This dissertation examines the relevance of studying vitiligo, emphasizing its
prevalence among the world population (up to 2.8%). Vitiligo is classified as an
acquired chronic disease from the dyschromias group. This disease occurs in people
of all races and genders and can develop at any age, but is most often diagnosed
between the ages of 8 and 25. Although vitiligo is not life-threatening, it significantly
affects the quality of life of patients and their psycho-emotional state and can lead
to social maladaptation.
The factors leading to the sharp decrease in melanin synthesis and the death
of melanocytes, which underlie the development of vitiligo, are still debated. The
unclear mechanisms of vitiligo pathogenesis explain the therapy’s complexity.
Phototherapy widely used does not always lead to the expected result, and the need for
prolonged treatment with many procedures often leads to side effects and/or
complications (development of persistent erythema, hyperpigmentation in the
peripheral zone, premature aging, especially face location).
Cellular technologies have been widely used in clinical medicine in vitiligo
treatment in recent decades and have been reflected in a number of studies. In Ukraine,
this treatment method for vitiligo is not yet sufficiently covered.
The study aim to increase the effectiveness of vitiligo treatment by developing a
comprehensive pathogenetic therapy using narrow-band phototherapy 311nm and cell
(regenerative) technologies, taking into account the results of general clinical,
biophysical, morphological, and immunohistochemical studies.
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The scientific novelty of this dissertation research consists in the scientific
justification of a complex approach to the vitiligo treatment with the use of melanocytekeratinocyte suspension, automesoconcentrate and narrow-band UVB therapy,
specifically restoring the functions of keratinocytes and compensating for the loss of
melanocytes.
For the first time, the study identified specific biophysical abnormalities in
vitiligo-affected skin, including decreased hydration and changes in skin circulation.
Expanded and deepened knowledge about the development of vitiligo depending on
gender, age and concomitant pathology. Also, for the first time, indicators of the
histomorphological and histochemical condition of vitiligo skin in the dynamics
of treatment with the developed method in comparison with traditional treatment were
studied.
The practical value of the performed work consists in the development of a
complex and effective high-tech stepwise method of vitiligo treatment using cell
technologies and narrow-band UVB therapy, and the determination of a complex of
dermatological indices (VASI, VIDA , DLQI) to assess the degree of expressiveness
of the process and the subsequent effectiveness of vitiligo patients treatment.
The work is based on the results of diagnostics, treatment, and monitoring at the
Department of Dermatovenereology, Allergology, Clinical and Laboratory
Immunology of Shupyk National Healthcare University of MoH of Ukraine from 2019
to 2023. It includes 107 patients with vitiligo aged 19 to 65 years, including 45 men
and 62 women, who were diagnosed with the form, type, and stage of vitiligo,
Fitzpatrick skin type, duration of the disease, causes of onset and r relapses of vitiligo.
To determine the severity, prevalence, stability of vitiligo, the effectiveness of the
conducted therapy, and the impact of vitiligo on patients' quality of life, the following
dermatological indices were used: VASI, VIDA, DLQI. All patients underwent
a comprehensive examination including complete blood count, biochemical blood
analysis, thyroid function test, comprehensive immunological study, morphological,
immunohistochemical, and morphometric studies of vitiligo areas, ultrasound
examination of vitiligo skin, as well as evaluation of moisture, Dopplerography,
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dermoscopy of the skin with vitiligo. The study was conducted before the start of
treatment and 16 weeks after the start of treatment in accordance with the principles
of bioethics set out in the Helsinki Declaration of the World Medical Association –
"Ethical Principles for Medical Research Involving Human Subjects" and the
"Universal Declaration on Bioethics and Human Rights" (UNESCO).
The comparative gender-based clinical-epidemiological analysis of vitiligo
characteristics in the studied group of patients revealed that individuals of active
reproductive age (19-39 years) predominated – 63 (58.9%) patients. Stress was most
often the triggering factor for vitiligo – in 48 (44.9%) patients, more often in men than
in women – 23 (51.1%) and 25 (40.3%) patients, respectively; skin damage – in 26
(24.3%) patients, also more often in men than in women – 13 (28.9%) and 13 (21.0%)
patients, respectively.
