What Is Vitiligo? All About This Unique Skin Condition That Impacts Skin Pigmentation, and How To Treat It – Parade Magazine

Vitiligo is a condition that causes the skin to begin to lose its pigmentationor colorfor no apparent reason, resulting in white patches that are especially noticeable in people whose skin tone is naturally dark.

If youve heard of this chronic skin condition, theres a very good chance it was in association with Michael Jackson. The King of Pop is reported to have had vitiligoand other celebrities have it as well, including model Winnie Harlow, who has had an empowering presence of showing the condition's unique beauty and style. All in all, though, its a fairly rare disorder: Approximately .5% to 2% of the worlds population has vitiligo, according to a study in Dermatology Reports.

Whats behind this uncommon disease and is there a treatment for it? Heres what the experts have to say.

What is vitiligo exactly? Vitiligo is mainly an autoimmune disease of the skin that targets pigment-producing cells called melanocytes, says Bassel H. Mahmoud, M.D., Ph.D., an associate professor of dermatology and member of the Vitiligo Clinic and Research Center at the University of Massachusetts in Worcester. This results in patches of depigmentation in the form of chalky white areas on the skin which can range from being very small to very large, even covering most of the skin surface.

There are two different types of vitiligo, per the National Institutes of Health. The most common is called non-segmental vitiligo. This tends to spread slowly with new patches developing off and on, says Dr. Mahmoud. Non-segmental vitiligo tends to be symmetric, meaning it appears on both sides of the body, and may stop and start throughout the persons life. It usually occurs on one or a few areas of skin, although it can sometimes occur more broadly across the body.

The other type is known as segmental vitiligo. Segmental vitiligo may spread quickly, but it tends to stabilize after six to 12 months and then stop, says Dr. Mahmoud. Once segmental vitiligo stops spreading, most people do not develop new patches later in life.

Vitiligo is an equal-opportunity skin disruptor, affecting both women and men and people of all races. You might think the disease is more common in the Black community, but thats only because it is more visible, due to their darker skin, says Nada Elbuluk, M.D., an associate professor of dermatology at the University of Southern California Keck School of Medicine and director of the USC Skin of Color Center and Pigmentary Disorders Clinic in Los Angeles. People with whiter skin can get vitiligo as well, the appearance is just not as dramatic.

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When you think of autoimmune diseases, you might picture lupus or rheumatoid arthritis. With those conditions, the bodys immune system, which normally functions as a barrier to prevent harmful bacteria, viruses and infection from infiltrating the body, turns on itself and begins attacking healthy cells in the body instead.

When the immune system begins to attack healthy tissue, it often results in inflamed joints, according to the National Institutes of Health. In cases where the immune system attacks the skin, it can lead to rashes, blisters and color change. The latter is what happens with vitiligo, an autoimmune condition where the immune systems assault on skin cells results in the loss of pigmentation.

As is the case with many autoimmune conditions, scientists still arent sure what causes only some people to develop vitiligo. But certain risk factors make it more likely that youll develop the condition than others.

For instance, having another autoimmune condition may increase your risk: In a study by researchers at NYU Langone Health in New York City, scientists found more than a two-fold higher prevalence of rheumatoid arthritis and four-fold higher prevalence of multiple sclerosis in people with vitiligo versus the general population. The condition is associated with other autoimmune diseases as well, such as diabetes mellitus, thyroid disease or alopecia areata (a type of hair loss), adds Dr. Mahmoud.

Addisons disease, pernicious anemia, psoriasis and systemic lupus are also associated with vitiligo. In one study, 15% to 25% of people with vitiligo had at least one other autoimmune condition.

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Research in the journal Dermatologic Clinics suggests there may be as many as 50 different genetic variations that contribute to people developing this disease. (It should be noted that genetic predisposition and a hereditary condition are not the same: While its true you are at higher risk for vitiligo if one of your parents has the condition, even people without a first-degree relative who has vitiligo may still develop genetic mutations for it.)

Regardless, genetic variations alone are not enough to cause the diseasethat genetically inclined individual then needs to have a trigger event, Dr. Elbuluk says. For instance, they might get a sunburn or scrape their skin or even be exposed to a lot of stress, she explains. There needs to be something that triggers the onset of vitiligo.

Yes, actually. If you have vitiligo, your hair can become white, confirms Dr. Elbuluk. The same melanocytes that give your skin its color also give your hair its color, so hair can be affected as well. Not just the hair on your head, either: We have hair all over our bodies, Dr. Elbuluk points out, and people with vitiligo may lose hair color on their arms, legs and other areas. Whats more, some people also lose color in areas such as mucous membranes, which includes the inside of the mouth, nose and the genitals, adds Dr. Mahmoud.

Mainly though, youll notice the condition due to skin color loss in major areas of the body. Vitiligo can develop anywhere on a persons skin, says Dr. Mahmoud. It usually appears first on the face, hands and feet. Over time, the spots and patches can grow, and then appears on other areas of the body as well.

