Why the loss of colour shouldn’t mean loss of confidence

Of the many skin conditions which could affect anyone of us, few cause anxiety as Vitiligo. It is important to note, however, that the condition is nothing but harmless discolouration of the skin. It would be helpful to gain a closer understanding, in order to dispel some of the myths and fears surrounding vitiligo, and also to arrive at a realistic acceptance of the condition.

When skin loses colour

Vitiligo is a condition in which the skin loses its normal colour and white patches develop. This could occur anywhere on the body, and most people with vitiligo have white patches in multiple areas.  Vitiligo can be localised to a few body areas or generalized as a widely distributed loss of colour.

How vitiligo occurs   

Our skin normally contains melanocytes, or pigment cells, which are more or less evenly distributed and produce the melanin that gives the skin its characteristic colour. What happens in vitiligo is that melanocytes are destroyed, resulting in the loss of colour, leaving the area white.

What causes vitiligo?

The exact cause of vitiligo is not known. Medical research has not yet put a finger on what precisely sets off the destruction of melanocytes. However, multiple theories exist – a prominent one being that it is an autoimmune disease. Your body’s immune system mistakenly attacks some part of your own body; in this case, setting out to destroy the melanocytes.

It is believed is that some individuals happen to be genetically more susceptible to autoimmune diseases, which could then be triggered by environmental factors.

“Am I at risk for vitiligo?”

Globally, about 1% of people are affected by vitiligo.  In most cases, vitiligo develops early in life, between the ages of 10 and 30 years.  Ninety-five percent of those affected will develop it before  40.  Vitiligo doesn’t discriminate by gender nor by race, although loss of pigmentation is more noticeable on darker skin.

Risk factors include the presence of an autoimmune disease, such as thyroid disease (hyper and hypothyroidism), alopecia areata, or pernicious anemia. Family history is a factor too, although it does not follow that children of a parent with vitiligo will necessarily develop it.

Vitiligo commonly affects sun-exposed areas, body folds (such as armpits), previous sites of injury, areas around moles, or areas around body openings.  Vitiligo can also affect the eyelids, hair, and mucous lining inside the mouth and nose.

How vitiligo progresses

Symptoms often include rapid pigment loss on several areas of the skin.  A stable period may follow, without any progression of the condition. Later on, further cycles of pigment loss and stability may be observed.

Typically, both sides of the body are involved.  It is rare for melanin pigment to spontaneously return once the white patches have developed.

Vitiligo is classified into two main types:  segmental and non-segmental. Most cases are non-segmental, affecting both body sides and typically increase in coverage over time. About 10% of cases are segmental, meaning they mostly involve one side of the body and do not typically grow with time.  Segmental vitiligo is far more prevalent in the teenage years.

Clinical diagnosis of vitiligo is initially made by physical examination and confirmed by histo-pathological examination of a skin biopsy.

Not all cases of pigmentation loss are instances of vitiligo. Differential diagnosis includes multiple skin conditions with similar symptoms.

How is vitiligo treated?

There is no known way to prevent or arrest the process of melanocyte destruction and pigmentation loss. However, several methods can be used to improve the appearance of skin severely affected by vitiligo including topical corticosteroid and calcineurin inhibitors to darken the light patches, re-pigmentation using ultraviolet light therapy, and skin grafting. At a non-clinical level, there’s always the option of skin camouflage with make-up and other cosmetics. For those with light skin, sunscreen and makeup can be all that is typically recommended.

A combination of treatments generally has better outcomes.

Another approach is to even out skin tone by depigmenting unaffected skin areas with hydroquinone to lighten them. A permanent and vigorous removal of all the skin pigment can be achieved with monobenzone.  Sun-safety must be adhered to for life to avoid severe sun burn and melanomas.  Depigmentation takes about a year to complete. Yes, this is what Michael Jackson underwent.

New biological treatments are currently under investigation and look promising.  Janus kinase inhibitors are emerging as a potential treatment option for alopecia areata, eczema, and vitiligo.  However, they have not yet been approved for use in dermatologic conditions.

While as dermatologists we do our best to intervene and manage the visual appearance of vitiligo, we have observed that there is no better approach than confidence, information about the condition and a realistic approach to take vitiligo for what it is: a pigmentation condition that is not infectious and does no harm whatsoever. In fact, in the world of fashion, some models with vitiligo like Winnie Harlow, are flaunting it beautifully. And so should everyone else.

By Dr.Mohamed Dallah

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