Vitiligo and the stigma associated with it

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By Dr.Sravya C Tipirneni, Consultant – Dermatologist & Cosmetologist, Columbia Asia Hospital, Whitefield (A unit of Manipal Hospitals)

Vitiligo is a skin disorder in which white patches appear resulting in the skin losing its original
pigment. The condition occurs when melanocytes, which are essentially skin cells that produce
melanin, are destroyed by the body’s immune system. Melanin provides the necessary pigmentation
of the skin.


The main factor associated with vitiligo, is the stigma attached to it. Though not a life threatening or
contagious condition, there are still some prejudices attached to it. Many of the vitiligo patients tend
to develop low self-esteem as a result of the social and emotional trauma that comes with such a
condition and it is this issue which we counsel more in the hospitals everyday than the condition
itself.

Many cultures, across the world, attach a strong social stigma to the disease. People tend to sit away
from a person impacted by vitiligo, thinking it’s contagious. In India it can go to the extent of even
hampering marriage prospects. Thankfully, an alternative narrative is being built as well. Fashion
shows, ads, art exhibitions etc are featuring models with vitiligo, in a bid to drive away this wrongly
perceived stigma.


How does vitiligo happen?
Vitiligo usually sets in with a few small whitish or pale patches which may or may not spread in the
first place but causes more panic. In some cases, it spreads to all parts of the body within few weeks
or can take even a few months. There are numerous types in this spectrum. Some affect only the
hands and feet. Some only the tips and lips. Some are random and scattered patches throughout the
body, while some have extensive involvement as well.


Though, in some, it may spread and become larger over the course of time, it usually stays in the
same place for years for most of the patients. It is often seen that the location of smaller macules
moves over a period of time, as certain areas of the skin lose and regain their pigments. Those
suffering from larger patches become conscious about their condition which can lead to anxiety.


How common is vitiligo?
Globally, vitiligo occurs in about 1% of the population and is rare among the very young or very old.
It is seen more often in people with darker skin, though it impacts all races. It is most commonly
seen in people aged 10 to 30 years.


Causes
The affected person’s immune system may develop certain antibodies that destroy
melanocytes. Also, certain factors that may increase the chance of getting vitiligo may be inherited.
Or else, a defect in the melanocytes causes them to destroy themselves. These are the common
causes. Sometimes, Vitiligo may also be triggered by certain events, such as physical or

emotional stress. While, it can be said that Vitiligo is not necessarily inherited, about 30% of affected
people do have at least one close relative who has the condition.


Symptoms
Whitish of pale patches of skin appear spontaneously in different parts of the body. They are usually
asymptomatic. Some might have borders of differential colour gradation.
Problems associated with vitiligo
While vitiligo maybe termed as a cosmetic condition, it can be often seen that people with vitiligo
may end up suffering from a host of issues. As they lack melanocytes, patches are more sensitive to
sunlight than the rest of the skin, so they will burn rather than tan. People with vitiligo may have
some abnormalities in their retinas and some variation of colour in their irises but vision is usually
not affected. Patients with vitiligo may be more likely to get other autoimmune diseases such
as diabetes, hypothyroidism and pernicious anaemia.


But one of the key issues of people with vitiligo is the embarrassment that they feel about their skin.
As a result, they may suffer from poor self-esteem. Later, this could turn into some form of
depression. This can turn into a psychological issue and if the person affected is isolating himself,
then the family should definitely seek medical help.


Treatment 
Topical creams and ointments are available to take care of immune reactions. They aid in reinstating
the colour of the skin. To check the disease progression, often oral medication is also recommended
in certain cases. Light treatment is carried out to re-pigment the skin in suitable candidates. Those
who don’t respond to light therapy can be treated with surgical options.


Vitiligo management
Creating a uniform skin tone by either restoring colour or eliminating the remaining colour is
followed. The former is termed as re-pigmentation and the latter de-pigmentation. Common
treatments include camouflage therapy, re-pigmentation therapy, light therapy and surgery.
Counselling is almost ways be recommended. Most importantly, they need emotional support and
social acceptance, from friends and family. Education and awareness is key.

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