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Embracing Differences: Vitiligo

In a world that celebrates uniformity, the beauty of diversity still shines through, and one condition that exemplifies this uniqueness is vitiligo. It's a skin disorder that creates distinctive and striking patterns of depigmentation on the skin. Here, leading dermatologist Dr Viktoria Dr explains more about the condition.

Understanding Vitiligo

Vitiligo is a chronic skin disorder characterised by the loss of pigment-producing cells (melanocytes) in certain areas of the skin. This loss of melanocytes results in the development of white patches or depigmented areas on the skin, which can appear anywhere on the body. These patches can vary in size and shape, and they often stand out in sharp contrast to the surrounding skin.


The condition can either affect just one side of the body (segmental), or both sides (non-segmental), and is related to both disease progression and its response to treatment. Segmental disease seems to develop earlier in children or adolescents, and doesn’t seem to progress once it has affected that segment of the skin. Non-segmental does spread to other areas of the body, sometimes extensively, where we call vitiligo generalised, with lots of patches.


Vitiligo can affect anyone and there are no differences between ethnicities or the sexes. However, about 80 per cent of patients will have developed the condition before the age of 30, and 50 per cent before the age of 20. As a result, the vast majority of sufferers are a younger and generally otherwise healthy. The impact of the condition can be devastating, particularly for those with darker skin tones due to an association with social stigmatisation.


The Complex Causes of Vitiligo:

The underlying cause of vitiligo remains uncertain, but it is probably linked to genetics - although unearthing the responsible genes is challenging. There is a combination of 50 different genes which can lead to its development, which makes everything very complicated. Unfortunately there isn’t a single gene identified for vitiligo that we could work on. Environmental influences play a role too, in particular stress or trauma, and many of my patients say that they first developed vitiligo because of a stressful event in their lives.


Since vitiligo is an autoimmune disease, where the body's immune system mistakenly attacks and destroys melanocytes. Sufferers may be at a greater risk of developing other autoimmune disorders. One study from 2020 found that having vitiligo was associated with a 65% higher prevalence of hypothyroidism, although risk was also elevated for other conditions such as rheumatoid arthritis and multiple sclerosis.


Treatment for Vitiligo:

While there is no known cure for vitiligo, there are several treatment options available to help manage the condition and improve the appearance of depigmented areas. However, as lead author for the British Association of Dermatologists 2022 guidelines on the management of vitiligo, I noted that topical treatments are only really suited to those with limited disease.


For patients with more extensive vitiligo, we can offer phototherapy combined with oral steroids or topical creams, but only about 30-40% will improve, even after months of treatment. The recent approval of Ruxolitinib in the UK and EU has marked an important step forward in treatment, but there’s still a long way to go to ensure timely and effective treatments for all.


It's important to remember that vitiligo is not contagious. The beauty of diversity lies in our differences, and vitiligo is just one of the many ways in which people exhibit their unique beauty. As research into the causes and treatments for vitiligo continues, the hope for more effective therapies and, eventually, a cure remains strong. In the meantime, the most significant treatment we can offer those with vitiligo is compassion and respect for the beautiful tapestry of human diversity.

 

Dr Viktoria Eleftheriadou is a Consultant Dermatologist and Lead for National Vitiligo Clinic and Research at Walsall Manor and New Cross Hospitals and currently leads several international research projects on the condition. She is available for consultantations at Chamberlain Clinic - find out more here.

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