Understanding Vitiligo

Years ago, I was taking the subway downtown, maybe the 2 train for you native New Yorkers and I noticed a young Black woman standing by the doors. She was wearing jean shorts and had a lot of discoloration, on her legs. But she stood with confidence. I now realize she had a case of vitiligo.

Vitiligo also called leucoderma is an autoimmune disease wherein the immune system of the body attacks the healthy cells and it in turn starts affecting the body. The condition is characterized by white patches on the skin that develops as a result of melanocytes within the skin. These are the cells responsible for the skin pigment melanin that provides color to your skin. The white patches appear when the melanocytes die off.

Melanin is generated in response to the ultraviolet B radiation in sunlight. That’s why some of us who are lighter in complexion can walk away with a tan. Additional melanin is produced in dark-skinned people after sun exposure too but it’s less obvious.

Other vitiligo symptoms include those patchy areas of lost skin color; developing white patches of skin after an injury; and white lesions prominent on areas of the body such as face, hands or wrists.

Vitiligo can show up on its own or as a symptom of other autoimmune diseases such as pernicious anemia, lupus, and Addison’s disease. Vitiligo is not contagious. And no, it doesn’t affect a person’s ability to perform daily tasks. While you can’t die from vitiligo, the condition is damaging psychologically and socially. Having vitiligo can greatly affect a person’s quality of life, self-esteem, marriage, and employment.  

The disease may clear up on its own in some people. But for most people with vitiligo, the patches last and expand without treatment.

Vitiligo affects between 0.5 percent and 1 percent of the population worldwide. The disease can appear at any age but usually starts in your 20s and 30s. There is no cure to prevent the condition from spreading across the body. But doctors can treat vitiligo by making the discoloration less noticeable.

The cause of vitiligo is unknown. But scientists theorize certain factors are associated with the condition such as genetics (children of parents with vitiligo may be vulnerable), alopecia areata or other immune disorder (especially thyroid disease), and chemical exposure (excessive exposure to chemicals like rubber and plastic may make people vulnerable to the condition).

The goal of treatment for vitiligo is to minimize the contrast between white patches and the nonaffected skin. There is a plethora of treatments that your physician can try to make this possible. Suction blister epidermal grafting is what it sounds like, where a vacuum is used on skin divided into two parts, one with the white patches and other normal skin.

Other procedures include melanocyte epidermal cell suspensions where the skin pigment is taken from normal skin and converted into liquid form and inserted into the area with the white patches of skin. There is melanocyte culture which involves taking a skin biopsy and platelet rich plasma, which involves extracting plasma from the blood to be treated and injected into the area with the white patches.  

Medications are also available to treat including those that affect the immune system like calcineurin inhibitor ointments, such as tacrolimus (Protopic) or pimecrolimus (Elidel) that might be effective for people with small areas of depigmentation by moderating the immune attack on melanocytes. This may lead to repigmentation of the skin. Corticosteroid creams may be helpful for those in the early stages of this disease, but please note side effects such as skin thinning.

Patients with vitiligo may also benefit from light therapy. Some research indicates that phototherapy may slow or stop the progression of this condition. For instance, psoralen plus ultraviolet A light treatment (PUVA) is one form of light therapy (psoralen is a drug that causes the skin to darken when they react to ultraviolet A light). The treatment takes place three times a week. Keep in mind it may take months to notice any significant change in skin.

People with vitiligo must be diligent about protecting their skin. They must use sunscreen to protect their skin from sunburn, which may exacerbate the condition.

Some studies suggest that alternative treatments may help in managing vitiligo. In fact, one Indian study found that patients with vitiligo who were given ginkgo biloba may have slowed the progression of the disease. Other alternative treatments include vitamin B12, folic acid, and zinc, which studies indicate that some patients with vitiligo may suffer from these vitamin deficiencies.

As a person who has had skin problems her entire life, I sympathize greatly with those of you that have this illness. It can be devastating to watch your skin change and not know what to do about it. Yes, I have never had vitiligo but to those of you that have it, don’t lose hope. Treatments are improving to manage this condition effectively. Skin doesn’t make you who you are but what matters is how you treat yourself and others.