVRF

19. April
AVRF

20. SUPPORT
organizations
1)National Vitiligo Foundation
2)Vitiligo Support International
3)American Vitiligo Research Fou

21.  Nation Library of Medicine (Medicine Plus)
 American Vitiligo Research Foundation
 National Institutes of Health, Department of Health and Hum
: National Institute of Arthritis and Musculoskeletal
and Skin Diseases
 Drugs.com (Treatments)
 youtube.com (Lee Thomas- Turning White 20/20
Interview)
 National Vitiligo Foundation (video gallery-Elizabeth
Vargas Interview)

22.  National Vitiligo Foundation
 American Vitiligo Research Foundation Inc.
 Visualdxhealth
 Revolution Health
 WWHT Dermatology
 Elidel
 National Vitiligo Foundation
 Vitiligo Support International

23. Kids coping with Vitilig
Lee Thomas
Elizabeth Vargas Interv

25. Ingredient Main active substance Action
Coconut oil is the only
type of oil that one
Coconut oil contains should use on one‘s
essential saturated skin for it is absorbed
and unsaturated fatty easily and keeps the
Cocos nucifera oil acids, High skin soft. Coconut oil
concentration of contains Vitamin E
Vitamin E and K, high Alpha Tocopherol. This
concentration of Zinc kind of Vitamin is a
.and Iron well-known potent
antioxidant and is
.beneficial to the skin

26. Ingredient Main active Action
substance
Psoralea corylifolia Psoralea corylifolia Psoralea corylifolia appears to have
a purely local action with a specific
extract contains flavons, effect on the arterioles of the
subcapillary plexuses, which are
isoflavons, dilated so that the plasma is
furanocoumarins, increased in this area. The skin
becomes red and the melanoblasts
chalcones and )pigment-forming cells( are
stimulated. In leukoderma,
coumesterol group of melanoblasts do not function
compounds which properly and their stimulation by the
drug leads them to form and
includes psoralen, exudate pigments, which gradually
diffuse into the white leukodermic
isopsoralen and patches.] Also, the phytochemically
.bavichinin2 induced covalent binding of the
drug to pyrimidine bases is
responsible for its therapeutic
effect. The photoconjunction
involves thymine dimer adducts on
the opposite strands of DNA.
Psoralen has been found to
intercalate into DNA, where they
form mono- and di-adducts in the
presence of long wavelength UV
light and thus are used for the
treatment of hypo-pigmented
lesions of the skin, such as
.leukoderma

27. Ingredient Main active substance Action
Barberry includes such
alkaloids as
berbamine, berberine,
oxyacanthine, resin
and tannins, and Barberry root has
Berberis vulgaris root chelidonic acid. antioxidant and
extract Barberry Root also cytoprotective
constituents the B- .properties
vitamin thiamine,
vitamin C, lutein,
zeaxanthin, the
carotenoids beta-
carotene, chromium,
.zinc, and cobalt

28. Ingredient Main active substance Action
Picrorhiza kurroa was
found to be a potent
immunostimulant of
Picrorhiza kurroa root both cell-mediated
Picrorhiza kurroa root extract contains and humoral immunity.
extract Kutkin, D-Mannitol and picrorhiza was
Vanillic acid reported to stimulate
cell mediated and
humoral components
of the immune system
including stimulation of
.phagocytosis

29. Ingredient Main active substance Action
Powerful and broad
spectrum anti-
Melaleuca Alternifolia Terpineol ,Cineol, microbial agent )Anti-
)TeaTree( Leaf Oil Pinene ,Terpinenes bacterial, anti-fungal
and anti-mycotic
agent(, and it has an
immune system
stimulant effect

30. Ingredient Main active substance Action
Used by the Aboriginal
people of Australia for
the treatment of
muscle and joint pain,
contains a variety of
Emu oil Linolinic acis and fatty acids. Modern
Oleic acid research into the
properties of emu oil
has found that this is
the greatest skin
emollient in the world,
with deep skin
penetration properties
better than any other
.natural oil

31. Ingredient Main active substance Action
)Vitamin E )Tocopherol Alpha-tocopherol Powerful anti-oxidant
agent

32.  Natural pathway for PUVA therapy.
 Rich source of natural powerful anti-
oxidants.
 Rich source of essential minerals and
vitamins for vitiligo patients.
 Safe with minor side effects.
 Cost effective.

33. Great thanks for your listening
Kena Roots for therapeutic cosmetics
Dr. Hani Malkawi