Vitiligo

Jeffrey Sassmannshausen, MD

Melanocytes are special cells in the epidermis, which produce melanin, giving our skin color. The more melanin that you produce, the darker your natural skin color. We are all familiar with tanning, which is increased melanin production as a result of exposure to UV radiation from the sun or tanning beds. Melanin is our body’s way of trying to protect us from the damaging effects of UV radiation.

Vitiligo is a condition that causes a loss of pigment in the skin and may include the pigment in hair as well. Vitiligo affects approximately 1% of the population and can occur equally in men and women of all races. The tendency for vitiligo can run in families and can start at any age, but mostly has its onset between 10-30 years old.

Often vitiligo presents with well-defined patches around the eyes, mouth, fingers, elbows, knees, low back, and genital area. These patches will be lighter in color than the surrounding skin initially due to decreased melanin production by the melanocytes in the skin. The discoloration typically progresses to being completely white with no pigment whatsoever due to loss of melanocytes in the skin. Vitiligo can be triggered by an autoimmune process in which the body’s immune system mistakenly begins to attack and destroy melanocytes. Vitiligo may also be associated with other types of autoimmune conditions, particularly thyroid disorders.

In people with vitiligo, the areas of skin that have lost pigmentation have absolutely no natural protection from the sunlight and are at much higher risk for developing skin cancers. People with this condition must be extraordinarily diligent with sun protection all year long. Heliocare® is an over-the counter supplement containing antioxidants from the Polypodium leucotomos fern that can be additionally helpful. The powerful antioxidants in Heliocare help the body to protect itself from free radicals caused by sun damage.

Vitiligo is socially stigmatizing, particularly in skin of color, and can be emotionally devastating. Particular cosmetics can be used to cover up and/or disguise areas of discoloration. There are some treatments that may help to induce a return of pigment including topical medications, light-based treatments, and surgical micrografting procedures. The sooner treatments for re-pigmentation are started, the better the chance of success. There is also a topical treatment that causes a permanent loss of pigment on all of the skin, which may be desirable for patients with extensive vitiligo so that they can be one color.

There is some move towards de-stigmatizing vitiligo in the media and industry. Mattel has released a Barbie doll with vitiligo. Winnie Harlow, a contestant on America’s Next Top Model, has found success by embracing her vitiligo and not hiding it. Big Krizz Kaliko, a rapper and singer, has vitiligo and titled his debut album with the name of his skin condition. Jon Hamm (Mad Men), Hollie Marie Combs (Charmed), Hedvig Lindahl (Swedish soccer goalkeeper), and of course, Michael Jackson all have/had vitiligo.

Currently, there is a lot of research being done that is targeting the direct causes of melanocyte destruction. New treatments are coming for vitiligo! Stay tuned!

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