vitiligo2
TRANSCRIPT
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VITILIGORESIDENTE MEDICINA INTERNA 2° UNIDAD MEDICA DE ALTA ESPECIALIDAD # 14ADOLFO RUIZ CORTINEZ
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Vitiligo. n engl j med 360;2
•Es una despigmentación de la piel que resulta de un proceso autoinmune dirigido contra de los melanocitos.
•Enfermedad monomorfa caraterizada por manchas acromicas e hipocromicas.
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EPIDEMIOLOGIA• Es el desorden despigmentario mas común.
• Afecta a un 0.38% de la población.
• Prevalencia de 0.5 – 1 % de la población mundial.
• Alta incidencia en India (8.8%), seguido de Mexico (2.4 – 4%) y japon (1.68%).
• Vitiligo no segmental tiende a ocurrir a cualquier edad, mientras que el segmental ocurre a edades mas jóvenes.
Vitiligo. n engl j med 360;2
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SEGMENTAL
NO SEGMENTAL
CLASIFICACION
Vitiligo. Vol 386 July 4, 2015
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Revised classification/ nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2012; 25: E1–13.
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Revised classification/ nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2012; 25: E1–13.
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Revised classification/ nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2012; 25: E1–13.
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Acrofacial
Mucosa
Generalizado Universal
Mixto
Revised classification/ nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2012; 25: E1–13.
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PATOGENESIS
The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force. Pigment Cell Res 2007;20:27 35.
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GENES IMPLICADOS EN EL VITILIGOPTPN22 CD80IL2R α CCR6GZMB NLRP1FOXP3 C1QTNF6
BACH2 CASP7IFIH1 TRIF
Six decades of vitiligo genetics: genome-wide studies provide insights into autoimmune pathogenesis. J Invest Dermatol 2012; 132: 268–73..
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Immunopathogenesis of vitiligo. Autoimmun Rev 2011; 10: 762–65.
ANTIGENOS DE SUPERFICIE IDENTIFICADOS EN VITILIGO
GP100MART1
TyrosinasaTyrosinasa relacionada a proteínas 1 y 2
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Innate immune mechanisms in vitiligo: danger from within. Curr Opin Immunol 2013;
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EVALUACIONExamen clínico
Identificar
fototipo de piel
Duración,
extension y
actividadDevelopment and validation of the K-VSCOR for scoring Koebner’s phenomenon in vitiligo/ non-segmental vitiligo. Pigment Cell Melanoma Res 2013; 26: 402–07.
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The Koebner phenomenon: review of the literature. J Eur Acad Dermatol Venereol 2002; 16: 241–48.
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The Koebner phenomenon: review of the literature. J Eur Acad Dermatol Venereol 2002; 16: 241–48.
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TRATAMIENTOInterrogator
io de la enfermedad
Escala de koebner
Identificar factores
ambientales
Evaluar la calidad de
vida
Identificar otras
enfermedades
Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A. Arch Dermatol 1997; 133: 1525–28
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Vitiligo as a systemic disease. Clinics in Dermatology (2014) 32, 430–434
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Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol 2013; 168: 5–19.
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EsteroidesInhibidores
de Calcineurina
• Primera línea de tratamiento
Fototerapia, Esteroide sistemico
Injertos y tratamientos
despigmentantes
Valerato de betametasonaPropionato de
clobetasol
Pimecrolimus Tacrolimus
NB UVB, PSOLARENO,
PUVADEXAMETAS
ONA
Segunda línea
Tercera línea
Injerto tisular – celular.
Monobenzona – metoxifenol
Laser y crioterapia
Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol 2013; 168: 5–19.
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Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol 2013; 168: 5–19.
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ESO ES TODO….