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Mauro Picardo (editor) - Vitiligo

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Mauro Picardo (editor) Vitiligo

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Vitiligo has been, until recently, a rather neglected area in dermatology and medicine. Patients complain about this situation, which has offered avenues to quacks, and has led to the near orphan status of the disease. The apparently, simple and poorly symptomatic presentation of the disease has been a strong disadvantage to its study, as compared to other common chronic skin disorders such as psoriasis and atopic dermatitis. Vitiligo is still considered by doctors as a non disease, a simple aesthetic problem. A good skin-based angle of attack is also lacking because generalized vi- ligo is clearly epitomizing the view of skin diseases as simple targets of a systemic unknown dysregulation (diathesis), re? ecting the Hippocratic doctrine. This view has mostly restricted vitiligo to the manifestation of an auto-immune diathesis in the past 30 years. Thus, skin events, which are easily detected using skin biospies in most other situations, have not been precisely recorded, with the argument that a clinical diagnosis was suf? cient for the management (or most commonly absence of mana- ment) of the patient. This book is an international effort to summarize the information gathered about this disorder at the clinical, pathophysiological and therapeutic levels. Its primary aim is to bridge current knowledge at the clinical and investigative level, to point to the many unsolved issues, and to delineate future priorities for research.

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Part 1
Defining the Disease
Mauro Picardo and Alain Taeb (eds.) Vitiligo 10.1007/978-3-540-69361-1_1 Springer-Verlag Berlin Heidelberg 2010
11. Historical Aspects
Yvon Gauthier 1
(1)
Service de Dermatologie, Hpital Saint-Andr, CHU de Bordeaux, France
(2)
Department of Dermatology, CHU Ibn Sina, Rabat, Maroc
Yvon Gauthier (Corresponding author)
Email:
Laila Benzekri
Email:
11.1
11.2
11.3
11.4
11.5
11.6
Core Messages
  • The term vitiligo was introduced in the first century of our era.
  • The mistaking of leprosy for vitiligo in the Old Testament under Zoorat or Zaraath is an important cause for the social stigma attached to white spots on the skin.
  • Modern photochemotherapy (PUVA) was an improvement of photochemotherapy practised in the ancient world with herbals containing furocoumarins.
  • The stigma historically associated with the disease has not disappeared, and information and educational programmes should be implemented to fight this problem, especially the fear of contagion.
The physician must know what his predecessors have known, if he does not deceive both himself and others
Hippocrates
11.1 Before Vitiligo: Understanding Old Terms Meaning White Skin Spots
Even though the term vitiligo appeared in the first century of our era, descriptions of the disease now known as vitiligo can be found in the ancient medical classics of the second millennium bc [).
Fig 111 Ebers papyrus Leipzig Museum Hundreds of years before Christ - photo 1
Fig. 1.1.1
Ebers papyrus (Leipzig Museum)
Hundreds of years before Christ, vitiligo was present in ancient Indian sacred books, such as the Atharva Veda (1400 bc) and the Buddhist sacred book Vinay Pitak (224544 bc). Atharva Veda gives a description of vitiligo and many achromic or hypochromic diseases under different names such as Kilasa, Sveta Khista, Charak. The sanskrit word Kilas is derived from kil meaning white. So kilas means which throw away colour; the term Sveta Khista was meaning white leprosy and vitiligo was probably confused with macular leprosy. The term Charak used by villagers means, which spreads or is secret. In the Buddhist Vinay Pitak, the term kilas was also used to describe the white spots on the skin [].
Descriptions of vitiligo and other leukodermas can also be found in other ancient Indian medical writings such as the Charaka Samhita (800 bc) (medicine), Manus mriti (200 bc) (law) and Amorkasha (600 ac) [].
