As I grew up in the early aughts with vitiligo, I frequently found myself explaining my skin condition to my classmates and friends. More often than not, I was met with blank stares in return. However, in more recent years — thanks in large part to the supermodel Winnie Harlow, who also has it — vitiligo awareness has grown significantly. Still, while vitiligo is front and center on magazine covers (and even on Barbie® dolls!), few people outside of the dermatology world are actually aware of its causes and treatment options. To shed more light on the concern, I spoke with Pearl Grimes, MD, a board-certified dermatologist in Los Angeles and the director of The Vitiligo and Pigmentation Institute of Southern California. Keep reading to learn all about vitiligo, including options for treatment, and the things that everyone should know about the common skin condition.
What is vitiligo?
Vitiligo is a benign condition best known for the “white” patches it leaves on skin of all shades, caused by the loss of skin’s pigment. It can occur in either a localized (specific to one area) or generalized (all-over) distribution, which leads to depigmented or “white” spots. Vitiligo is quite common, and affects between 0.5 and one percent of the world’s population. Though it is most noticeable on those with dark skin tones, the skin disease occurs fairly equally among all ethnicities and races. It is not contagious.
What causes vitiligo?
Melanin — the pigment that gives skin, hair, and eyes its color — is produced by special cells called melanocytes. When they stop making melanin, vitiligo occurs. The cause of that process remains largely unknown, but many theories have been proposed, with data to support them. “Data now documents that vitiligo is an autoimmune disorder, where the body’s immune system attacks pigment cells through the gamma-interferon pathway,” Dr. Grimes says. “Genetics play a huge role in vitiligo, and 35% of patients will have a family history of [the disorder].” One of the genetic factors for being at risk of having vitiligo are known as immuno-susceptibility genes. They’re not specific to vitiligo, but rather, could make you predisposed to autoimmune disorders overall, including conditions like rheumatoid arthritis or lupus.
In addition to having a family history of the skin concern, there are certain diseases affiliated with vitiligo. “We know that [the risk of] Hashimoto’s thyroiditis is increased in patients with vitiligo,” she says. So, if a patient has a family history of vitiligo and all of a sudden gets Hashimoto’s, they should keep their eyes peeled for white patches in the future. “The risk is there, but we also don’t want them to become paranoid,” adds Dr. Grimes. (Remember, while it can be aesthetically frustrating, vitiligo is a benign condition!)
Environmental factors can also play a part in a vitiligo diagnosis. While they don’t quite cause vitiligo, they can accelerate it. Things like stressful events, sunburn, and infection can activate some of the immune system’s pathways that are thought to elicit vitiligo. In particular, acutely emotionally stressful events can impact the immune system, and thereby trigger the disorder, says Dr. Grimes. So, if you’re genetically predisposed to vitiligo, have been under a great deal of duress lately, and are suddenly noticing new “white” patches on your skin, the condition could be to blame.
How is vitiligo treated? Is there any way to prevent it from spreading to other areas of the body?
If you don’t have vitiligo, but have a family history of it or the immuno-susceptibility genes associated with the condition, Dr. Grimes encourages taking certain precautions, including getting a physical once a year, getting your bloodwork checked, and trying to control your stress levels.
Should you already have the condition, know that there are several vitiligo treatments available, but choosing which method makes the most sense depends on the severity and extent of involvement of the depigmentation (basically, how much area the “white” patches cover). “If someone has limited involvement, we use topical corticosteroids, which have been shown to repigment vitiligo in some cases,” Dr. Grimes explains. “If patients have more extensive involvement, we [also] rely on narrow-band UVB phototherapy,” a form of controlled light therapy which could help restore pigment to affected areas. The dermatologist is also a firm proponent of supplements, as they can help with stabilization of vitiligo. More specifically, she routinely checks vitamin D levels in all of her patients — and has observed a lot of vitamin D deficiency in those who have vitiligo. That’s why she often recommends a vitamin D supplement and a multivitamin.
There are currently no drugs that are FDA-approved to repigment areas affected by vitiligo. However, the FDA has approved ingredients to address depigmentation, including monobenzone, which you may have heard of in other skincare contexts (say, lightening hyperpigmentation). Hydroquinone is a similar ingredient, though it has not been FDA-approved. The idea is that these active ingredients can be used on parts of the body that are unaffected by vitiligo, lightening them in color to more closely match the white patches.
However, it’s essential to use these treatments under supervision of a medical professional, and as they could permanently depigment your (unaffected) skin, it’s understandable that you might want to seek other options. The good news is that new treatment therapies are being developed and studied every day. “We are in the midst of a major paradigm shift in approaches for repigmentation, and it’s pretty exciting,” shares Dr. Grimes. “I think that in the next five to eight years, vitiligo will be like psoriasis, in that we will have multiple therapeutic options for it.”
Hydroquinone has not been FDA-approved. Talk to your doctor before starting any treatment with it.
If someone is bothered by depigmented areas but is more interested in temporary options, they can always go the cosmetic route. For example, Dermablend® Professional is a dermatologist-tested brand with makeup products that are proven to help temporarily even out complexions of those with vitiligo.
What should more people know about vitiligo?
Even as awareness of vitiligo continues to grow, Dr. Grimes says there are still many things she wishes the world knew about the condition. One is just how psychologically devastating it can be, especially for people with noticeable, widespread depigmentation. While my vitiligo is only in a small spot and is not terribly noticeable, millions of other people around the world — some as young as 10 — are more visibly affected by the condition, and thus more susceptible to hurtful, ignorant scrutiny from an uninformed public. For this reason, vitiligo can be especially difficult for people whose depigmented patches cover their entire bodies, or for those with darker skin, on which depigmented spots appear more starkly.
While we support accepting and embracing your “white” patches, you don’t have to: “Understand that you don’t have to live with vitiligo,” explains Dr. Grimes. “Treatments are available, and if your physician doesn’t or isn’t interested in treating it, simply move forward in finding someone who will treat it.” The right doctor will help their vitiligo patient get to a more secure and understanding place with their condition. “I wish for a cure, but who knows whether we may ever get there,” she says. “So, right now, I’m just going to wish for the things that are possible.”
We’ve made great strides in the past few decades; as the world becomes more cognizant of vitiligo and its effects, I find myself having to explain it less and less frequently. When I mention my own vitiligo, I'm no longer met with the blank stares that tarnished my childhood years — instead, people nod along in familiarity. But even as the condition continues to become a household name, the research around it and its potential treatments has a long way to go. The more we talk about it, normalize it, and support organizations like The Vitiligo Research Foundation and The Vitiligo Society, the more progress we can make.
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