Vitiligo: Treating those white patches on your skin

American Amy Deanna was the first model with vitiligo to helm one of cosmetics company CoverGirl’s campaigns in 2018. — Amy Deanna/Instagram

White patches on the skin, especially on the face, hands or body, often raise curiosity and concern.

Many people wonder if this condition is dangerous or contagious.

The truth is, this condition is a skin health issue called vitiligo, a pigmentation disorder that causes the skin to lose its natural colour and turn lighter or white.

Vitiligo is an autoimmune disease that happens when the body’s immune system attacks melanocytes, the cells that are responsible for producing skin colour.

It is estimated that about 0.5% to 1% of the world’s population lives with this condition.

The white patches usually appear symmetrically, such as on both hands or both feet, but they can also occur in other areas like the hair, inside the nose or in the mouth.

Although vitiligo does not cause physical pain, it can have a significant emotional impact, especially on people with darker skin.

The condition can affect anyone, regardless of gender, race or age.

Unknown cause

The exact cause of vitiligo is still not fully understood.

However, experts believe that the main risk factors are a combination of genetics and environmental triggers.

Studies show that about half of vitiligo patients develop it before the age of 20, and one-third of them have a family history of the same condition.

Vitiligo is also linked to other health problems, such as diabetes, thyroid disorders, pernicious anaemia and Addison’s disease.

Vitiligo can be classified into several types:

• Segmental vitiligo – affects only one side of the body, usually from the neck down to the legs
• Generalised vitiligo – involves several parts of the body
• Acrofacial vitiligo – mainly affects the face and hands
• Universal vitiligo – affects almost the entire surface of the skin.

Among these, generalised vitiligo (also called vitiligo vulgaris) is the most common form.

Treatment options

There is currently no medicine that can completely cure vitiligo or stop the loss of pigment cells.

American singer Michael Jackson was infamous for his skin tone, which noticeably lightened throughout the years. However, this was due to the onset of vitiligo and the use of cosmetics to ensure his skin tone remained an even colour. — Handout

However, several treatments are available to help improve the skin’s appearance, reduce the size of white patches and encourage the return of natural skin colour.

Treatment may involve medications, light therapy or surgery, depending on factors such as the patient’s age, the affected areas, the extent of the condition, disease activity and how vitiligo impacts daily life.

Doctors may also recommend combining different approaches for better results.

One of the main groups of medicines used in vitiligo treatment is corticosteroids.

These medicines work by suppressing the immune system so that it does not continue to attack melanocytes, and also by helping to control inflammation.

Corticosteroids can prevent vitiligo from getting worse and promote the return of skin pigmentation.

For localised vitiligo, topical corticosteroids such as betamethasone cream are commonly prescribed.

In more serious cases, oral or injectable corticosteroids like prednisolone or dexamethasone may be used.

Usually, patients are advised to take these medicines at a low dose and for a specified duration to achieve the desired results.

However, prolonged use can lead to side effects such as acne, weight gain, a rounder face (moon face), insomnia, skin thinning and stretch marks.

Another group of medicines widely used in vitiligo treatment is calcineurin inhibitors, including tacrolimus and pimecrolimus.

These medicines reduce the immune system’s response against melanocytes and encourage the growth of these pigment-producing cells.

Children with vitiligo, ­especially those with patches on the face and neck, tend to ­benefit the most from this treatment.

Still, some side effects may occur, such as itching, redness or a burning sensation on the skin.

Apart from medicines, another common treatment for vitiligo is phototherapy.

This method uses targeted ultraviolet (UV) light to stimulate the skin to produce more melanocytes and restore pigment, while also slowing down the appearance of new white patches.

The frequency of phototherapy sessions depends on the activity of the disease and the extent of the affected areas.

As an alternative, some patients may be offered skin surgery or laser therapy, especially when medicines and phototherapy do not provide satisfactory results.

These options are usually considered for patients whose vitiligo has already stabilised.

Preventive precautions

Those with vitiligo should be very diligent about using sunscreen when they go out as they lack sufficient melanin, which protects the skin against UV rays. — dpa

It is important for patients to understand that vitiligo cannot be completely cured.

However, with proper treatment recommended after a thorough medical assessment, the condition can be controlled and prevented from getting worse.

For this reason, following the prescribed treatment plan is crucial to maximise its effectiveness.

Patients who are given medicines should use them correctly and for the recommended duration in order to minimise the risk of side effects.

Patients with vitiligo also need to be extra careful with sun exposure, especially during hot weather.

Unlike normal skin that is protected by melanin, vitiligo-affected areas lack this natural shield.

Sunburn is not only painful, but may also cause the white patches to spread and increase the risk of other skin problems, such as skin cancer.

To reduce these risks, patients are advised to use sunscreen products with at least SPF (sun protection factor) 25, capable of filtering both UVA and UVB rays.

Water-resistant or long-lasting products are generally the best choice.

For better protection, additional steps should also be taken.

These include wearing loose clothing, preferably cotton, as well as wide-brimmed hats and sunglasses.

Patients are also encouraged to stay in shaded or covered areas during hot weather.

Such precautions are especially important for children and babies, as their skin is far more sensitive compared to adults.

Emotional support needed

Although vitiligo is not ­contagious and people living with the condition can still enjoy a normal life, the noticeable changes in skin colour often affect emotions, leading to stress, sadness and low self-esteem.

In such situations, the ­support of family and those around them is crucial in ­helping patients maintain self-confidence and adhere to treatment.

Patients experiencing emotional distress or depression are advised to seek psychological support and counselling from healthcare professionals.

Overall, vitiligo is not an infectious disease and can still be managed with various treatment options.

While it cannot be completely cured, choosing the right treatment approach, along with emotional support from family and the community, can empower patients to live well.

For any inquiries regarding ­medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.

Mohd Shahiri Abd Ghapar is a pharmacist with the Health Ministry’s Pharmacy Practice and Development Division. This article is courtesy of the Division. For more information, email [e-mail]. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.