Though vitiligo, the disease with white spots, was recognized in the ancient times, it was frequently confused with leprosy. Even Hippocrates (460355 bc) did not differentiate vitiligo and leprosy, and included lichen, leprosy, psoriasis and vitiligo under the same category. In the Old Testament of the Holy Bible, the Hebrew word Zora'at is referring to a group of skin diseases that were classified into five categories []: (1) White spots per se, interpreted as vitiligo or post-inflammatory leukoderma; (2) White spots associated with inflammation; (3) White spots associated with scaling; (4) White spots associated with atrophy; (4) White spots associated with the regrowth of white hairs.
Ptolomy II (250 bc) asked for a translation of the Hebrew Bible into Greek so that more people could understand the Bible. The word Zora'at' was unfortunately translated in Greek versions of the Bible as white leprosy (Leviticus Chap. XIII). According to modern dermatologists and theologians, biblical leprosy represented not a specific illness, but psoriasis or leukoderma and other disorders perceived to be associated with spiritual uncleanliness. Consequently, persons with white spots, independent of the cause, were isolated from the healthy ones [].
Bohak, baras, alabras are the Arabic names used to describe vitiligo. Baras means white skin. In the Koran (Surah The family of Imran ] in 1973 explained that alabras meant vitiligo. For this theologian, the aetiology of vitiligo in the Koran was unknown but inherited and not contagious.
Fig 112 In the Koran Surah the Table verse 109 The name vitiligo was - photo 2
Fig. 1.1.2
In the Koran: Surah the Table verse 109
The name vitiligo was first used by the famous Roman physician Celsus at the second century bc in his medical classic De Medicina. The word vitiligo has often been said to have derived from vitium (defect or blemish) rather than vitellus meaning calf [].
11.2 From Celsus to the Modern Period
Several studies in the late nineteenth century reported that there was a propensity for depigmentation in traumatized clinically normal skin of vitiligo subjects. There appeared to be a minimal threshold of injury, required for a depigmented patch to occur [) or true vitiligo?
Simultaneously, there have been many attempts to classify vitiligo, often with confusing results. Classi-fications have been based either on the distribution or localization of hypopigmented macules (focal, segmental, generalized), [].
Until now,specific pathomechanisms of vitiligo have not been identified, and the only highly characteristic feature, studied by light and electron microscopic study, was considered to be the partial or total absence of mel-anocytes in the epidermis. Although the initial cause of vitiligo remains unknown, there have been significant advances in our understanding of this disorder. Three main theories have been proposed successively. The neurogenic hypothesis suggested that a chemical could be released from nerve endings in the skin, which would induce melanocyte destruction [].
11.3 Social Status of Vitiligo Patients Across the Ages
The history of vitiligo reveals much information regarding the social stigma of patients suffering from this disease. In the Buddhist literature (624544 bc) we can read men and women suffering from the disease named Kilasa were not eligible to get ordain-ment . The social implication of this disease is also well documented in Rigveda (Indian book) persons suffering from switra and their progeny are disquali-fied from marrying others [].
Herodotus (484425 bc) in his book Clio, has written if a Persian has leprosy or white sickness he is not allowed to enter into a city or to have dealings with other Persians, he must have sinned against the sun. Foreigners suffering from this disorder are forced to leave the country; even white pigeons are often driven away, as guilty of the same offence .
In Leviticus (XIII, 34), white spot diseases are considered as a punishment sent by God: Anyone with these skin affections must wear torn clothes and have his hair dishevelled, he must conceal his upper lip, and call out unclean, unclean. So long the disease persists, he is to be considered virtually unclean and live alone outside the camp . During many centuries, the stigma of leprosy was strengthened by old edicts and cruel laws [].
In 1943, according to the initiative of Pope Pius XII and the American Catholic office, the church added the following note with reference to Leviticus XIII: Various kinds of skin blemishes are treated here, which were not contagious but simply disqualified their subjects from associations with others, until they were declared ritually clean. The Hebrew term used does not refer to Hansen's disease, currently called leprosy [].
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