백반증의 임상적 고찰 및 병원론적 분류에 따른 비교연구

Abstract

[한글]

백반증은 전 인구의 1 내지 2%에서 밭생하며 아직까지 병원론적 기전(pathogenic mechanism)이 명확히 밝혀지지 않은 저색소성 피부질환이다.

연구자는 연세대학교 의과대학 세브란스병원 백반증 특수크리닉에 내원한 1315명의 백반증 환자들을 대상으로 임상적 고찰을 시행하고, 병원론적 분류에 따라 구분한 비분절헝과 분절헝 백반증환자들의 임상적 특성을 비교연구하여 다음과 같은 결과를 얻었다.

1. 조사 대상환자 1315명 중 남자는 609명(46.3%), 여자는 706명(53.7%)이었다.

2. 대상환자들을 임상적으로 분류하먼 전신형이 50.2%, 국소형이 49.7%, universal type이 1명이었고, 병원론적 분류시 분절형이 203명(15.4%)이고 비분절헝은 1112명(84.6%)이었다.

3. 평균발병연령은 21.9세(남자 : 20.7세, 여자 : 22.9세)이며 내원평균연령은 27.8세(남자 : 26.7세, 여자 : 28.8세)였고, 펑균이환기간은 6.0년이었다. 25세 이전에 발병한 환자가 전채의 62.9%를 차지하였으며, 호발 연령군은 6-15세군(30.4%) 이었다

4. 초발병병은 76.8%가 단발병소로 나타났으며 71.1%가 노출부에 발생하였다. 초발 부위로는 얼굴(24.5%)이 가장 빈도가 높았으며 얼굴부위에서는 특히 이마 (19.2%)에 많이 나타났고 여자(24.4%)는 남자(12.1%)에 비해 목부위의 초발병변 발생이 많았다.

5. 내원시 환자의 73.6%가 병이 진행 중이였으며, 일부 환자에서 소양감(9.6%) 또는 작열감(0.8%)의 증상을 보였다.

6. 가장 흔한 유발인자는 외상(44.1%)이었고 다음으로는 정신적 긴장, 일광화상, 일광조사, 염증, 임신 및 출산과 피임제 순이었으며, 일광조사는 병변의 악화와 완화에 모두 관련이 있었다.

7. 가장 빈도가 높았던 내원 전 치료법은 국소 스테로이드제 도포법(46.8%)이었다.

8. 전체 환자의 27.0%에서 백모증이 나타났으며 가족럭은 12.2%, 계절에 따른 악화가 15.4%에서 그리고 Koebner's 현상이 18.0%에서 관찰되었다.

9. 병변의 평균침범범위는 7.3%(남자 : 7.6% 여자 : 7.0%)로 남녀 모두 5%이하 침범군(71.6%)이 가장 많았다.

10. 분절형은 비분절형에 비해 백모증의 발생빈도가 높고(81.7% : 21.0%) 통계학적으로 의의있게(p<0.05) 발병연령 및 내원연령이 낮고 이환기간이 짧은 임상적 특성을 보였으며 비분절형에서는 분절헝보다 면연학적 또는 알러지성 병인을 암시하는 질환들과 높은 연관성을 가져 두 군의 발병에는 서로 다른 병원론적 기전이 관련됨을 추측할 수 있었다.

Clinical study of vitiligo and comparative study of type A and type B vitiligo

Min Seok Song

Department of Medical Science The Graduate School, Yonsei University

(Directed by professor Yoon-Kee Park)

This is an analysis of 1315 vitiligo patients who had vested vitiligo special

clinic in Severance Hospital. In addition, comparative clinical study of

non-segmental type(type A) and segmental type(type B) vitiligo patients to

investigate the hypothesis concerning the pathogenesis Of vitiligo was done.

The results are summarized as follows:

1. There were 609 Hales(46.3%) and 706 females(53.7%).

2. There were 660 cases(50.2%) of generalized type, 654 cases(49.7%) of localized

type and one case of universal type vitiligo. Among them 203 cases(15,4%) were

non-segmental tyre and 1112 cases(84.6%) were segmental type.

3. The mean age of onest was 21.9 years (male: 20.7, female: 22.9) and the mean

age of visit was 27.8 years (male: 26.7, female: 28.8) .

4. Mede of onset was single in 75.8%.

5. The most common site of initial involvement was face(24.5%), especially the

forehead(19.2%), and the neck was more commonly involved in female(24.4%) than in

male(12.1%).

6. The disease was progressive in 73.6% of patients at the visit.

7. Pruritus(9.6%) and burning sense(0.8%) were observed in some patient.

8. The most common precipitating factor was trauma(44.1%) .

9. The most common previous treatment was topical steroid therapy(46.8%) .

10. The most common degree of depigmented lesion was 5-10%(71.6%) and the mean

percentage of depigmented lesion was 7.3%(male: 7,6%, female: 7.0%).

11. Poliosis was observed in 27.0% and family history was present in 12.2% of

patients.

12. Clinically type B vitiligo occured at younger age and had shorter duration of

disease progression and more poliosis than type A vitiligo. Association with

diseases with a proven or suggested allergic or immunological etiolicy was more

often found in type A, which findings support the hypothesis that type A and type B

vitiligo have a different pathogenesis.

[영문]

This is an analysis of 1315 vitiligo patients who had vested vitiligo special clinic in Severance Hospital. In addition, comparative clinical study of non-segmental type(type A) and segmental type(type B) vitiligo patients to investigate the hypothesis concerning the pathogenesis Of vitiligo was done.

The results are summarized as follows:

1. There were 609 Hales(46.3%) and 706 females(53.7%).

2. There were 660 cases(50.2%) of generalized type, 654 cases(49.7%) of localized type and one case of universal type vitiligo. Among them 203 cases(15,4%) were non-segmental tyre and 1112 cases(84.6%) were segmental type.

3. The mean age of onest was 21.9 years (male: 20.7, female: 22.9) and the mean age of visit was 27.8 years (male: 26.7, female: 28.8) .

4. Mede of onset was single in 75.8%.

5. The most common site of initial involvement was face(24.5%), especially the forehead(19.2%), and the neck was more commonly involved in female(24.4%) than in male(12.1%).

6. The disease was progressive in 73.6% of patients at the visit.

7. Pruritus(9.6%) and burning sense(0.8%) were observed in some patient.

8. The most common precipitating factor was trauma(44.1%) .

9. The most common previous treatment was topical steroid therapy(46.8%) .

10. The most common degree of depigmented lesion was 5-10%(71.6%) and the mean percentage of depigmented lesion was 7.3%(male: 7,6%, female: 7.0%).

11. Poliosis was observed in 27.0% and family history was present in 12.2% of patients.

12. Clinically type B vitiligo occured at younger age and had shorter duration of disease progression and more poliosis than type A vitiligo. Association with diseases with a proven or suggested allergic or immunological etiolicy was more often found in type A, which findings support the hypothesis that type A and type B vitiligo have a different pathogenesis.