Quality of Life in Vitiligo

Latte. Caramel. Maple. Almond. Espresso. Mocha. No, these are not the ingredients for a decadent dessert. Rather, they are descriptions of varying foundations and skin-toned makeup. The names are usually associated with specific shades. While determining the appropriate shade for foundation and makeup can be an easy remedy, for some of us it can be a daily challenge that involves precise application of colors and layering, especially if we have a change in skin pigmentation.^[1] 

Vitiligo is a non-contagious disease in which the skin cells charged with producing skin pigment (color) are eliminated and/or lose their ability to produce proper pigment.^[2] The end result of this process is a loss of color in the skin, known as depigmentation (complete color loss), or hypopigmentation (partial color loss). As the most common depigmenting disorder, it affects all ages and all skin types, with a worldwide prevalence of 0.3%-0.5%.^[3] Vitiligo usually appears on the skin between the ages of 10 and 30.^[2] While the exact underlying cause of vitiligo is still under research, it is linked to changes in genetics as well as the abnormal function of the immune and nervous systems.^[4] Factors such as sunburn, stress, and friction can worsen affected areas.^[4]

Perceptions of Vitiligo

Historically, the name “vitiligo” may have developed from the word, “‘vitium,” meaning spots or blemish.^[5] When researchers conducted polls, 20% of the general public incorrectly believed vitiligo to be caused by an infection; most of the individuals who believed that vitiligo is caused by infection were less educated.^[6] Approximately 33% of those taking the poll mistakenly believed vitiligo was contagious, and 22.5% believed vitiligo was due to lack of hygiene. Given the negative public perceptions of vitiligo as well as the discoloring nature of the disease, patients suffering from vitiligo often develop an impaired quality of life.^[7] These false beliefs of vitiligo (that it is contagious, caused by infection, and unhygienic) have increased the stigma of the disease.^[8] In certain parts of the world where leprosy is prevalent, vitiligo can be mistaken for the colorless patches of leprosy. This may lead to unnecessary stress and significant prejudice.^[9]

The Impact of Darker Skin in Vitiligo

While vitiligo affects sexes and races equally, it is more noticeable in darker-skinned individuals.^[10] Melanin is the pigment in the skin produced by skin cells known as melanocytes. While light and dark skin generally has the same number of melanocyte cells, they differ in the amount of melanin produced. Darker skinned individuals produce more melanin than their fair-skinned counterparts.^[11] In vitiligo, the pale uncolored patches of skin contrast starkly against the darker surrounding skin. This contrast is more obvious and socially embarrassing in those with darker skin, leading to higher levels of psychological distress.^[9,12]

Improving Psychological Health in Those with Vitiligo

Since visual appearance is often important for making a first impression, negative public assumptions about vitiligo may result in higher risk of depression, more social isolation, and greater anxiety among vitiligo patients.^[8,13-16] Most of the bullying and stigma of “being different” starts around the middle and high school years of a child’s life. Medical treatment for vitiligo should not only focus on improving the appearance of the affected areas but also help elevate self-esteem through activities not directly related to outward appearance.^[17] Psychotherapeutic techniques such as relaxation techniques, talk therapy, and hypnosis can help improve patient participation in social activities and lessen the social anxiety of vitiligo.^[17] Treatment of vitiligo, including topical steroids as well as light/laser therapy, can help improve not only the underlying medical condition but also improve the patient’s quality of life.^[18,19]

In patients with a similar disease of skin discoloration, albinism, the best approach found to reduce the stigma and the prejudice was through good public awareness.^[20] While many treatment options are available to treat the underlying disease, the psychological effects of vitiligo may be best remedied with public awareness.^[21] In particular, educating parents can help their children and themselves better cope with the emotional distress of vitiligo.^[22] Individuals like Chantelle Winnie, former America’s Next Top Model contestant, and successful model, have helped boost awareness, encouraging to “love the skin, you’re in.”^[23] While her vitiligo gave her suicidal thoughts as an adolescent, her uniqueness helped her rise to fame as an international model, gracing magazines like Glamour UK and Vogue Italia, successfully overcoming her anxiety about her skin.^[24] While vitiligo can be a disfiguring disease, it is not contagious and should be understood – not stigmatized by society.