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Yıl:2005; Cilt: 18; Sayı: 1>> Özet
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Düşünen Adam: Psikiyatri ve Nörolojik Bilimler Dergisi; 2005;18(1):21-31
Vitiligonun psikiyatrik yönü
M Sukan, F Maner, M Tosun
Bu derleme yazısında cildiye ve psikiyatrinin ortak konusu bir hastalık olan vitiligoda sosyodemografik, klinik özellikler, psikolojik etkiler ve tedaviye ilişkin yazın gözden geçirilmiştir. Cilt ve psişe aynı embriyonik kökeni paylaştığı için, psikolojik etmenler çeşitli cilt hastalıklarının başlangıcını ve alevlenmesini etkileyebilmektedir. Vitiligo toplumun % 1-4'ünü etkileyen, yaygın, kazanılmış, depigmente edici bir bozukluktur. Beyaz Leke Hastalığı, lökoderma ve beyaz lepra olarak da adlandırılmaktadır. Sebebi ve gelişimi tam olarak bilinmemesine rağmen otoimmün, nöral ve özyıkım kuramları öne sürülmektedir. Günümüzde en geçerli olanı, melanosit özyıkım varsayımıdır. Vitiligonun ileri safhasında melanositlerin yıkımı ortaya çıkmaktadır. Bu yıkıma melanosit reseptörlerinin aktivasyonu sonucu melanogenez düzeninin bozulması neden olur. Hastalığı tetikleyici etmenler olarak ciddi güneş yanıkları, mantar ve bakteri enfeksiyonları, yineleyici travma ve emosyonel stres vurgulanmıştır. Vitiligo lezyonları utanma, öfke, kaygı, engellenme, sosyal geri çekilme, hayal kırıklığı, damgalanma duygusu, sosyal, iş, okul yaşamında aksamalara, karşı cinsle ilişki sorunlarına ve cinsel sorunlara neden olabilmektedir. Vitiligo hastalarında, dermatolojik tedaviyle birlikte, psikotrop ilaç tedavisi, psikoterapi önemli olup, dermatolog ve psikiyatrist işbirliğinin en etkili tedavi yaklaşımı olduğu gözlenmektedir.
Psychiatric Aspect of Vitiligo: A Review
In this article, literature has been reviewed about the sociodemographical, clinical features, psychological impact and treatment in a psychocutaneous disorder, vitiligo. The skin and psyche share embryonic origins so psychological factors may affect the onset and progression of various skin conditions. Vitiligo is a common, acquired and depigmentating disorder which has a prevalence 1-4 % in general population. It is also named as White Spot Disease, leucoderma and white leprosis. Although patogenesis of vitiligo is not accurately known, otoimmune, neural and self-destruction theories have been proposed. Currently, the most valid theory is self-destruction of melanocytes. In the terminal phase of vitiligo, the self-destruction of melanocytes occurs. Melanogenesis disregulation which is caused by the activation of melanocyte receptors leads to this destruction. Severe sun burns, mycotic and bacterial infections, repeated trauma and emotional stress have been emphasized as precipitating factors in vitiligo. Vitiligo lesions may lead to the feeling of shame, rage, anxiety, frustration, social isolation, disappointment, stigmatization and patients experience troubles in social, professional and school life, problematic relations with opposite sex and sexual problems. Psychotropic medications and psychotherapy together with dermatological therapy in the treatment of vitiligo patients and the collaboration of dermatologists and psychiatrists are crucial.

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