Clive Anderson - AT THE DERMATOLOGIST PERHAPS THE most distressing skin diseases for patients are those that result in the skin becoming pale and discoloured. This is especially true in black skin and is a cause of significant suffering for patients and their families.
The most serious of this group of disorders is vitiligo. It is reported that a certain famous male pop star suffers from this affliction and it may be the cause of some of his seemingly bizarre behaviour.
Vitiligo is a skin condition that results from a complete loss of pigment in certain areas of the skin. Any part of the body may be affected with the commonest affected areas being the face, lips, legs and genital areas. One or two in every 100 people are affected with the disease, often before the age of 25. Our skin colour is determined by the pigment melanin. This pigment is produced in cells called melanocytes. If these cells die or stop producing melanin, the skin will be normal in all respects except for an absence of colour -- it will be completely white.
Vitiligo often begins with a rapid loss of colour. For reasons that are not clear, the process may continue or suddenly stop. Cycles of pigment loss, followed by a quiet phase, may continue indefinitely. Rarely, the skin pigment returns on its own. The severity and extent of the pigment loss varies with some patients having only small patches and others suffering extensive depigmentation. Unfortunately, there is no way to predict how much pigment the patient will lose.
Vitiligo is not caused by an infection. The question is often asked - "I wasn't born with vitiligo. If it's not infectious. How did I get it?" The most probable explanation is that it is in the genes that you inherit. Your genes contain a factor that predisposes you to develop vitiligo.
"But how can it be genetic when no one in my family has vitiligo?" Most people say this. Apparently, more than one gene is responsible for the development of vitiligo. A critical combination of genes is necessary to start the process. Since genes are inherited in a random fashion from both parents, only sometimes will these genes come together in the same person. Persons in the same family who do not inherit this combination of genes are unlikely to develop vitiligo. Even those persons who do inherit a complete set may require some other stimulus, external or internal, to trigger the appearance of the patches. Because of these factors the vitiligo genes may pass through several generations without anyone showing the disorder.
There is an association between vitiligo and some other diseases such as diabetes, thyroid disease, a type of anaemia and a particular type of hair loss called alopecia areata. These diseases seem to have a relation to the production of antibodies to our own tissue. They are often termed autoimmune diseases and it is felt that vitiligo may have a similar mechanism.
VITILIGO CAN BE TREATED
It is important to understand that the skin in vitiligo is healthy and persons with this condition are not unhealthy in any way. Contrary to what some patients and even some health providers feel, vitiligo can be treated. Sometimes the best treatment is no treatment. Depending on the extent of the condition, some patients after discussion with the dermatologist may opt for camouflage make-up to disguise the white patches. This make-up, if applied properly, is even waterproof.
Re-pigmentation therapy employs the use of topical corticosteroids especially if the area involved is small. A product formulated from placental tissue in Cuba is also now available locally. This treatment is applied to the affected area twice daily and there are reports of significant successes. Psoralens are chemicals that make the skin sensitive to light. When applied to the skin and subsequently exposed to measured doses of light, it facilitates the migration of melanocytes into the white patches. Skin grafting is another option where normal skin is transferred to the white areas. Other treatment options include a new class of immunomodulator that is safe to use on the sensitive skin arrears and even on children.
IS VITILIGO CUREABLE?
There is no single cure for vitiligo. Research continues however and new treatments continue to be developed.
There is hope.
Dr. Clive Anderson is a Dermatologist and Venereologist.
