An investigation into the causes, symptoms and treatments of vitiligo.
Vitiligo. You might have heard of it before. Perhaps you even know someone who has it. Or you’re a super fan (like us) of fashion model Winnie Harlow who is loud and proud about living with it.
But how much do you really know about the skin condition? Gritty Pretty spoke to Dr Michelle Rodrigues, founder of Chroma Dermatology and Derya Koch, dermal clinician and founder of Victorian Dermal Group to get all the insights on vitiligo–from what causes it to who it can affect and if there are treatment options for those that want it.
Koch explains that vitiligo is an autoimmune disease of the skin. “It targets pigment-producing melanocytes and results in patches of depigmentation that are visible as white spots.” The white patches caused by vitiligo tend to start at a young age. Rodrigues notes that around 70 per cent of people affected by vitiligo will have their first spot developed before the age of about 25.
Loss of pigmentation in the skin is the most common symptom of vitiligo. Rodrigues explains that some recent studies have also shown a correlation between vitiligo and hearing loss. “The inner ear does contain melanocytes and if they are affected patients can have certain types of hearing loss.”
Vitiligo affects up to two per cent of the global population, explains Koch. She also notes that vitiligo is attributable to genetic and environmental factors. “There’s a partly genetic component to vitiligo whereby genes are inherited from either mum or dad that potentially make that individual more susceptible to certain kinds of autoimmune conditions,” explains Rodrigues.
She shares that someone with vitiligo might not have a family history of the condition itself, instead they may have a family or personal history of other autoimmune conditions. “Things like type one diabetes, celiac disease, rheumatoid arthritis, and lupus are just some of the very many autoimmune conditions that can be seen in patients with vitiligo or in family members of those who are affected by vitiligo.”
Meanwhile, Koch highlights that melanocytes in patients with vitiligo are more susceptible to oxidative stress. Environmental factors from skin trauma and surgery through to psychological or physical stress can trigger the onset of vitiligo. These environmental factors are associated with those who are genetically predisposed to vitiligo. Other environmental factors include exposure to certain chemicals in cleaning products and hair dyes.
… Only if you want to, of course! Rodrigues shares that darker skin tones are more likely to seek treatment for vitiligo, because it shows up on the skin more. While treatment of the white patches on the skin is a personal choice, Rodrigues advises seeing a GP as soon as possible before deciding next steps.
“There can be associations with vitiligo and other issues, such as hearing loss and development of other autoimmune conditions … there would need to be blood tests and further investigations to check for these.”
For those who do wish to get treatment, Rodrigues highlights that it’s important to establish the goals of your treatment before proceeding. She shares that for some patients, the goal is to stop the vitiligo from spreading and to bring as much or all of the pigment back as possible. For others, the goal is simply to stop the progression of vitiligo.
Treatment for vitiligo in Australia is done through regulation of the autoimmune response by using topical and systemic immunomodulatory agents (aka, medical drugs). Phototherapy (UVB light) is another option. This stops the immune system from attacking the pigment cells and encourages pigment cells to regenerate. “It’s like planting trees and we try to give it fertiliser to make them grow. The UVB can be thought of as fertiliser, we’re trying to really encourage growth and repigmentation of affected areas,” explains Rodrigues
“Following successful re-pigmentation, application of calcineurin inhibitors is recommended to prevent recurrences. Combination therapies are generally considered to be more successful than monotherapies … Using these treatment options, it may be possible to halt disease progression, stabilise depigmented lesions, and achieve re-pigmentation” says Koch.
Both Koch and Rodrigues note that there are also cosmetic camouflage options for those who don’t want to go down the path of medical treatment, and that the earlier the treatment is sought, the better.
Finally, if you have vitiligo, Rodrigues wants you to remember you’re not alone. “If you’re seeing symptoms, reach out to your clinician and let them know what’s happening and how you’re feeling about it.”