Vitiligo
1. What is vitiligo?
Vitiligo is an autoimmune disorder; it is a result of immune cells attacking the pigment cells (melanocytes) of the skin of the same individual. This results in the skin turning white due to the loss of pigment (melanin). Why this happens is genetically controlled. In an Individual with vitiligo, the pigment cells on their skin are genetically prone to external stress, including emotional stress and repeated trauma. When stressors arise, these pigment cells releases “alarm signals” that activates the immune system that results in the attack and disappearance of these pigment cells .
2. What concerns do vitiligo patients have ?
In Skin Physicians, we see around 100 vitiligo patients per month. Their main concerns include their physical appearance, especially when the white patches affect the exposed parts of their body like the face, hands, arms and legs. Being Asians with skin of colour, these white patches are a stark contrast to their normal skin colour. Patients are socially embarrassed with this presentation and many of them are depressed because of this. They can be embarrassed in performing tasks like a simple handshake, if vitiligo affects their hands. Many patients faced curious stares from passerby on the streets. They can also become very self-conscious of their appearance and become insecure. Sad to say children with vitiligo may be made fun of or taunted in schools. In certain Asian cultures, e.g. among Indians, it can be a taboo to have vitiligo. Affected patients (and their unaffected family members as well!) may face difficulty in finding a spouse and getting married.
3. At what age does vitiligo appear?
Vitiligo affects all age groups. 50% of vitiligo appears during childhood and 50% appears during adulthood
4. Is vitiligo hereditary?
Vitiligo is a genetic condition; it is hereditary. However the genetics is complex. In other words, whether the offsprings of an affected individual will present with vitiligo cannot be predicted with certainty. Someone may not see any signs of vitiligo even if their family has it, or it might skip a generation.
5. Can vitiligo cause an itch or rash?
It can. In early stages of vitiligo, the skin can be red (inflamed) and itchy before it loses its colour. As you may recall, the loss of pigment cells is due to “autoimmune destruction”. When the body’s immune cells attack the pigment cells of the skin, the skin may turn red and inflamed due to this attack.
6. Can those who have vitiligo go out in the sun, or is it advisable not to?
Vitiligo patients can go out in the sun but with caution. It depends on the duration of sun exposure and the extent of white patches in an affected individual. In vitiligo, the white patches have lost their pigment cells (melanocytes) and hence the loss of their protective pigment (melanin). Because of this, it makes the affected skin prone to sunburn. However if the sun exposure is short like simple walking from building to building, generally a sunblock is not required. However if the sun-exposure is prolonged, e.g. playing beach volleyball, cycling or hiking during the day, application of a sun-block is a must to prevent a sunburn.
7. What are the treatment options for vitiligo patients in Singapore?
Generally the approach to treating vitiligo is to:
- Stop its spread/ expansion (Induce Stability)
- Restore the Colour (Repigmentation)
- Camouflage
To stop the expansion and spread of vitiligo, medical treatment with oral steroids, steroid creams and topical immunomodulators can be used. Oral antioxidants have also been shown to be helpful. In situations where vitiligo is expanding or spreading rapidly, systemic immunosuppressant drugs are employed. Recently a new class of drugs called the Janus Kinase (JAK) Inhibitors have shown promising results in arresting the expansion of vitiligo and restoring skin colour. A topical form of JAK inhibitor will be available in Singapore later this year.
To restore skin colour, phototherapy is invariably required. Phototherapy involves the application of narrowband ultraviolet B (NBUVB) light twice to thrice weekly to the vitiligo patches. For patients with a few limited vitiligo patches, phototherapy can be administered using a handheld device (targeted phototherapy like the Excimer Light /Laser). However for patients with more extensive vitiligo, full body phototherapy will be required, and this involves stepping into a cabinet that contains full height NBUVB lamps. The restoration of skin colour takes time, and it usually takes 6 to 7 weeks of treatment to see results.
Patients with vitiligo on the exposed parts of the body (e.g. face or hands) can cover up the affected areas with a camouflage cream. Various cover-up creams are available commercially (many of which are water-resistant).
8. Cellular grafting as a treatment for vitiligo
For patients whose vitiligo is stable and who fail to respond adequately to the above treatments, surgical grafting can be considered. This involves transplanting the patient’s normal skin (i.e. tissue grafting) or skin cells (i.e. cellular grafting) onto the vitiligo areas to replenish the lost pigment cells.
For cellular grafting, the procedure is performed on an outpatient basis and takes about 3 to 4 hours to complete. Return of skin colour takes about 2 to 3 months to occur. This procedure is most effective for stable vitiligo, especially segmental vitiligo.
Non-cultured cellular grafting is an established and evidence-based transplant service offered by our centre for vitiligo treatment. Dr Goh Boon Kee first introduced cellular grafting as a clinical service in Singapore in 2006 and has since successfully transplanted more than 800 patients (Press Release 2006). He has also mentored and taught this procedure to the younger dermatologists in Singapore.
9. Advice for those suffering from vitiligo.
A) Not to be disheartened! The advances in dermatology have made vitiligo a treatable condition. With proper treatment, the skin colour can be restored. But you need patience for the skin colour to be gradually restored using the current medical treatments. Seek medical treatment!
B) Avoid physical trauma to the skin. Repeated knocks or cuts can result in vitiligo appearing on the injured areas.
C) Reduce emotional stress. Psychological stress can be a trigger for new patches of vitiligo appearing on the skin. So take things easy. Learn to relax. Physical Exercise (like jogging, swimming or practicing yoga) is a good way to relieve emotional stress. Think positive!
D) Eat healthily.
Many patients have avoided citrus fruits because “the internet” claims that it will worsen vitiligo; that is NOT true. In general , there is no food restriction in patients with vitiligo, but the advice is still a good balanced diet. Foods rich in antioxidants are beneficial to patients with vitiligo, so grab your fruits and vegetables!
Recommendations:
Vitiligo is a medical condition and not just a cosmetic concern. Vitiligo occurs because of an autoimmune cause.
Vitiligo is not an infectious disease; it is not contagious. You can safely shake the hands of an individual suffering from vitiligo.
Individuals with vitiligo need our support! They need our empathy. This condition is treatable. With medical treatments they can regain their skin colour, restore their self-confidence and assimilate fully into society.
