Hope for Women with Vitiligo

By Dr. Dara Spearman

Dermatologist
 

Peggy - Beyond Vitiligo Project Director

Vitiligo is a disease whereby the melanocytes, the cells that give our skin pigmentation, are destroyed. This results in depigmented (or white) patches of skin. This can be localized to certain areas of the body or generalized, involving most of the body surface area. These patches may also be found on both the mucous membranes (tissues that line the inside of the mouth and nose), and in the retina (inner layer of the eyeball). The hair that grows on areas affected by vitiligo may also become depigmented. Vitiligo is a condition that is limited to the skin, hair and mucous membranes and does not cause internal problems. However, it has been shown to be highly associated with a number of other autoimmune diseases, mostly thyroid disease, but also pernicious anemia, rheumatoid arthritis, lupus, and adult-onset autoimmune diabetes.

Vitiligo can have a significant effect on an individual's psychological well being. For women of color, this is especially true due to the sharp contrast of the depigmented skin with their natural, darkly pigmented skin. In fact, in some cultures there is a social stigmata associated with the condition. People affected by the disease may be viewed as evil and/or are shunned by the community.

There are a number of treatments available for vitiligo, although at this time there is no cure. For some individuals, treatment may actually involve only sun protection to prevent tanning of the unprotected areas. For lighter-skinned individuals, the difference may be hardly perceptible. For darker individuals, sun protection is necessary to prevent sunburn of the affected areas but does not improve the appearance. In people with limited involvement, makeup or cosmetic camouflage solutions can be used to hide the vitiligo patches. I often recommend Dermablend or Leg Magic cosmetic camouflage to my patients. Micropigmentation tattooing of small areas may also improve appearance.

If the patches are so widespread that coverup is not an option, other treatments are available from your dermatologist. Treatment is usually aimed at repigmentation, or returning normal pigment. Initially, topical steroid creams are often prescribed, although this treatment only results in repigmentation in 25 percent of individuals. PUVA is a therapy that improves appearance in 50-70 percent of patients. This therapy involves a medication, psoralen, and a special type of ultraviolet light, UVA. The psoralen may be applied topically to the affected areas, but is often taken in pill form. This therapy can be time consuming with two to three treatments per week for months and may also increase the risk of skin cancer.

Newer therapies include transplantation of melanocytes to affected areas to repigment the region. This is performed by taking skin grafts from inconspicuous sites, such as the gluteal region, separating out the melanocyts and then grafting them to the affected areas. The area is then exposed to UV light for two months with 70-85 percent of people experiencing almost complete repigmentation. It was discovered in early 2008 that piperine, a compound in black pepper, can stimulate pigmentation in the skin, particularly when combined with ultraviolet radiation. This repigmentation is often darker and more evenly distributed than with ultraviolet light alone. Finally, complete depigmentation with a chemical called monobenzylether of hydroquinone is an option for patients with extensive involvement. Vigilant sun protection is especially important to prevent sunburn and skin cancer.

If you are affected by this condition, it is important to discuss your treatment options with a dermatologist and to realize that new, effective therapies are available