Written by: Jasmine Biju
Medically reviewed by: Dr. Lohi Pratti
Image Source: Verywell Health
Vitiligo is a skin condition that results in the loss of pigmentation in the skin. It can affect any body part, age group, gender, or race. It is not confined to just one demographic, though it only affects 1% of the population. Vitiligo does not cause discomfort to the skin, but its emotional and social implications are what may make the condition devastating. In fact, this is the very reason why research is being conducted on cures for this condition. Vitiligo occurs when melanocytes, cells that are responsible for making pigment, are destroyed by the immune system.
Vitiligo is an autoimmune condition in which the body’s immune system attacks healthy cells and tissues. Vitiligo is non-contagious, along with many other autoimmune conditions. With vitiligo, the immune system destroys melanocytes, or pigment-producing cells, which results in lighter or white patches on the skin. Apart from the autoimmune hypothesis, biochemical theory and convergence theory are also thought to be the cause of vitiligo development. The biochemical theory is damage to melanocytes due to increased oxidative stress. Convergence theory is that vitiligo can only happen when a number of factors come together. These include genetics, susceptibility to environmental changes, an altered skin microenvironment, a defect in the melanocytes themselves, and an autoimmune response. Vitiligo most commonly affects the face, mouth, and rubbing areas such as arms and hands. Numerous patients also are diagnosed with one other autoimmune condition. On the face, lesions tend to show up around the mouth and eyes. Lesions can also form in places that are often traumatized, like the knees and elbows. The most difficult sites to treat are the lesions over lips and fingertips (so-called lip-tip variant). The disease’s course is often hard to predict, and it changes based on how it is treated.
Having vitiligo can be life-changing in the sense that it causes social insecurity. The social influence that vitiligo has on those diagnosed results in a potentially lower quality of life. Individuals may find challenges with self-esteem and the social stigma associated with vitiligo. This stigma arises from the lack of awareness about this condition, and the false assumptions many make about the contagiousness of this autoimmune disorder. Though it is not life-threatening, it may detriment one’s confidence in social situations.
Vitiligo is linked to other autoimmune diseases, so it is important to use a multidisciplinary treatment approach. Psychotherapy is especially important to reduce the emotional stress that can come with this condition. For the past 3,400 years, treatment options for vitiligo have remained relatively the same. However, a 2022 study on Ruxolitinib, an FDA-approved topical cream, changed that. In the study, Ruxolitinib 1.5% cream was applied twice daily for 20 weeks to 10% of the body surface area, or 3.75 g for each application. Patients who finished the experiment had statistically significant improvements, with face lesions responding better. Incyte (the manufacturing company) said that it might take over five months to show results in patients ages 12 and over when applied twice a day. Ruxolitinib works by addressing repigmentation in individuals with vitiligo. The most common side effects are itching at the site of application, redness, or headaches. Aside from Ruxolitinib, treatment can include a CO2 laser, skin grafting, and melanocyte cell transfer. However, surgical treatments are suggested only in stable vitiligo (no progression of patches/new patches for 2 years).
Those diagnosed with vitiligo do not have to handle their problems on their own. Many may deemphasize the emotional aspect of vitiligo, however, many support groups exist to help patients in need of moral support. In fact, most patients may benefit from psychosocial support in conjunction with a treatment option. If you or someone you know is diagnosed with vitiligo and are in need of resources, please visit the Global Vitiligo Foundation or Vitiligo Support International.
Having vitiligo is a beautiful thing, and those diagnosed with this condition should embrace it. The beauty of scientific advancement is greater research is being conducted in producing new treatment options, and the continuation of distributing the current medications that are available.
References:
Center for Drug Evaluation and Research. “FDA Approves Topical Treatment.” U.S. Food and Drug Administration, FDA, https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-topical-treat ment-addressing-repigmentation-vitiligo-patients-aged-12-and-older.
Dillon, A.B., Sideris, A., Hadi, A., Elbuluk, N., 2017. Advances in Vitiligo: An Update on Medical and Surgical Treatments. J. Clin. Aesthetic Dermatol. 10, 15.
Jan, N.A., Masood, S., 2022. Vitiligo, StatPearls [Internet]. StatPearls Publishing.
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“Opzelura the First FDA-Approved Drug for Vitiligo.” UMass Chan Medical School, 22 July 2022,
https://www.umassmed.edu/vitiligo/blog/blog-posts1/2022/07/opzelura-the-first-f da-approved-drug/.
Pennmedicine.org,https://www.pennmedicine.org/for-patients-and-visitors/patient-information/con ditions-treated-a-to-z/vitiligo. “Say Hello to OPZELURA.” OPZELURA, https://www.opzelura.com/.
“Vitiligo.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 10 Nov. 2022,
https://www.mayoclinic.org/diseases-conditions/vitiligo/symptoms-causes/syc-203 55912.
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