Albinism — Know It All!

Editorial

All you need to know about Achromasia.

Know your ailment well, so you can manage it better!!

Here we come with Albinism today!

What is Albinism?

Albinism is also known as Achromasia.

Albinism consists of a group of hereditary melanin synthesis defects and is usually characterized by a congenital decline or loss of melanin pigment. Albinism occurs from a complex mechanism of biochemical reactions through the deficient synthesis of melanin from tyrosine.

Multiple causes of albinism are known. The phenotypic variation of albinism is attributed to multiple gene defects affecting different points in the pathway of melanin, resulting in reduced development of melanin at differing degrees. Additionally, owing to this hypopigmentation, subsequent developmental changes occur in the optic system.

The ophthalmologist plays an important role in identifying albinism since the main morbidity is the ocular characteristics of most types of albinism. Hypopigmentation-related modifications to the optic system include reduced visual acuity secondary to foveal hypoplasia and optic nerve misrouting at the chiasm. In the peripheral retina, other characteristics include photophobia, iris transillumination, nystagmus, and pigment deficiency. For both forms of albinism, these ocular variations are widespread.

What Causes Albinism?

  • Albinism is genetic. It’s not infectious, it can’t be “caught” by anyone else. People are born with albinism when their parents carry a gene or genes from albinism.
  • In the most prominent types of oculocutaneous albinism, for an infant to be born with the disease, both parents must bear the albinism gene. And if the gene is borne by both parents, the risk of each of their kids being born with albinism is one in four.
  • Their offspring won’t have oculocutaneous albinism if only one parent has the gene and the other parent has a regular pigment gene. Yet an infant has a one-in-two chance of becoming a “carrier” of the gene for albinism. When a person who carries the gene ends up with someone who also carries the gene to have a son, there is a one in four risk that their baby may have albinism. A baby with albinism may be born to parents whose colouring is characteristic of people of their ethnic background, because most people who have an albinism gene do not exhibit any symptoms of the disease.
  • Only males who have inherited an albinism gene from their mothers are affected by the most prevalent type of ocular albinism. Any females, whether they have inherited this mutation, may have a milder version of the disease.

Types of albinism

Types of albinism are classified based on how they’re inherited and on the gene that is affected.

  • Oculocutaneous albinism (OCA), the most common type, means a person inherited two copies of a mutated gene — one from each parent (autosomal recessive inheritance). It’s the result of a mutation in one of seven genes, labeled from OCA1 to OCA7. OCA causes decreased pigment in the skin, hair and eyes, as well as vision problems. The amount of pigment varies by type, and the resulting color of skin, hair and eyes also varies by and within types.
  • Ocular albinism is mainly limited to the eyes, causing vision problems. The most common form is type 1, inherited by a gene mutation on the X chromosome. X-linked ocular albinism can be passed on by a mother who carries one mutated X gene to her son (X-linked recessive inheritance). Ocular albinism occurs almost exclusively in males and is much less common than OCA.
  • Albinism related to rare hereditary syndromes can occur. For example, Hermansky-Pudlak syndrome includes a form of OCA as well as bleeding and bruising problems and lung and bowel diseases. Chediak-Higashi syndrome includes a form of OCA as well as immune problems with recurrent infections, neurologic abnormalities and other serious issues.

What are the symptoms of Albinism?

Signs and signs of albinism include colour and vision of the face, hair, and eye.

Skin Compared with siblings, the most identifiable type of albinism results in white hair and very light-colored eyes. The colour of the skin (pigmentation) and hair can range from white to brown, and can be about the same as that of albinism-free parents or siblings.

Any individuals might grow with exposure to the sun:

Freckles

  • Moles with or without pigment are usually pink-colored moles without pigment.
  • Big patches of freckle-like (lentigines)
  • Sunburn and being unable to tan
  • Face pigmentation never improves with those persons with albinism. For some, the development of melanin during childhood and teen years may begin or increase, resulting in minor changes in pigmentation.

Hair

The colour of your hair will vary from very white to very brown. People of African or Asian origin who have albinism can have golden, reddish or brown coloured hair. Owing to exposure to natural minerals in water and the environment, hair colour can also darken by early adulthood or stain, and become darker with age.

Color of eyes

They also have pale eyelashes and eyebrows. The colour of the eyes may vary from very light blue to brown and can alter with age.

In the coloured portion of the eyes (irises), the loss of pigment renders the irises somewhat transparent. This means that the irises are unable to stop light from penetrating the eye entirely. Because of this, in certain lights, very light-colored eyes can appear red.

