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Vitiligo: Causes, Treatment & Celebration Of The Rare Skin Condition

Vitiligo seems like a hidden disease with limited awareness, but for the over 200,000 patients in the United States (and almost 2 percent internationally) who suffer from vitiligo, the lack of knowledge and information can be frustrating. Vitiligo is a condition in which the skin loses pigment, resulting in patches of lighter or white skin spreading diffusely throughout the body.

While the cause is debated and treatment options continue to develop, managing vitiligo1 can have both physical and psychological repercussions. Recently, though, models, influencers, and celebrities with vitiligo have helped raise awareness, as well as helped others embrace their own skin condition. Here, everything you need to know.

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What is vitiligo?

For most of the population, vitiligo is currently perceived as an abnormal skin condition in which the skin starts to lose melanin, the pigment that essentially gives skin its trademark color. The way it works is that melanocytes—cells that create melanin—in the skin die off, no longer protecting the skin from harmful UVA and UVB rays.

A vitiligo patient may suffer from patches of depigmented or white skin anywhere, including visible areas like the face and hands. (In fact in a recent study, 75% of patients2 with the condition had patches on either of these locations.)

Premature graying of hair and discoloration of mucus membranes are also telltale signs of vitiligo.

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What causes vitiligo?

There is uncertainty around the causes of vitiligo, although there is a known genetic component. Recent studies show that changes in the genes that regulate glutathione, a potent antioxidant, play a role in vitiligo. Vitiligo is historically thought to be an autoimmune disorder, or a condition where the immune system reacts on itself1, but this has not been confirmed. It's also unclear exactly how the body attacks the pigment cells, causing them to die.

We do know, however, is that many with vitiligo also have another autoimmune disorder3. A few of the most common are: scleroderma, lupus, thyroiditis, psoriasis, and alopecia areata, or baldness.

Vitiligo and mental health.

As we work on the chemistry of vitiligo, or the "why" of this disease, the psychological implications can be equally devastating.

Many vitiligo patients become self-conscious about the visibility of this disease, retreating from social occasions or trying to find ways to camouflage their appearance. In fact, reviews suggest that over half of patients with vitiligo express some negative effect2 about their self image or their experience with the condition. For the majority of vitiligo patients, the disease began in childhood, spreading through the years.

But thanks to efforts being made on Instagram, mainstream beauty advertising campaigns, and the skin positivity conversation—it's starting to get better.

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Vitiligo treatment.

Currently the treatment for vitiligo focuses on using sunscreen to cover up areas where the skin has depigmented; phototherapy with UVB or UVA light, typically done in a clinic setting; or in some extreme cases, depigmentation, where the "normal" skin is depigmented to match the white patches. Additionally, dermatologists recommend a one-month trial of topical corticosteroids to stop the depigmentation or the spread of vitiligo, or use of a topical vitamin D cream (Dovonex).

Psoralens are also used in combination with UVA and UVB therapy, slowly returning pigment to the skin over six to 12 months. Psoralens4 are light-sensitive compounds that work to absorb UV radiation, essentially acting like UV light.

Vitiligo cure?

Photo: Pablo Anton
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These treatments have some success in treating vitiligo but often work best to control the spread, if desired, and to work on self-confidence rather than full reversal of this disease. More cutting-edge treatments include using pseudocatalase, an enzyme that helps repigment the skin. A drug that mimics the melanocyte-stimulating hormone, MSH, is also being used more frequently in the treatment of vitiligo.

While these treatments offer patients options, rethinking vitiligo opens additional avenues for treatment. Like many autoimmune diseases, vitiligo is a manifestation of an immune system disorder, triggered by any of a number of factors. Thinking about vitiligo from the inside out expands the toolbox5 with which to approach this disease.

Natural vitiligo management techniques.

There are increasing reports that vitiligo can be caused by a trifecta of multiple factors: genetics, exposure to certain chemicals, oxidative stress, viral triggers, and stress. Anecdotally, some say they have also seen hormone imbalances trigger vitiligo in practice.

Approaching vitiligo with this whole-systems approach may ultimately be of more benefit than a single-treatment approach. Managing inflammation, oxidative stress, your immune system, and even hormone balance can influence the spread of this disease.

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Vitiligo and inflammation.

Inflammation begins in the gut, so following a diet that reduces inflammation is important in the management of all autoimmune diseases, including vitiligo. Lowering gluten and dairy intake while limiting sugar are central tenets of this diet. Increasing healthy fats, including omega-3 and omega-9 fats, further helps to lower the inflammatory load.

Oxidative stress is caused by natural wear and tear, environmental aggressors, or stress. It is the process where the body begins to produce more free radicals, damaging and changing our DNA. A diet high in antioxidants from brightly colored fruits and vegetables can prevent oxidative stress. Oxidative stress and melanocyte survival may be influenced by glutathione, the antioxidant released when greens are blended or juiced.

Vitiligo and thyroid function.

Some practitioners also say to have seen vitiligo connected to imbalances in thyroid function. Optimizing hormone balance, which I discuss in my mindbodygreen class on hormone balance, and thyroid function can be helpful as well. Lastly, understanding your toxic load and the role of toxins in the expression of vitiligo is an evolving field. Taking steps to minimize exposure to environmental toxins in household products, personal body care, cosmetics, and food is important.

A number of herbal products5 and natural products have been recommended for treatment of vitiligo with varying levels of success. In ayurveda, herbal formulas that mimic the activity of psoralens are often used to treat vitiligo. The herbs Katuki and Bakuchi show psoralen and antioxidant activity respectively, repigmenting the skin. Turmeric has been used as well for skin repigmentation. Many of these herbs and natural products are used both topically and internally.

Replacing B vitamins and silica have shown some promise in the treatment of vitiligo while Ginkgo biloba has been shown to have anti-inflammatory effects and to be useful in treating vitiligo. The recommended dose is 120 milligrams per day. In Chinese medicine, the plant Psoralea cordyfolia is a natural source of psoralens. The seeds were used in combination with other herbs to repigment the skin.

Vitiligo and stress.

Stress management is also a factor in vitiligo. Some studies point to the use of St. John’s wort6 in controlling stress and helping to manage depression and anxiety. You can also turn to yoga or breath work practices.

The takeaway.

As treatment options continue to evolve, understanding the complexities of vitiligo is critical to its resolution. From focused treatment options to underlying causes, shifting thinking about vitiligo to a whole-systems approach can bring greater success. Helping patients and family members through the psychological and self-esteem issues associated with vitiligo should also be a priority.

Taz Bhatia, M.D.
Taz Bhatia, M.D.

Dr. Taz Bhatia is a board-certified physician, specializing in integrative and emergency medicine, pediatrics and prevention, with expertise in women’s health, weight-loss, hormone balance and nutrition. She attended Emory University, the University of Georgia and the Medical College of Georgia, and was a recipient of the Emily Gardner Award for Best Pediatric Resident in 2000. She is the author of the Superwoman RX and The 21-Day Belly Fix. Personal health challenges in her twenties combined with a broken health care system motivated Bhatia to pursue an alternative definition of health and healthy living. As a young resident, she was sick and without answers, and began searching for help to heal her health issues. Studying various systems of medicine including Chinese Medicine, Acupuncture and Ayurveda, she found a wealth of information not yet taught in conventional medical schools. It led her to opening her now nationally-recognized practice, CentreSpring MD (formerly Atlanta Center for Holistic and Integrative Medicine). Today, Bhatia and her team work relentlessly to find a patient’s core health problems, their centre, in order to spring them forth in health, pulling from multiple systems of medicine, including integrative, functional, Chinese and holistic medicine.

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