CAMAGÜEY.- Vitiligo is a disease that causes the skin to lose pigmentation, it attacks the melanocyte (cell of the skin and eyes that produces and contains the pigment called melanin, that is, it gives color to the skin). It is still not known for sure what its cause is, although there are several theories such as a neurogenic one, which foresees the neural condition; the cytotoxic one, which conceives the toxins that the organism releases and affects the normal and physiological functioning of this cell to secrete this pigment; and another one based on genetic predisposition. It is even said that they all make a synergy so that the condition appears.
Upon learning that Dr. María Teresa Díaz Renón, Consultant Professor, specialist in Dermatology, Master in Natural and Traditional Medicine (MNT) and in Infectious Diseases, from the Manuel Ascunce Domenech University Hospital, was the principal investigator of the program related to the clinical trial planned for Melagenina Plus in adult patients we were interested in the condition.
She then delegated to Dr. Fidencio I. Vega Olivares, from Mexico, who is a specialist in Comprehensive General Medicine (MGI) and a resident of Dermatology at that hospital institution and very committed to the study because it is the argument of his specialty thesis. It was him who introduced today's topic, so I inquired:
— You already said that the causes of the condition are still unknown, but can it be hereditary?
— There is a 30% prevalence of it being hereditary. In our patients we found a family history in around two percent, but the conclusion is reached that there is a trigger that has a great influence with stress as a vital factor, and this conclusion is that it appears after an important event, such as: the loss of a loved one, a divorce, something tragic for the lives of these people and the skin manifestations begin.
— Could an event of this nature be a trigger in the face of a genetic predisposition?
- It happens like that sometimes. And other times they comment that their grandparents were never treated, but they suffered from spots on their skin and, of course, if they were never studied by a doctor, they don't know what it was.
— Are the lesions itchy or painful?
— No, but they can be seen, perhaps at the beginning those affected do not pay much attention, but when they observe that they begin to spread and, in addition, they feel stressed, who is not, it is very difficult to live without stress.
— In general, when do they go to the specialist?
— The lesions begin to proliferate and when they reach the face is when they worry the most.
"Within the study that we do due to the clinical trial, they are taken to the psychiatrist, to the psychologist, and to specialists in Natural and Traditional Medicine (NTM) and endocrinologists, the latter because there is a relationship with thyroid conditions and that is why within the complementary tests are ordered hormonal and enzyme release that are closely linked.
— Does this ailment have a sex predilection?
— It attacks both men and women. What happens is that women are more concerned with aesthetics and since it is a little more altered, then it tends to proliferate more in the female sex.
— Apart from aesthetics, does it affect other spheres of life?
- Yes. In fact, it even affects the sexual sphere, modesty triggers this difficulty; however, in man it is not like that, he is a little more indifferent to these matters, so those little spots proliferate less and may even disappear.
— Does it appear at any age or does it have a defined age group?
— It usually affects after the age of 30, but it has been seen that in recent decades the age has been getting shorter and it is found in adolescents, and even in children.
— Is there only one type of vitiligo and is it curable?
— No. There are several. There is one that is completely repigmented and does not reappear, while in other cases the skin re-pigments and after 20 or 30 years it reappears; and another one that does not tend to re-pigment in its entirety, but luckily this type only appears in one or two percent of patients.
— And if the cause is determined?
— It must be treated and in this way a treatment is focused towards reducing it.
— In this type of consultation it is not customary to mention the medications indicated in order to prevent people from taking or applying drugs on their own, something that we varied on this occasion with great justification, so what is the patient treated with?
— Here at "Manuel Ascunce"Hospital, Melagenina Plus is offered to patients free of charge. The patient who meets the inclusion criteria in the clinical trial is studied in this consultation, with only a lesion in another part of the body other than the face can already be inserted.
— How do those affected come to this consultation?
— Dr. María Teresa Días Renón coordinates with the specialists of the province and guides them so that when someone with these criteria is treated, they are referred and benefited. Here the appropriate complementary tests are indicated, including hormonal ones, then an informed consent form is given to the patient where every detail is explained and if they agree, they enter the trial, always knowing that they can withdraw if they decide so; if the patient gets pregnant, she leaves the program; or if a patient has unbalanced comorbidity due to the use of some medications such as steroids because they tend to modify the lesions and this does not allow us to measure the effectiveness of the medication, which is Melagenina Plus, produced at the Center of Placental Histotherapy. Every ten years this study is carried out in different provinces of the country.
— Is it the same Melagenina as the one used about 30 years ago and is it applied in the same way?
— The one that is being used is the Fourth Plus. With the first, which emerged 35 years ago, you had to put it on and expose yourself to the sun twice a day; when the second one appeared, the same was twice a day and you had to go to a center daily to receive Infrared Rays because that heat increases blood circulation, provides more oxygen and creates new nutrients that stimulate cell regeneration and tissue repair.
"The method of application was somewhat tedious and according to the studies it was improved, so Calcium was incorporated into the formula of the extract of human placenta with pigmenting factors and it was seen that it had a greater acceptance, it adhered better to favor the release of melanin helping the melanocyte to absorb more fluid from the placenta and another exploration was done in which the dose was regulated and applied once a day without the need to be exposed to the sun, thus there is greater efficacy and more well-being".
— What is the difference with the fourth one?
— It is to further regulate the dose of Calcium and also a single application, which is a relief for the patient and less stress at the time of treatment.
— What do you advise your patients?
— We have seen the improvement of our patients when they take a little effort and do not check themselves constantly. I advise you to stop worrying so much about the change in the lesions, this makes them improve, yes, they should continue their treatment and when they succeed, the re-pigmentation process begins.
"Every three months we measure the lesions using a system called the Vitiligo Air Surface Index, VASI, for its acronym in English, and it is very exact and difficult, this is how it is done internationally, plus a study of comparative photos every six months.
"The comparisons are favorable and the patient notices that there are islands of pigmentation within the lesion, however, he had not noticed it and that encourages him to continue."
— How has the effect been in general?
— There is no doubt that the effect has been beneficial, which is why in less than a quarter we almost reached the figure conceived for the entire year and always under strict control, it is very rigorous.
— And the acceptance of the patient?
— Very good because they see favorable results and that motivates them.
Translated by Linet Acuña Quilez