Vision

A central characteristic in all cases of albinism is visual deficiency. Eye concerns and complications can include:

  • Rapid, automatic shifting of the eyes back-and-forth (nystagmus)
  • Head gestures to try to minimise repetitive eye movements and see better, such as bobbing or tilting the head,
  • Inability of both eyes to remain directed or to move in unison at the same point (strabismus)
  • Extreme nearsightedness or clairvoyance
  • Light-sensitivity (photophobia)
  • Abnormal curvature (astigmatism) of the front surface of the eye or the lens inside the eye, producing blurred vision
  • Abnormal retina growth, which results in diminished vision
  • Nerve impulses that don’t obey the normal nerve paths from the retina to the brain (misrouting of the optic nerve)
  • Weak understanding of the profundity
  • Legal blindness or complete blindness (vision less than 20/200)

What are the Complications of Albinism?

As well as social and mental difficulties, albinism may include skin and eye problems.

Complications for the eye:

  • Vision disorders can impair literacy, work and the ability to drive.
  • Complications on the skin
  • People with albinism have skin that is very susceptible to sensitivity to light and the sun. Sunburn is one of the most severe albinism-related risks because it can raise the risk of developing skin cancer and thickening of the skin related to sun exposure.

Challenges — social and mental

  • Any persons with albinism can face prejudice. Some peoples’ attitudes to those with albinism may also have a negative effect on those with the disorder.
  • People with albinism can face concerns about their looks, eyewear or visual aid devices through intimidation, teasing or poking. Typically, they look very different from their own family members or ethnic groups, so they might sound like outsiders or are treated like outsiders. Such interactions can lead to social alienation, low self-esteem and tension.
  • It is preferred to use the word “person with albinism” to reduce the stigma of other words.

How is Albinism diagnosed?

The foundation of the diagnosis of albinism is:

  • A physical assessment including the examination of skin and hair pigmentation
  • A detailed eye test
  • Comparison of the pigmentation of your infant to that of other members of the family
  • Medical history examination of your infant, including if bleeding has occurred that does not stop, excessive bruising or sudden infections
  • Your child’s eye test should be carried out by a medical doctor specialised in vision and eye problems (ophthalmologist). An identification of possible nystagmus, strabismus and photophobia is part of the test. The specialist also uses a device to examine the retina visually to assess if symptoms of premature growth are present.
  • Genetic consultation may assist in assessing the form and inheritance of albinism.

What is the treatment for Albinism?

It can’t be healed because albinism is an inherited disease. The aim of treatment is to get good eye care and to check the skin for signs of anomalies. Your primary care specialist and physicians specialised in eye care (ophthalmologist), skin care (dermatologist) and genetics may be interested in your care team.

Medical Care:

No possible successful therapy or remedy for albinism existed until late 2011, although the following could be positive and some potential optimism could be provided by a new medication:

Low-vision aids: In all cases, no one system can fulfil the needs of all patients. Young kids will actually need glasses, whereas bifocals may be needed for older kids. For close-up work and distance vision, telescopic lenses placed on glasses (bioptics) are occasionally recommended. The use of Braille is not required since the dots are read visually by children with albinism.

To minimise photophobia, tinted glasses can be used. Some patients don’t like tinted lenses; when outside, they might benefit from wearing a hat or visor.

It is preferred to start eye-patching babies at 6 months of age for the treatment of strabismus (prior to completion of eye development). With glass correction, some cases of strabismus can improve.

Nitisinone, approved by the US Food and Drug Administration (FDA) for the treatment of type 1 inherited tyrosinemia, improves the levels of plasma tyrosine and increases the pigmentation of the eyes and hair. For persons with ocular albinism, nitisinone may soon be a possible therapy.

Surgical Care:

After strabismus surgery, Albino individuals with strabismus rarely gain binocularity and depth perception, likely because they lack the requisite neural connections.

Due to nystagmus and inherently weak retinal pigment epithelium-retinal adhesions, patients with albinism appear to perform poorly after retinal detachment reconstruction.

What lifestyle changes should patients with Albinism make?

You should help your child develop strategies of self-care that can carry into adulthood:

  • Using poor vision aids in the classroom, such as a hand-held magnifying glass, a monocular or a magnifier connected to lenses, and a tablet synced to a smart board (a touch-screen digital computer board).
  • Always use sunscreen that protects against both UVA and UVB light with a sun protection factor (SPF) of 30 or greater.
  • Avoid high-risk or extended sun exposure strictly, such as being outside for long stretches of time or in the middle of the day, at high altitudes, and with thin cloud cover on sunny days.
  • Wear protective clothes, including colourful clothing, such as long sleeves, collared jackets, long trousers and gloves, wide-brimmed hats, and special clothing for UV protection.
  • Cover the eyes with dim, UV-blocking sunglasses or transition lenses that darken under bright light.

References:

All Images used are for representation purposes and are obtained from google search and we do not intend to violate copyrights, all credits are due with respective content owners. If you wish to take credit or intend to remove the image, Kindly let us know in the comments.

https://kidshealth.org/en/teens/albinism.html

https://emedicine.medscape.com/article/1200472-overview

https://www.medicalnewstoday.com/articles/245861

https://www.mayoclinic.org/diseases-conditions/albinism/symptoms-causes/syc-20369184