Vitiligo is an acquired disorder of depigmentation characterized by white macules and patches on various parts of the body reflecting selective melanocyte destruction. This condition affects all races across the world. Although it is not a painful condition, there is a lot of stigma associated due to cosmetic disfigurement. The condition tends to affect the quality of life of the person suffering from the disease and the patients often suffer from psychological distress and low self-esteem. They are at times subjected to social neglect, which in turn makes them isolate themselves from society.
Inadequate knowledge and age-old misconceptions are the key reasons for this undue apprehension associated with the condition. There is a misconception that the disease can spread by contact. However, Vitiligo is non-contagious and does not spread by contact. Another myth is about dietary habits. For instance, people used to implicate sour food, fish, white food, etc and consider them to be the reason for vitiligo. However, there is no scientific evidence to support this belief. In fact, people belonging to different races, religions and socioeconomic groups with different dietary habits do not show any significant variation in a predisposition towards the disease.
Another myth that surrounds the condition is the belief that vitiligo and leprosy are the same. Kilasa or external kushta (vitiligo) and leprosy were described together in Ayurveda and were believed to have a similar etiology. The suffix ‘Kushta’ was used for all skin diseases in Ayurveda. However, it became synonymous with leprosy later. Similarly, white spots were described in the old testament under the Hebrew word ‘Zora at’ which was translated as ‘lepra’ in Greek and English bible leading to confusion between vitiligo and leprosy.
The exact cause of vitiligo is unknown. Multiple theories have been proposed including a hypothesis based on genetic, autoimmune, neural, biochemical, autocytotoxic phenomenon and antioxidant deficiency theory. Stress, focus of infection and impaired melanocyte migration may also contribute to the pathogenesis. The disease has a familial incidence of 1.56-34%. Genetic studies suggest a polygenic multifactorial inheritance and a role of acquired factors for its clinical expression. Vitiligo has been reported in association with several autoimmune disorders such as diabetes mellitus, alopecia areata, pernicious anemia, Addisons’s disease, and thyroid disorders.
The course of the disease is unpredictable and uncertain; however, it generally shows a tendency towards slow progression. There is no ideal treatment in the absence of a clear understanding of the etiopathogenesis.
Some of the preventive measures that one could take to protect oneself are:
Vitiligo can be treated through various treatment options like phototherapy, surgical treatment, cosmetic camouflaging and bleaching. However, it is not always successful and there can be frequent recurrences and spread throughout the lifespan. Some of the studies have also suggested the incorporation of psycho-social interventions and counselling in the treatment of vitiligo. Counselling may have a positive effect on the course of vitiligo. In a nutshell, improving the quality of life of vitiligo patients will require knowledge about the condition and social acceptance.
Dr. Priya Vernekar, Consultant Dermatologist, Narayana Multispeciality Hospital, Whitefield