Dr Payal Chauhan & Dr Ria Sharma
Vitiligo is a disorder marked by the disappearance of skin pigment, which leads to the formation of white spots that can appear anywhere on the body. The Global Vitiligo Foundation (GVF) reports that vitiligo affects around 70 million people in the world. In India, the condition’s prevalence varies from 0.25% to 4% , with regions like Gujarat and Rajasthan experiencing rates as high as 8.8%. Given the significant number of individuals affected, it is essential to inform the public about the causes, symptoms, prevention and treatment options for vitiligo.
“Everyone has differences, and vitiligo is just another difference, like freckles, big hair, or tiny ears,” says 29-year-old Canadian model Winnie Harlow. Harlow, the first model with vitiligo to walk the runway at the 2018 Victoria’s Secret Fashion Show, has worked with brands like Sprite and Swarovski and was named one of BBC’s 100 Women in 2018. Her life story is one of overcoming adversity, and it serves as an inspiration to many. Growing up with vitiligo, Harlow endured bullying and abuse. She often recalls that it was people’s negative opinions, rather than her appearance, that most damaged her self-esteem.
The legendary performer Michael Jackson also had vitiligo. Renowned for his music, dance, and groundbreaking videos, Jackson found himself at the centre of controversy as his skin lightened over time. Accusations of skin bleaching were rampant until a 1993 interview with Oprah Winfrey, where he revealed his vitiligo diagnosis, which began at around 24 years of age and progressed over a decade, affecting his entire body.
In addition to them, others who have vitiligo include Rasheed Abdul Wallace, a retired professional NBA basketball player; Gautam Singhania, an Indian textile tycoon; and Chandrababu Naidu, the Chief Minister of Andhra Pradesh, India.
If vitiligo did not hinder the achievements of these remarkable individuals, it underscores the importance of spreading awareness about this condition. By educating others about this simple change in skin colour, we can ensure that no one feels that having vitiligo will prevent them from achieving their dreams.
Hence each year on June 25th, World Vitiligo Day is observed to enhance efforts in vitiligo healthcare and education and to raise awareness. This day honours the lives of individuals living with vitiligo, highlighting their challenges and triumphs. The first World Vitiligo Day was organized in 2011 by the VR Foundation (USA) and VITSAF (Nigeria). The date, June 25th, was chosen by Yan Valle, CEO of The Vitiligo Research Foundation, to honour Michael Jackson’s legacy.
One common question is: when and how does one develop vitiligo? The answer is that according to the reported data, vitiligo can appear as early as birth or as late as 81 years of age. The likelihood of developing this condition increases with a positive family history along with autoimmunity in which our body’s immunity destroys the pigment-producing cells called melanocytes resulting in white patches. Conditions like pernicious anemia, Graves’ disease, Addison’s disease, thyroid disorders, hyperparathyroidism and diabetes mellitus are associated with vitiligo. It is crucial to discuss these possibilities with your doctor to rule out any related autoimmune disorders. Another theory suggests that an imbalance between oxidants and antioxidants may lead to the destruction of melanocytes. Additionally triggering events such as stress, severe sunburn or skin trauma such as contact with a chemical can lead to the development of white patches.
At the beginning of the disease, one may notice white coloured spots that may appear anywhere on the body or mucous membrane ( including oral and genital ) and gradually increase in size and number. During active vitiligo, the patches might feel itchy. However, these spots and patches generally do not cause any discomfort.
Vitiligo can lead to the loss of colour in a person’s hair, as hair contains melanin. When vitiligo affects the skin, the hair in the affected area can become white. Additionally, vitiligo can cause hair to turn prematurely grey, impacting areas such as the scalp, eyelashes, eyebrows, or beard. These symptoms should prompt a consultation with a dermatologist.
Remember not all white patches are vitiligo !
Patients should understand the importance of consulting a qualified dermatologist rather than self-diagnosing any condition. Various skin disorders can cause lightening of pigmentation, and it is best to rely on a professional to make an accurate diagnosis.
Early diagnosis and treatment is the key !
Most of the time people reach out to the doctor after trying all non-scientific (desi) treatment options causing the worsening of the disease which makes it difficult for the doctor to treat as the disease has already spread to the entire body.
Vitiligo always starts with a localised patch and therefore we need to visit the doctor as soon as possible to control it at the earliest stage with the application of topical creams/ointments.
Once it starts spreading actively to different sites of the body, administration of oral drugs becomes imperative. Other measures like phototherapy and surgical options can be suggested depending on your treating dermatologist. In addition to these, oral antioxidants and supplements like ginkgo biloba, vitamin D, B12, E, folic acid, zinc, L – phenylalanine, and polypodium leucotomas can be given. Although further research is required to verify their effectiveness, some evidence suggests that these supplements may be beneficial.
Hence it is always better to treat this condition early so we as doctors can teach the patients how to control its spread.
Sun exposure and Vitiligo !!
Skin that has lost its pigment is more prone to sunburn. Severe sunburn can exacerbate the existing vitiligo or can act as a potential risk factor for initiating it.
Hence according to the American Academy of Dermatologists, “proper application of sunscreen is extremely crucial. Apply sunscreen whichprovides broad-spectrum protection, is water resistant and has SPF 30 or higher at least 15-20 minutes going out in sunlight. For regular clothing, choose clothes that are heavier and darker, like denim, as light-coloured fabrics offers much less protection from UV radiation”.
Busting Vitiligo Myths
Several myths float around about vitiligo – ranging from the nature of the disease to its treatment.
Myth:- “Many people believe that if you have fish and curd/milk together, it causes vitiligo. There is also a common belief that people with vitiligo should avoid sour food.
Fact:- There is no scientific proof to support either of these dietary connections to vitiligo.”
Myth:- “You can cure vitiligo and return the natural colour of the skin by rubbing a variety of oils or taking certain supplements.
Fact:- Unfortunately, there is currently no cure for vitiligo, nor is there a convenient, easy treatment that addresses the disease process. However, there are several therapies that people with vitiligo may try after consulting their dermatologist.”
Myth:- “Vitiligo can spread from one person to another by mere contact.
Fact:- Vitiligo is neither contagious nor infectious, and there’s no way to get it from someone else. So, there is no reason to avoid people who may have visible signs of the disorder.”
Myth: “Only dark-skinned people are affected by Vitiligo.
Fact: The occurrence of vitiligo is not determined by skin colour. It affects individuals of all races, irrespective of their skin tone.”
As we wrap up our journey of World Vitiligo Day, it is crucial to emphasize the invaluable resources our community has to offer. The dermatology department at AIIMS Jammu will be well-equipped with facilities and a dedicated team of doctors devoted to delivering exceptional care. From the latest diagnostic tools to advanced treatment options like phototherapy, our doctors are dedicated to providing patient-centred care tailored to each individual’s unique needs.
As we conclude World Vitiligo Day, let us reaffirm our commitment to raising awareness, and supporting those affected by vitiligo. Together, we can build a more inclusive and compassionate world where everyone feels empowered to embrace their unique beauty.
(The writers Dr Payal Chauhan is Associate Professor and Dr Ria Sharma is Senior Resident, Department of Dermatology, AIIMS Jammu)
