Experts highlight misconceptions about vitiligo at awareness seminar

Vitiligo is a long-term skin disease characterized by milky-white patches of skin losing their pigment. These patches, which can appear anywhere on the body, result from the destruction of melanocytes, the cells responsible for producing melanin, the pigment that gives skin its colour. While the exact cause of vitiligo is still unknown, scientists believe it to be an autoimmune disorder, where the body’s immune system mistakenly attacks the melanocytes.

These views were shared by lead speaker and renowned dermatologist Prof Dr Azim Jahangir Khan, board certified by the American Board of Dermatology, at a public health awareness seminar titled ‘Recent Advances in the Management of Vitiligo’, held at the prestigious Postgraduate Institute Cosmetique, DHA, Lahore.

He said vitiligo can affect people of all skin types but is more noticeable in individuals with darker skin, it can develop at any age. However, for many people with it, the white patches begin to appear before age 20, and can start in early childhood. In addition, researchers continue to study how family history and genes may play a role in causing vitiligo.

“Sometimes an event – such as a sunburn, emotional distress, or exposure to a chemical – can trigger vitiligo or make it worse. Vitiligo seems to be more common in people who have a family history of the disorder or who have certain autoimmune diseases, including: Addison’s disease, Pernicious anemia, Psoriasis, Rheumatoid Arthritis, SLE, Thyroid disease or Type 1 diabetes.”

The seminar’s aim is to educate the medical community and the public, challenge misconceptions and support individuals living with the condition and to remove the stigma and negative perception surrounding vitiligo.

“Vitiligo is not contagious or life-threatening, but it can have significant psychological and emotional effects on those who have it. It has an estimated prevalence of 0.5–2% of the population in South Asia,” added Prof Azim.

“Generalized vitiligo is the most common type of vitiligo. Approximately 98 percent of people have this type of vitiligo. Segmental vitiligo usually onsets at an early age. About 2 percent of people have this type of vitiligo. It appears on one side of the body without crossing the midline, and it presents in an isolated segment such as the leg, arm, or face.

“Segmental vitiligo usually progresses rapidly for about 6 months to 24 months, and then stops. After this period, segmental vitiligo does not spread any further. Trichome vitiligo is often known as a clinical variant of vitiligo with three different sections characterizing its appearance. This type of vitiligo heralds active, progressive vitiligo and should be treated as soon as possible,” said UK-certified Dr Amnah Raj, consultant dermatologist and hair transplant expert and fellow of the American Society of Dermatologic Surgery.

“Depending on the type of vitiligo diagnosed, a doctor may order blood tests or evaluations for other conditions related to vitiligo. Many people with vitiligo are otherwise healthy, but some types of vitiligo can be associated with a higher risk for thyroid problems and various autoimmune conditions,” said Dr Asma Sana, consultant dermatologist, melanocyte transplant surgery expert and a diplomate of the American Board of Internal Medicine.

She said that if you are diagnosed with generalized vitiligo, the doctor may also recommend visits to an ophthalmologist (eye specialist) or audiologist (hearing specialist). Melanocytes are found in the eyes and inner ears as well as the skin, and cells in these areas can be impacted by vitiligo too.

Vitiligo isn’t the only possible cause of skin depigmentation. The process of ruling out similar conditions is referred to as differential diagnosis, infections such as tinea versicolor, a common fungal infection, Skin exposure to certain chemicals, Scarring, Eczema, Albinism.

“Your doctor may be able to rule many of these conditions quickly based on a visual exam, your medical and family history, or simple blood tests,” further explained by Dr Asma Sana.

Although it cannot be cured, there are several promising new treatments for vitiligo are currently available, including JAK (Janus Kinases) inhibitors like Upadacitinib and povorcitinib, as well as melanocyte-stimulating agents like afamelanotide. These therapies, along with others are offering hope for more effective and targeted treatments beyond traditional options like corticosteroids and phototherapy.

Melanocyte-keratinocyte transplant procedures and other surgical therapies may help repigment segmental vitiligo. VYN201 is a novel BET proteins inhibitor, showing potential superiority over JAK inhibitors in reducing inflammation and promoting melanocyte recovery.

Some clinicians are exploring the use of combination therapies, such as combining melanocyte transplantation with JAK inhibitors or tacrolimus, to improve outcomes, explained by Dr Asma.

Vitiligo can have a profound impact on an individual’s life. The visible nature of the condition often leads to self-consciousness and anxiety. People with vitiligo may face social stigma, discrimination, and bullying, which can further affect their mental health and self-esteem. The psychological toll of feeling different or being treated unfairly can be immense, often leading to withdrawal from social interactions and a decline in overall quality of life, said Dr Saima Malik, Cardiff University, Wales Qualified Dermatologist & Fellow American Society of Dermatologic Surgery.

Organizations such as Postgraduate Institute Cosmetique work tirelessly to provide resources, support, and advocacy for those affected by vitiligo, host events, and create educational materials to further the understanding of vitiligo and combat the associated stigma. By amplifying the voices of those with vitiligo and promoting positive representation, they help to foster a more inclusive and compassionate society, elaborated Dr Saima Malik.

Embracing vitiligo is not just about individual acceptance; it’s also about fostering a broader cultural shift towards inclusivity and diversity. Schools, workplaces, and media outlets play crucial roles in shaping societal attitudes. Implementing educational programmes that teach about vitiligo and other visible differences can help to cultivate empathy and acceptance from a young age.

Employers can create inclusive environments by adopting policies that protect against discrimination and by celebrating diversity in all forms, educate your friends and family about the condition to dispel myths and misconceptions, added Dr Saima Malik.