Truths, myths and treatment of Vitiligo

By Dr. Ronald Katureebe 

Vitiligo is one of those skin conditions that will easily be noticed by the plain eye especially when It gets to its advanced stages.

This is due to its attention grabbing nature as a skin defect because of the light skin patches it manifests with. 

There are also many misconceptions about it in our traditional cultures. In some cases it’s associated with witchcraft, ‘burning of twins’ and venereal diseases all of which is not true. 

What is Vitiligo?

Vitiligo is a chronic skin condition through which the skin loses its natural pigment or melanin.

 It makes the skin appear pale or become much lighter than normal.

 The condition is fairly common affecting about 70 million people worldwide which is approximately 1% of the global population.

This condition is unpredictable as it doesn’t have a standard way of presenting. In some cases I presents with small patches and in some cases these cover much wider areas even causing total loss of skin colour.

Who does it affect?

Vitiligo can start any age including children and babies but may also start to show after one is already an adult. However more than half the cases of the disease handled are among the less than 20 year age group. 

What causes Vitiligo?

Vitiligo is an auto immune disease which simply means the condition occurs as a result of the body’s own immune system attacking the skin cells that make melanin known as melanocytes.

In some cases Vitiligo is also associated with other auto immune diseases like thyroid disease and diabetes although in most cases it’s occurrence has been observed to be independent of other conditions.

It has also been linked to repeated trauma or over rubbing of the skin and it affects both men and women equally. 

Is Vitiligo a genetic condition?

To a certain extent yes medical research has shown Vitiligo has a genetic basis as it does run in some families. However it has also been noted in a significant number of cases it does occur spontaneously.

As a result it is not a given that if parents have it, they will pass it on to their children.

What are the symptoms of Vitiligo?

Vitiligo manifests with patches on the skin, the affected parts turn to a lighter shade than the rest of the skin. In advanced stages the patches or affected parts become white.

It also manifests with lesions that are not itchy or painful, some people tend to experience mild irritation before the lesions appear. 

This skin disorder may take the form of symmetrical Vitiligo which affects both sides of the body the left and the right and in other cases it takes the form of asymmetrical or segmental Vitiligo which affects only one side either right or left.

Where does it Manifest?

Vitiligo usually shows on the face, body openings like the lips, nose, genitals, skin folds, under arms, palms, feet, waist and the trunk which includes the back and the tummy.

Some people can get sun burns in affected areas.

Diagnosis 

Your doctor will diagnose Vitiligo through observation (clinical diagnosis) to determine whether the patches are of the said disease.  

In some cases according  a Dermatologist may examine the patches using a specialised light (Ultra Violet) lamp. Tests are also done to rule out other auto immune diseases.

Can it be cured?

There is treatment for Vitiligo and the success of this depends different factors. 

For cases that are less than 2 years and areas that involve the face, trunk and arms, these tend to respond better to treatment than the lips, palms and feet which are more resistant. 

 Children tend to respond much better than adults to treatment.  Non segmental or symmetrical Vitiligo is more responsive to treatment.

Generally the earlier treatment is sought the more effectively the condition will be managed.

When some one has had Vitiligo for a long time it gets harder to treat and manage.

Treatment

A combination of steroid treatment can stop the spread of Vitiligo. These may include tablets, topical steroids and steroid creams can be effective in treatment.  

Photo therapy, light treatment can help with repigmentation and certain types of laser treatment has shown progress in treating Vitiligo.

Medical camouflage treatments (pigments) are also used for stable Vitiligo which has not responded to standard treatment.

 Surgery which involves melanocytes grafting ie removal from an area which has to one without. This procedure is suitable for stable Vitiligo affecting small areas.

 Alternatively one can opt for methods that result into complete removal of pigment to make the skin uniform.

It’s important to note that psycho social support is a critical part of treatment for Vitiligo given the condition comes with a lot of stigma for victims. 

Myths and truths 

Vitiligo is in no way linked to being ‘ burnt by twins’ as folk tales in some Ugandan cultures have always asserted.

It is also not linked to any other serious skin disease besides being a defect of skin pigmentation. Vitiligo is not infectious and unaffected parts of the skin remain very normal and healthy. Dr. Katureebe concludes.

The Writer is the Lead Dermatologist at Kampala Dermatology clinic Bugolobi 

Email: rmkatureebe@gmail.com