Just as there is no single known cause for vitiligo, there is no known way to prevent it from developing either. We dont have a way to screen for it in utero or test to see if you might get it later in life, says Dr. Elbuluk. There is no way to prevent it if you are genetically predisposed.

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The main thing, she says, is to try and reduce exposure to the things experts know can trigger the condition. For instance, we know that stress can be a trigger event for people who are predisposed to vitiligo, she says. So as much as you can improve your emotional balance and psychological wellbeing, it may be beneficial.

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There is no cure for this skin condition, but there are effective treatments available and several promising options in the pipeline. Current treatments include:

This non-invasive approach uses narrowband UVB light to improve the color of depigmented skin. A study in JAMA Dermatology found that 74% of people with vitiligo saw at least 25% improvement in their condition after using phototherapy for six months, while 44% of people saw a 75% or greater improvement in vitiligo on their face after six months. (Notably, study participants did not see a major improvement of the condition on their hands or feet using phototherapy.)

Once considered the standard treatment approach, PUVA is used less frequently now due to newer methods that have fewer side effects. Psoralens are types of drugs, in topical or pill form, that cause the skin to darken when exposed to ultraviolet A light. This approach is not recommended for women who are pregnant or breastfeeding; it may also raise your risk for skin cancer.

Research in the Journal of the American Academy of Dermatology found improved skin color in 82% of vitiligo cases after three weekly laser therapy sessions, for a total of 12 treatments total.

According to a meta-analysis in the Journal of Clinical and Aesthetic Dermatology, 65% of people with vitiligo had improved pigmentation three months after daily use of a corticosteroid cream. (The American Academy of Dermatology notes that this approach may be most successful for vitiligo on the face; it is less effective on hands and feet.)

If vitiligo lesions fail to respond to the treatments above, dermatologists refer to it as recalcitrant vitiligo, says Dr. Mahmoud. The treatment resistance is usually related to a complete loss of the melanocyte reservoir in the affected area, he says. In these cases, repigmentation will not be achieved unless melanocytes are harvested from normally pigmented skin then introduced surgically into the affected white area of vitiligo.

Surgery involves either tissue or cellular transplantation procedures. Melanocyte keratinocyte transplantation procedure (MKTP) is a cellular transplantation technique that is emerging as an important solution, says Dr. Mahmoud. MKTP is a precise, fast and safe surgical technique for transplantation that enables treatment of large, depigmented lesions during a single surgical setting. A recent review in JAMA Dermatology of 8,776 patients who underwent surgery for vitiligo found that 81% of participants experience at least a 50% improvement in their skin pigmentation with surgical intervention.

A last resort option, the systematic removal of pigmentation works best for people who have already lost the majority of their skin color due to vitiligo. This approach uses a cream to remove pigment from the rest of the skina process that can take several years of daily treatments to complete.

In addition, a class of drugs called Janus kinase (JAK) inhibitors have shown success in clinical trials for treating vitiligo, according to a new study, but are not yet approved by the Food and Drug Administration for this condition. JAK inhibitors work by targeting and disrupting the signals from specific proteins that trigger the depigmentation process.

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Given the ongoing, disruptive nature of the disease, its natural to wonder if alternative approaches like changing your diet might help reduce the appearance of vitiligo. In a nutshell: Nope. There are no clinical trials showing direct correlations between diet, exercise and vitiligo, says Dr. Elbuluk. Still, a healthy eating plan may have benefits: There are some studies that show certain antioxidants may help stabilize vitiligo, so [a] healthy, balanced diet is goodeven if there is no hard data that eating certain foods will make a difference.

So ignore what you may have seen on the internet about vegan diets miraculously curing the condition: Science does not support it. Recent research in both the Journal of Alternative and Complementary Medicine and Dermatologic Clinics suggests that there is not enough evidence to conclusively say any specific diet can make a major impact on this diseaseand if it does, it is in conjunction with traditional medical intervention.

Many people living with vitiligo say the stigma and misinformation spread by the general public make them feel ostracized with this disease. It is not contagious and people with vitiligo have not done anything to bring it on themselves, stresses Dr. Mahmoud. The mental health aspect of the condition is challenging, he adds: Vitiligo can have a devastating psychological effect on patients and can affect their quality of life.

A growing social movement encourages people with vitiligo to embrace their unique skin appearance, and a growing number of celebrities are opening up about life with this condition. These are some of the public figures who have been associated with vitiligo:

Bottom line? There is nothing easy about living with vitiligo, but theres no reason to feel embarrassed, either. As more and more celebrities raise their voices and celebrate their skin differences, theyre paving a path for others to do the same.

Next up: Protect your skin with the best sunscreen for every type of skin.

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What Is Vitiligo? All About This Unique Skin Condition That Impacts Skin Pigmentation, and How To Treat It - Parade Magazine