If you were an 80s kid or followed Motown, you probably remember the King of Pop—Michael Jackson (MJ). Although he was known for his music and dance moves, MJ also made headlines for his skin condition, vitiligo, and his legacy is still alive today.
Vitiligo is a chronic skin condition and affects about 1% of the world’s population. There are three main patterns of vitiligo: 1. Focal: white patches limited to one or a few areas 2. Segmental: depigmented areas occur only on one side of the body, and 3. Generalized: pigment loss is widespread across the body. Segmental vitiligo is thought to be related to a problem with the nervous system. Focal and generalized vitiligo is considered autoimmune. The immune system attacks the pigment-producing cells, called melanocytes, in the skin. As a result, the skin loses pigment. Because you have pigment cells in the eye and hair, vitiligo can also cause the eyes to lose color and the hair to become white. Vitiligo can occur anywhere on the skin and often presents around the eyes or mouth, on the tops of the hands, and even the genitals.
When vitiligo first starts, the skin might look slightly lighter and then gradually become completely white. Some areas of vitiligo even look red along the edges in the beginning stages. If you have darker or tanned skin, vitiligo can be more pronounced. Anyone can get vitiligo at any point in life, but it typically appears between 20 and 30 years of age and men and women are equally affected. If melanocytes in the eye and inner ear are affected, vitiligo patients can also present with uveitis and hearing loss. Moreover, patients with vitiligo may be at risk for other conditions that are considered autoimmune, such as thyroid disorders, lupus, Type 1 diabetes and psoriasis. About 15-25% of patients with vitiligo also have another autoimmune disease.
Vitiligo is not contagious, and early diagnosis is helpful to be successful with treatments. Lesions that are a few months old tend to respond better to treatment than lesions that have been present for several years. The goal of treatment is to stop or slow the progression of vitiligo. Treatment options focus on repigmenting skin and preventing worsening, covering up white patches, or destroying any residual areas of normal pigmentation to have skin that is all white. Treatment options include topical creams like steroids, calcineurin inhibitors or vitamin D, oral steroids, phototherapy and surgery such as skin grafting. Some vitiligo patients choose to remove any remaining pigment from their skin. This is what Michael Jackson decided to do.
There is no cure for vitiligo and treatment is often disappointing for patients. But there is hope. Now there is an FDA approved topical medication to treat vitiligo called ruxolitinib. There are also clinical trials underway looking at other topical and oral therapies for vitiligo. The challenge remains to educate the public and insurance companies that vitiligo is a medical condition that has cosmetic implications and it should not be reduced to just a cosmetic concern.
Like other skin conditions, vitiligo can greatly impact someone’s quality of life. Patients with vitiligo may not feel comfortable engaging with society, and in some cultures, vitiligo patients are treated as social outcasts. Vitiligo may also be confused with leprosy or thought to be a punishment for past sins. And because our skin color is closely tied to our racial and ethnic ties, vitiligo can lead to an identity crisis for patients. It’s not surprising then that patients with vitiligo can suffer from poor self-esteem, depression or anxiety. If someone has vitiligo, it is important to address their skin, but also their mental and emotional well being as a part of their treatment. Trotter’s Take: If you think you have vitiligo, see your dermatologist to evaluate and confirm the diagnosis. While new treatments are still developing, we have better options now to help treat vitiligo and empower patients to overcome this challenging condition—or, as MJ would say, “Beat it!”
Do you know someone who has vitiligo? Then listen to my podcast with Dr. Seemal Desai, as he shares his brother’s journey with vitiligo.
