The skin is an ever-changing organ that contains many specialized cells and stru ctures.

The skin functions as a protective barrier that interfaces with a someti mes-hostile environment. It is also very involved in maintaining the proper temp erature for the body to function well. It gathers sensory information from the e nvironment, and plays an active role in the immune system protecting us from dis ease. Understanding how the skin can function in these many ways starts with und erstanding the structure of the 3 layers of skin - the epidermis, dermis, and su bcutaneous tissue. Epidermis The epidermis is the outer layer of skin. The thickness of the epidermis varies in different types of skin. It is the thinnest on the eyelids at .05 mm and the thickest on the palms and soles at 1.5 mm. The epidermis contains 5 layers. From bottom to top the layers are named: stratum basale stratum spinosum stratum granulosum stratum licidum stratum corneum The bottom layer, the stratum basale, has cells that are shaped like columns. In this layer the cells divide and push already formed cells into higher layers. A s the cells move into the higher layers, they flatten and eventually die. The top layer of the epidermis, the stratum corneum, is made of dead, flat skin cells that shed about every 2 weeks. Specialized Epidermal Cells There are three types of specialized cells in the epidermis. The melanocyte produces pigment (melanin) The Langerhans' cell is the frontline defense of the immune system in the skin The Merkel's cell's function is not clearly known Dermis The dermis also varies in thickness depending on the location of the skin. It is .3 mm on the eyelid and 3.0 mm on the back. The dermis is composed of three typ es of tissue that are present throughout - not in layers. The types of tissue ar e: collagen elastic tissue reticular fibers Background: Vitiligo is an acquired pigmentary disorder of the skin. Genetic factors, oxidat ive stress, autoimmunity, and neurochemical agents might be contributing factors for the development of the disease. Aims: To evaluate the oxidative stress level and tyrosinase activity in vitiligo patie nts and to compare them with healthy volunteers. Materials and Methods: We used Comet assay to evaluate DNA strand breaks in peripheral blood cells of a ctive vitiligo patients. We then extracted total protein from lesional and nonle sional skin of ten selected patients. Tyrosinase activity was found to play a cr ucial role in melanogenesis. Results: The basal level of systemic oxidative DNA strand breaks in leukocytes increased in vitiligo patients compared to healthy participants. We observed that tyrosina se activity in lesional skin was lower than in nonlesional skin.

Conclusion: Our finding suggests that increased levels of oxidative stress might impact tyro sinase activity and eumelanin synthesis via anabolism pathway of melanin synthes is. In sum, we observed a negative correlation between levels of systemic oxidat ive stress and of tyrosinase activity. The following is a partial list of studies demonstrating these vitiligo vitamin deficiencies: "Abnormally low levels of Vitamin B12, Folic Acid and Vitamin C are found in a l arge number of vitiligo patients." Vitiligo: Nutritional Therapy, by Leopoldo Mo ntes, M.D., M.S., FRCPC Westhoven Press, Buenos Aires. "Patients with vitiligo show diminished blood levels of folic acid, Vitamin B12, and ascorbic acid (vitamin C). Prolonged oral administration of these vitamins was followed by definite repigmentation without side effects," Folic Acid and Vi tamin B12 in Vitiligo: A Nutritional Approach, Cutis Magazine, Volume 50, July 1 992. "In India, BEHL (1994), a vitiligo expert who has probably managed more vitiligo patients than any other dermatologist worldwide, has observed copper deficiency in the serum and in the skin of vitiligo patients." Vitiligo: Nutritional Thera py, by Leopoldo Montes, M.D., M.S., FRCPC, Westhoven Press. Buenos Aires. "Nutritional deficiencies, both in animals and in humans, are known to alter mel anin pigmentation. Copper and zinc deficiencies have been reported to induce hyp opigmentation in various animals. Hypopigmentation of the skin and hair results from copper deficiency in humans; the depigmentation associated with chronic exc essive molybdenum intake is related to a decreased storage of copper in the live r. Copper would seem of prime importance because tyrosinase is a known copper-re quiring enzyme." Vitiligo and Other Hypomelanoses of Hair and Skin, by Jean-Paul Ortonne, M.D., Plenum Medical Book Company, NY. "Achromotrichia has been claimed as an early indicator or copper insufficiency. This color change is associated with the decreased activity of tyrosinase, a cop per-containing polyphenyl oxidase which is required for the synthesis of melanin pigment from tyrosine." Copper in Animals and Man, Volume II, by John Howell, M cC., D.V.Sc., F.R. C.Path. Jeffrey M. Gawthorne, Ph.D., CRC Press, Inc., Boca Ra ton, FL. There is evidence that vitamin consumption can lead to some stabilization and in some cases repigmentation. Vitiligo patients showed significant improvement in the following clinical studies. A clinical study describes the use of vitamin supplements in the treatment of vi tiligo. Supplementation with large amounts of folic acid (1-10 mg. per day), vit amin C (1 gram per day) and vitamin B12 injections (1,000 mcg. every other week) , produced marked repigmentation in eight of the fifteen people studied. These i mprovements became apparent after three months, but complete repigmentation requ ired one to two years of continuous supplementation. In another study of people with vitiligo, supplementation with folic acid (10 mg . per day) and vitamin B12 (2,000 mcg. per day), combined with sun exposure, res ulted in some repigmentation after three to six months in about half of the part icipants. This combined regimen was more effective than either vitamin supplemen tation or sun exposure alone. Researchers V.G. Kolyandenko, V.N. Korol, et al at the National Medical Universi ty in Kiev Ukraine, recognize the content of copper and zinc is reduced in vitil iginous skin. A topical with copper and zinc was applied to the skin of 12 vitil igo patients, followed by UV light exposure. The results were encouraging. It pr omoted normalization of skin-pigment function. Pantothenic acid has also been attributed to forming new melanin and is essentia

