Vitiligo: causes, symptoms and the stigma surrounding the condition

Around one in 100 people across the world live with vitiligo, a long-term autoimmune skin condition that creates lighter areas of skin.

With so many people affected, vitiligo ranks among the most prevalent skin disorders. Research also indicates that a considerable number of cases have not been diagnosed, so the actual number of people with vitiligo could be greater still.

Nevertheless, misconceptions about vitiligo remain widespread. Those living with the condition can encounter stigma and intrusive questioning, which may adversely affect their wellbeing.

What causes vitiligo?

Human skin consists of two layers: the epidermis, the visible outer layer, and the dermis beneath it.

Skin tone is largely shaped by melanin, a pigment made by specialist cells called melanocytes, which are located in the epidermis.

Everyone has melanocytes, although the quantity and kind of melanin produced by the skin naturally differs between individuals and populations. Melanin also helps determine hair and eye colour.

Vitiligo develops when the immune system incorrectly identifies melanocytes as harmful. It then attacks and destroys these cells, resulting in pigment loss.

The condition is first set off either by a person's genetic makeup or by environmental influences, including stress, severe sunburn, and contact with melanocytotoxic chemicals found in certain cosmetics and household products.

Such factors can provoke an immune reaction or damage melanocytes directly. As these cells are lost, the affected skin no longer produces pigment, becoming lighter or entirely white.

How vitiligo affects the skin

Vitiligo can occur in people of every ethnic background, age and skin type, though it tends to be more visible on darker skin tones.

It can emerge on any part of the body, but frequently affects the face, hands, arms, eyes and mouth. Hair that grows from depigmented areas may lose its colour as well.

The condition may progress slowly or appear quickly. Some people experience just a small number of patches, whereas others develop increasingly extensive depigmentation.

Most often, patches occur on both sides of the body and expand over time, known as non-segmental vitiligo. More rarely, they form on only one side of the body, which is termed segmental vitiligo.

Symptoms, patterns and related conditions

Some individuals experience slight itching, tingling or burning, particularly when fresh patches develop. Because there is less melanin, affected skin may also be more sensitive to sunlight.

As vitiligo is associated with an impaired immune system, people who have it may be slightly more likely to develop other autoimmune conditions, including thyroid disease and type 1 diabetes.

Several treatments for vitiligo are currently available. They are intended to limit the condition's progression and improve the appearance of the skin over the long term.

A misunderstood condition

Although vitiligo affects a large global population, false beliefs and stigma surrounding it continue.

Studies show that some people still mistakenly regard vitiligo as contagious, connected with poor hygiene, or socially undesirable. This points to persistent shortcomings in public understanding.

People with vitiligo may face staring, judgement, insensitive remarks and intrusive questions about their appearance, at times every day.

Model Winnie Harlow, who has vitiligo and has spoken openly about living with the condition, said in a recent interview that, during her childhood, parents instructed their children not to play with her because they might "catch her skin". Harlow was also bullied throughout her years at school.

Many accounts have documented anxiety, depression, social exclusion and low self-esteem among people with vitiligo.

Skin colour is central to the formation of identity and can influence a person's sense of inclusion, acceptance and belonging.

The visible pigment changes associated with vitiligo can additionally expose people to social and societal stigmatisation, exclusion, reduced employment opportunities and intrusive questioning.

Public attitudes must change because vitiligo is fundamentally a condition arising from cellular biology and immune dysfunction.

Understanding this matters, as it has a substantial effect on how society treats people with visible medical conditions such as vitiligo.

Benedicta Quaye, Lecturer in Anatomy, Lancaster University

This article has been republished from The Conversation under a Creative Commons licence. Read the original article.