Vitiligo is an acquired pigmentation disorder of unkown cause that is characterised by the development of white patches related to the selective loss of the cells that make melanin pigment (melanocytes). Dr Jonathan Smith discusses this misunderstood disorder.
About 1% of individuals in the USA and in Europe have vitiligo, but the prevalence ranges from less than 1 in a thousand to 8% worldwide. A recorded predominance of women reflects their greater willingness to express concern about cosmetically relevant issues. Half of all patients develop the disease before 20 years of age, a time when physical appearance is perceived as important so as to be accepted by one’s peers and to attract a life partner.
Generalised vitiligo is the most common clinical presentation and often involves the face and distal parts of the limbs i.e. exposed areas not covered by clothing. Ignorance regarding its cause has resulted in vitiligo being referred to as ‘white liver’ and acquiring the stigma of an association with alcohol abuse. In many societies it’s also perceived as being contagious and put into the same category as leprosy or sexually transmitted disease, resulting in social ostracism.
The attitude and prejudice of the ignorant also affect the psychosocial development of children at school and on the playground, as well as the chances of school and tertiary education graduates when applying for jobs.
The fact that the course of the disease is unpredictable and the response to treatment varies also causes severe psychological stress and an increased risk of developing psychological and even psychiatric disorders requiring professional treatment.
Vitiligo has a major impact on self-esteem and the perception of self, causing embarrassment, shame, insomnia and depression. There is often no correlation between the severity of the disorder and its effect on an individual’s quality of life.
Therefore, all those with vitiligo should do a quality of life assessment when first diagnosed and regularly during treatment.
As with many problems facing society, the solution to the psychosocial implications of vitiligo lies in educating the general population regarding the disorder and decreasing the misguided stigma attached to it.
Those with vitiligo should also receive psychological counselling as studies have shown that one hour of weekly cognitive behavioural therapy and coping skills training improves the quality of life, self-esteem and perceived body image profoundly.
In addition, psychological stress can influence the progression of the condition. Therefore, its treatment improves the long-term prognosis of vitiligo.
Treatment options include topical treatment and the VTRAC Excimer Lamp system at Lasermed. This is a non-invasive UV lamp for phototherapy without any photo-sensitising (reaction of skin to sunlight) of specific disorders, eg Vitiligo on white and ethnic skins of all ages. The light delivers a short wave length of UV radiation (UVB responsible for tanning) that penetrates the epidermis using a lamp on specific areas. Only the affected area gets treated with a time-controlled dose or influence.
