New hope, new treatments for those who are fighting skin patch stigma

Michael Jackson had spoken about his vitiligo in an interview with Oprah Winfrey back in the ’90s when hardly anyone knew about the skin condition. Since then, awareness has increased but stigma prevails. On World Vitiligo Day, Srirupa Ray speaks to Dr Kanika Sahni, vice-president of Vitiligo Foundation of India, about myths, mental health and how to manage the condition.

What causes vitiligo?

Vitiligo is an autoimmune disorder characterised by the loss of normal pigment from skin in localised areas. It’s due to an abnormality in the melanocytes (cells that produce melanin, a pigment that gives us our skin, hair and eye colour) in these areas, which makes the body’s own immune response destroy them. Sometimes, external chemicals can induce vitiligo-like depigmentation, but very often there is no external cause.

Any recent rise in vitiligo onset?

On an average, in India, about 1-2% of the population is affected. I don’t believe there’s a recent increase in its prevalence, but it might be that patients are coming forward more often to seek treatment, with greater awareness about the disease.

Can vitiligo have stress or dietary triggers, or be inherited from family members? Does it cause other health complications?

Usually, diet does not have a role to play in vitiligo. Thus, restricting food items or avoiding certain foods is not recommended for patients. Stress, as for any other disease, can induce reactive oxygen species (or ROS, a group of highly reactive molecules containing oxygen that can damage cells) which can precipitate vitiligo or even worsen it for some. A family history doesn’t necessarily increase one’s susceptibility to the condition. Sometimes, thyroid illnesses or other endocrine disorders might be associated with vitiligo, but these are rare. Usually, vitiligo is a standalone condition.



What are the treatment options?

That depends on the type and extent of disease. If it’s a stable segmental vitiligo affecting small areas of the body, chances of re-pigmentation being achieved with surgery are very high. For other types of vitiligo, much depends on whether the patient is developing new lesions or not, as well as their location. Lesions on the face or trunk are generally better responsive to medicine and light therapies whereas for other areas, surgical treatment might be preferred.

Do tell us about your recent research on vitiligo stability and progression, and how that impacts treatment.

Our understanding of why vitiligo tends to reactivate or persist in certain areas has advanced a lot with research. Now we know for sure that once segmental vitiligo stabilises, it’s very unlikely to spread. Usually, the period of achieving stability is one to two years. But generalised vitiligo is very hard to predict, and many patients might continue to have progression many years after having stable disease. It’s crucial to identify disease stability as it alters management. For unstable disease, we might need to give oral medications to suppress immune response and stop progression. But for surgery, the disease must be stable for at least a year.

Celebrities with vitiligo, such as model Winnie Harlow, have spoken about how it impacts mental health. Do doctors consider this aspect as well?

Just as any other visible skin condition, vitiligo has significant impact on the patient’s self-esteem and their interaction with family and friends. It also shows higher incidence of anxiety and depressive symptoms, both in children and adults. At times, the distress might be so severe that they might require psychological intervention or even medication. So, it’s important to talk to the patient and understand how they feel. Try to take their attention away from the vitiligo patches and make them focus on other areas of life that might be working better.