Vitiligo: Fighting The Stigma Around This Skin Condition

Vitiligo is a condition that causes patchy loss of skin coloring (pigmentation).

In addition, hair on these regions of skin can also lose pigment and appear white. 

The average age of onset of vitiligo is in the mid-twenties, but it can appear at any age. 

The size and number of patches varies from person to person. The condition tends to progress over time, with larger areas of the skin losing pigment. However, the patches can remain stable or even improve in some affected individuals. 

Researchers have identified several forms of vitiligo. Generalized vitiligo (also called nonsegmental vitiligo), which is the most common form, involves loss of pigment (depigmentation) in patches of skin all over the body. Depigmentation typically occurs on the face, neck, and scalp, and around body openings such as the mouth and genitals. 

Sometimes pigment is lost in mucous membranes, such as the lips. Loss of pigmentation is also frequently seen in areas that tend to experience rubbing, impact, or other trauma, such as the hands, arms, and places where bones are close to the skin surface (bony prominences). Another form of the condition, called segmental vitiligo, is associated with smaller patches of depigmented skin that appear on one side of the body in a limited area. This form occurs in about 10 percent of affected individuals.

Vitiligo is generally considered to be an autoimmune disorder. Autoimmune disorders occur when the immune system attacks the body's own tissues and organs. In people with vitiligo the immune system appears to attack the pigment cells (melanocytes) in the skin.

About 15 to 25 percent of people with vitiligo are also affected by at least one other autoimmune disorder, particularly autoimmune thyroid disease, rheumatoid arthritis, type 1 diabetes, psoriasis, pernicious anemia, Addison disease, systemic lupus erythematosus, celiac disease, Crohn disease, or ulcerative colitis.

In the absence of other autoimmune conditions, vitiligo does not affect general health or physical functioning. However, concerns about appearance and ethnic identity are significant issues for many affected individuals.

Frequency

Vitiligo is a common disorder, affecting between 0.5 percent and 1 percent of the population worldwide. However, many cases may not be reported, and some researchers suggest the condition may affect up to 1.5 percent of the population. While the condition may be more noticeable in dark-skinned people, it occurs with similar frequency in all ethnic groups.

Causes

Variations in over 30 genes, occurring in different combinations, have been associated with an increased risk of developing vitiligo. Two of these genes are NLRP1 and PTPN22. The NLRP1 gene provides instructions for making a protein that is involved in the immune system, helping to regulate the process of inflammation. Inflammation occurs when the immune system sends signaling molecules and white blood cells to a site of injury or disease to fight microbial invaders and facilitate tissue repair. The body then stops (inhibits) the inflammatory response to prevent damage to its own cells and tissues.

The PTPN22 gene provides instructions for making a protein involved in signaling that helps control the activity of immune system cells called T cells. T cells identify foreign substances and defend the body against infection.

The variations in the NLRP1 and PTPN22 genes that are associated with an increased risk of developing vitiligo likely affect the activity of the NLRP1 and PTPN22 proteins, making it more difficult for the body to control inflammation and prevent the immune system from attacking its own tissues.

Studies indicate that variations in a number of other genes also affect the risk of vitiligo. Many of these genes are also involved in immune system function or melanocyte biology, and variations in each likely make only a small contribution to vitiligo risk. Some of the gene changes associated with an increased risk of vitiligo have also been associated with an increased risk of other autoimmune conditions.

It is unclear what specific circumstances trigger the immune system to attack melanocytes in the skin. Research suggests that the immune system of affected individuals may react abnormally to melanocytes that are stressed by factors such as chemicals or ultraviolet radiation. In addition, the melanocytes of people with vitiligo may be more susceptible to stress than those of the general population and therefore may be more likely to be attacked by the immune system. 

The condition probably results from a combination of genetic and environmental factors, many of which have not been identified. Studies suggest that psychological stress, exposure to ultraviolet radiation, or contact with certain chemicals or skin-whitening products may trigger vitiligo in predisposed individuals.

 Inheritance: Vitiligo sometimes runs in families, but the inheritance pattern is complex because multiple causative factors are involved. About one-fifth of people with this condition have at least one close relative who is also affected.

Myths & Facts On Vitiligo

MYTH: People with vitiligo are born with patchy uneven skin because they have mixed-race parents.

FACT: Vitiligo is not related to ethnicity of the parents and most people with it have even skin pigmentation at birth. Vitiligo is a progressive medical condition that generally emerges as discolored patches in a young person before the age of 20, though it can occur in older age too.

MYTH: Only dark-skinned people get vitiligo.

FACT: Vitiligo affects people of all races equally; however, it may be more noticeable in people with dark skin.

MYTH: Vitiligo is related to other skin diseases such as skin cancer, leprosy, and albinism.

FACT: Vitiligo is a completely separate condition and not related to skin cancer, leprosy or albinism. It is thought to be an autoimmune disorder in which the immune system attacks and kills cells that make skin color, called melanocytes (ma-LAN-o-sites). Though it may be more common in people with a family history of vitiligo, it can occur in anyone. The cause of the disorder remains unknown.

MYTH: Vitiligo only affects skin that you can see, such as on faces and hands.

FACT: White or light patches caused by vitiligo tend to occur more commonly in sun-exposed areas, such as hands, feet, arms, face, and lips. However, these patches can also occur in the armpits, groins, eyes, navel, genitals and rectal areas. Similar patches may also appear on both the mucous membranes (tissues that line the inside of the mouth and nose) and the retina (inner layer of the eyeball). The hair that grows on areas affected by vitiligo can turn white as well. For some people, the patches may start out small and increase in size and number as the disease progresses.

MYTH: Vitiligo is made worse by eating certain combinations of foods.

FACT: Vitiligo appears to be entirely unaffected by food choices.

MYTH: People with vitiligo are often impaired with other physical and mental disabilities.

FACT: Generally speaking, most people with vitiligo are vibrant, normal individuals with a life-altering, but not necessarily life-threatening, skin disorder. The disease may be more common in people who have other autoimmune disorders, such as:

• Hyperthyroidism—an overactive thyroid gland

• Adrenocortical insufficiency—the adrenal gland does not produce enough of the hormone

• Alopecia areata—patches of hair baldness

• Pernicious anemia—a low level of red blood cells caused by the failure of the body to absorb vitamin B12

People with vitiligo should make regular doctor appointments to monitor for these and other potential conditions.

MYTH: You can predict who will have vitiligo and how extensive the disease will be by looking at them.

FACT: There is no superficial way to predict who will have vitiligo. The diagnosis of vitiligo is made based on a physical examination, medical history, and laboratory tests, sometimes including a biopsy. There is also no way to tell how much or which skin will ultimately be affected. Vitiligo is usually progressive, which means that over time white or discolored patches may spread to other areas of the body and become more extensive. Some people report additional depigmentation following periods of physical or emotional stress.

MYTH: You can cure vitiligo and return the color to white patches by rubbing a variety of oils into the skin 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 a number of therapies that people with vitiligo may try, including: UV light therapy, surgical skin and cellular grafts, tattooing, steroids, and medications. Also, some people simply opt to cover their skin with special cosmetics. If you have vitiligo, speak with your doctor to learn about all the options available to address the color loss of skin. In addition, research is underway to find better therapies. 

MYTH: If you see someone with vitiligo, you should turn the other way because it’s contagious.

FACT: Vitiligo is neither contagious or 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.