Did you ever wonder why Michael Jackson started to wear a white glove? While it may have been the beginning of a fashion trend, it was most likely an ingenious way to conceal a skin disorder – vitiligo.
Arnold Klein, MD, Michael Jackson’s dermatologist, observed in 1983 that Jackson had vitiligo. Initially, to treat his condition, Jackson used a light tone of makeup and skin-bleaching prescription creams to cover up or blend the uneven blotches of color caused by his disorder. Sadly, autopsy results stated that Jackson had tattooed lips and a dark tattoo along part of his scalp area most likely to blend his hairline with the wigs that he wore.
This month, we will discuss this skin and hair disorder that affects one to two percent of the world’s population. In the United States alone, 3 million cases are reported each year.
Vitiligo (vit-ih-LIE-go) is a skin pigmentation disease that causes the blotchy loss of color and sensitivity to sunlight. Any part of the body, hair, and even the skin inside the mouth can be affected. Determining how much color an individual will lose or how rapidly the condition will progress is impossible. It is common for discoloration to initially present on sun-exposed areas of the body. Typically, vitiligo appears before the age of 20 and it can last several years or be a lifelong ailment.
Vitiligo can affect all ethnicities but is more noticeable on darker skin tones. An individual with this condition often experiences stress, self-consciousness, depression, and shame due to their appearance and, usually, the individuals’ mental state affects their daily activities.
Skin color is obtained due to the content of melanin granules created and distributed by the melanocyte cell. These cells are located in the stratum germanitivum (stratum basale – the bottom layer) of the epidermis. Vitiligo destroys the melanocyte cells, preventing the distribution of color.
Types of Vitiligo
Generalized vitiligo is the most common form, with multiple patches appearing symmetrically on the body.
Segmental vitiligo appears at a younger age, usually on only one side of the body, progresses for a year or two, then stops.
Localized (focal) vitiligo appears typically on only one area of the body.
Vitiligo occurs when melanocytes experience apoptosis (cellular death) or stop producing melanin. Skin in the affected areas become lighter or even white.
Vitiligo may occur due to the following factors:
- a disorder where the immune system attacks and destroys the melanocytes in the skin
- family history (heredity)
- catalysts including sunburn, stress, or exposure to industrial chemicals
- Loss of skin color in blotches
- Premature whitening or graying of the scalp, eyelashes, eyebrows, or beard
- Loss of tissue color in the inside of the mouth and nose (mucous membranes)
- Loss of or change in the color of the retina
To diagnose vitiligo, a physician must examine the patient and review their medical history to rule out other conditions, including dermatitis or even psoriasis, which can leave areas of hypopigmentation. An ultraviolet light such as a Woods lamp can also be used as part of the examination.
In addition to the review of medical history and skin examination, the doctor may:
- take a skin biopsy of an affected area
- run blood tests to look for autoimmune diseases
Currently, there is no cure for vitiligo; however, many treatments are available that can restore pigment to affected areas but will not stop color loss from occurring in other areas. Results will vary and are not predictable, with the possibility of unwanted side effects. Some treatment plans take months before you can determine effectiveness, and the client may have to try several different options before the correct regimen is found. Unfortunately, even with a successful regimen in place, the results may not always last.
Medications: Some drugs, used alone or with light therapy, can help restore some skin tone.
Anti-inflammatory – Corticosteroid creams: Applying hydrocortisone may help color return, especially if started early in the disease; be patient, as results can take months.
- over-the-counter hydrocortisone is easy and effective; however, prolonged use can thin the skin.
- over-the-counter hydrocortisone at 1% is maximum strength. It can be purchased at 0.5% for use on children or to treat large areas of discoloration.
- prescription corticosteroids include betamethasone valerate, clobetasol, and propionate.
Calcineurin Inhibitors: Calcineurin is an enzyme that activates the t-cells (t-lymphocytes, a type of white blood cell) of the immune system. Tacrolimus or pimecrolimus ointments may be effective for people with small areas of depigmentation, especially on the face and neck.
- calcineurin inhibitors have fewer side effects than corticosteroids and can be combined with UVB light.
- the FDA has issued a warning about a possible link between calcineurin inhibitors and lymphoma and skin cancer.
Combining Psoralen and Light Therapy: Psoralen, a substance derived from plants, taken orally or applied to an affected area and coupled with photochemotherapy (light therapy – UVA, UVB, or excimer) can return color to patches of vitiligo. Combined approaches have shown to produce better results than individual methods. However, several treatments are required each week and treatment may take up to a year.
Depigmentation (skin bleaching): Bleaching agents may be considered when a large part of the body has lost color and when other options have failed. A bleaching agent like hydroquinone or benquin is applied to unaffected areas of skin to gradually lighten the skin, enabling it to blend with the area of hypopigmentation. Treatment can take up to nine months or more, with results being permanent.
Side effects include redness, swelling, itching, dry skin, and photosensitivity.
If light therapy is unsuccessful, the physician may consider surgery as an option or surgery in combination with light therapy to even out skin tone by restoring color.
Skin Grafting: The physician removes small sections of pigmented skin, then attaches them to areas of hypopigmentation. This option is typically used when there are only small patches of color loss. Areas of concern include potential infection, scarring, and uneven skin tone.
Suction Blister Epidermal Grafting (SBEG): Although it almost sounds barbaric, don’t judge unless you have vitiligo. The physician creates blisters on sections of skin that still have color with a suction instrument. Next, the tops of the blisters are removed and transplanted to an area of discolored skin. Pitfalls for this option include discomfort, due to the heat required to form a blister, the potential to scar, uneven appearance of skin that does repigment, or failure to obtain any results.
Micropigmentation (Tattoo): A colored pigment is implanted into the skin. This is a good option to blend color around the lips in darker complexions. However, when attempting to match the skin tone, there is always the potential to trigger another patch of vitiligo.
POTENTIAL FUTURE TREATMENTS
Afamelanotide: A melanocyte – growth-stimulating peptide drug implanted under the skin. It mimics the activity of the melanocyte-stimulating hormone in the melanogenesis cycle leading to the production of eumelanin.
Prostaglandin E2: A gel-based medication that helps control melanocytes is being tested to restore pigment on localized vitiligo that isn’t progressing.
Tofacitinib: An oral medication typically used to treat rheumatoid arthritis has shown some potential because it reverses the loss of pigmentation.
Lifestyle and Home Remedies to Live By:
- When outdoors, try to stay out of direct sunlight in shaded areas and wear clothing with ultraviolet protection.
- Never use a tanning bed.
- Protect from ultraviolet rays by wearing sunscreen that is broad-spectrum and water-resistant. Don’t forget to reapply sunscreen every two hours or after any activity inducing perspiration.
- Use a camouflage concealer if your appearance bothers you.
- Avoid tattoos except those used by a doctor for treatment, as inflicting damage to the skin can induce a new area of vitiligo.
New studies show the potential for restoring skin color with the following: ginkgo biloba, alpha-lipoic acid, folic acid, vitamin C, and vitamin B12 plus phototherapy. As always, never try new products or remedies before discussing them with a doctor.
Vitiligo presents many challenges for the client. Aestheticians can provide empathy to individuals struggling with this condition and deliver superior treatments to relax and renew their clients’ mind, body, and soul and restore their self-esteem.