Managing the Skin-Whitening Condition Vitiligo
By Dr. Hirshel Kahn
Winnie Harlow’s striking appearance regularly turns heads. The fan-fave from America’s Next Top Model – face of the Spanish fashion brand Desigual – has more than one million Instagram followers. This embrace was impossible for Harlow to imagine when she was younger – and left high school to escape peer torment over her unusual appearance: vividly contrasting dark and light patches of skin covering her body, the result of the skin condition vitiligo. Vitiligo usually does not cause physical harm. That said, the emotional toll can be quite severe.
Researchers are still working to unravel the genetic mystery of vitiligo, which causes patients to lose melanocyte skin cells. Melanocytes produce the pigment that gives skin its color. Without them, our skin is white.
According to the Vitiligo Research Foundation, as many as two percent of the world’s population suffers from the condition, with most experiencing what is known as “nonsegmental” or “generalized” vitiligo, where patches of skin on both sides of the body lose pigment, often in a symmetrical pattern. Vitiligo is not contagious. With nonsegmental vitiligo, an autoimmune response appears to be at work, with the body destroying its own melanocytes. Family history seems to be a risk factor, but many patients do not have relatives with the condition.
For patients, part of the challenge of coping with vitiligo is its unpredictability: The condition typically appears without warning, with about half of patients developing symptoms by the time they’re 21, according to the American Academy of Dermatology. After its onset, start-and-stop skin whitening episodes can take place without warning.
Ongoing research may provide the key to preventing the skin’s loss of pigment cells.
5 Recommendations for Managing Vitiligo
1. See a doctor as soon as you suspect vitiligo: In almost all cases vitiligo is not going to clear up. In fact, just the opposite. Once a patient sees skin color fading, they should consult a doctor. If it is vitiligo, they should be evaluated to make sure that other autoimmune diseases are not present and to ensure that their eyes are not affected. Also – importantly – early intervention can be crucial to empowering the patient to manage the condition and make informed choices.
2. Create an individualized treatment plan: Most current treatments focus on adding color to whitened skin. Approaches range from non-invasive cosmetics and dyes to steroidal creams, immunosuppressives (in topical or pill form), UVA light therapy, and laser therapy. There is also emerging use of surgery to introduce new melanocyte cells into affected areas of the skin. In some cases, a combination of therapies is used. Patients who want to minimize the appearance of vitiligo should partner with their doctor to create a treatment plan that will best meet their needs. Treatment involves several factors: Location and extent of the pigment loss, the patient’s tolerance for side effects, and time constraints.
3. Choose your doctor carefully: There is exciting research being done, for example, potential surgical approaches to repigmentation, as well as an increased genetic understanding that may pave the way for preventing loss of melanocytes. Patients will want to have a doctor who stays current regarding breakthroughs that may benefit them.
4. Maintain realistic expectations: Most treatments take time, e.g. steroidal creams usually take at least three months before effects are seen and light therapies require long-term sessions. Also, even successful treatments may fade. Patients should have a very clear understanding of what the treatment involves and what the outcome may be.
5. Pay attention to emotional needs: Many vitiligo patients suffer low self-esteem, social anxiety, and depression. Our emotional wellbeing is intrinsic to our overall health. Patients need doctors that are emotionally supportive and can provide referrals to adjunctive therapies. Online support groups such as Vitiligo Support International and Vitiligo Friends can provide a community, as well as a source for ongoing developments.
Early intervention and forming a partnership with one’s doctor are essential steps to managing the challenge of vitiligo.
Hirshel Kahn, M.D., is board certified and specializes in dermatology at Advanced Dermatology P.C.