l for copper absorption. In yet more studies, vitiligo patients who took vitamins experienced some improv ement. "Pantothenic Acid and PABA (a component of folic acid) supplements are ef fective in managing vitiligo," according to Carl C. Pfeiffer author of Mental an d Elemental Nutrients. Adelle Davis, the noteworthy American nutritionist states "Vitiligo has been cor rected by giving pantothenic acid or PABA (a component of folic acid) in Let's G et Well." In Natural Healing, Mark Bricklin reports "A group of 48 people ranging in age f rom 10-70 years were given all B vitamins. Within two months, the white areas tu rned pinkish, and after six months, all 48 people were reportedly free of the co lorless patches." Among the B vitamins are folic acid, vitamin B12, and pantothe nic acid. Researcher Juhlin L. Olsson found that "Folic acid and vitamin B12 supplementati on combined with sun exposure can induce repigmentation better than either the v itamins or sun exposure alone" in a study he conducted at the Department of Derm atology, University Hospital, Uppsala, Sweden. A vitamin and mineral supplement is convenient way to ensure consistent consumpt ion of adequate amounts of recommended vitamins and minerals. Because vitamin su pplements are natural, they can complement a more traditional treatment. Folic a cid, vitamin B12, vitamin C, pantothenic acid, copper, and zinc have been shown in scientific studies to improve and help manage vitiligo when used as part of a whole-health approach to vitiligo Layers of the Dermis The two layers of the dermis are the papillary and reticular layers. The upper, papillary layer, contains a thin arrangement of collagen fibers. The lower, reticular layer, is thicker and made of thick collagen fibers that ar e arranged parallel to the surface of the skin. Specialized Dermal Cells The dermis contains many specialized cells and structures. The hair follicles are situated here with the erector pili muscle that attaches to each follicle. Sebaceous (oil) glands and apocrine (scent) glands are associated with the folli cle. This layer also contains eccrine (sweat) glands, but they are not associated wit h hair follicles. Blood vessels and nerves course through this layer. The nerves transmit sensatio ns of pain, itch, and temperature. There are also specialized nerve cells called Meissner's and Vater-Pacini corpus cles that transmit the sensations of touch and pressure. Subcutaneous Tissue The subcutaneous tissue is a layer of fat and connective tissue that houses larg er blood vessels and nerves. This layer is important is the regulation of temper ature of the skin itself and the body. The size of this layer varies throughout the body and from person to person. The skin is a complicated structure with many functions. If any of the structure s in the skin are not working properly, a rash or abnormal sensation is the resu lt. The whole specialty of dermatology is devoted to understanding the skin, wha t can go wrong, and what to do if something does go wrong.