Nursing Assessment, Management and Treatment of Autoimmune Diseases
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● Self-destruction : A defect in the melanocytes causes them to self- destruct. Complications Because of the lack of melanocytes, af- fected skin is more sensitive to the sun’s rays than normal skin and will burn easily instead of tan. People with vitiligo may have retinal abnormalities that cause in- flammation of the retina or iris, but vision is typically not affected. Patients with vit- iligo may be more likely to develop other autoimmune diseases. Finally, changes in appearance caused by vitiligo may cause embarrassment and anxiety. Patients may face bullying or rude questions. Such fac- tors may lead to anxiety, excessive stress, and depression (Cleveland Clinic, 2020). Assessment and diagnosis The disease is often recognized from its physical appearance. A history and phys- ical is performed, and a skin biopsy may be taken to confirm diagnosis or to differ - entiate vitiligo from other skin conditions (Mayo Clinic, 2020d). Healthcare providers will also assess pre- senting signs and symptoms to make a diagnosis. Signs include the following (Mayo Clinic, 2020d): ● Patchy loss of skin color that usually first appears on the hands, face, and areas around body openings and genitalia. ● Premature whitening or graying of hair on the scalp, eyelashes, eyebrows, or beard. ● Loss of color in the mucous membranes of the mouth. Treatment There is no cure for vitiligo. The goal of treatment is to create a uniform skin tone by either repigmentation or by eliminat- ing remaining color (depigmentation).
Predicting the progress of the disease is difficult. The patches may stop forming without treatment. In most people, pig- ment loss spreads, eventually involving most of the skin (Mayo Clinic, 2020d). Figure 9 shows how a loss of pigmenta- tion looks. Figure 9. Vitiligo
Note . Heilman, 2015.
| NURSING CONSIDERATION
Patients have varying amounts of skin affected by vitiligo. Some people have few depigmented areas, while others experience widespread loss of skin color (Cleveland Clinic, 2020). Etiology The exact cause of vitiligo is unknown. However, experts propose several theo- ries about why it develops, including the following (Cleveland Clinic, 2020): ● Autoimmunity : Autoimmunity is the destruction of melanocytes by the body’s immune system. ● Genetics : About 30% of vitiligo cases run in families. ● Neurogenics : A substance toxic to melanocytes may be released at nerve endings in the skin.
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