Disease, myths and treatment of Vitiligo

Dr Shivani Ranjan, Dr Devraj Dogra

Vitiligo also called the ‘White spot disease of skin’ is known in local language as safeddagh, phulbhari, svetakustha. The term ‘vitiligo’ was derived from the latin word “Vitilium” meaning blemish. The roman physician Celsus first used the term vitiligo in the 2nd century AD. Even the Rigveda mentions Vitiligo as ‘Kilasa’meaning white spotted deer. Mexico and India are pointing the highest incidence of this condition. Based on the dermatological outpatient’s records, the incidence of vitiligo is found to be 0.25-2.5% in India. Although vitiligo does not produce any physical impairment, it may significantly influence the psychological and psycosocialwell being of the patients. In India, this disease is associated with many religious beliefs and the patients are discriminated by the family and the society in general and girls in marriageable age particularly find it frustrating to get suitable matches. This makes the patient and their family to go behind rituals rather than seeking a medical help. The delay in treatment further complicates the disease condition. Patients get depressed because of the cosmetic impact of the disease, which further triggers their disease condition.

World Vitiligo Day is observed on 25th of June every year aimed to build global awareness about vitiligo, a disfiguring skin disease that can have a significant negative social and psychological impact on patient’s health. This day is also celebrated to make the people comfortable with the idea of living happily with the disease by decreasing their apprehensions about the disease and discrimination.This year the theme of The World Vitiligo Day 2025 is “Innovation for Every Skin, Powered by AI”. This theme emphasizes the use of artificial intelligence to improve access to information and support for individuals with vitiligo, as well as to drive advancements in diagnosis, treatment, and care.

What causes vitiligo?

While the exact cause remains unknown, there are various hypothesis like the role of genetic factors, autoimmune phenomenon, neurogenic etiology and role of toxins like phenol and quinones. There are certain other known causes of leukoderma like contact dermatitis to chemicals like bindi, footwear, burns and trauma.

Presentation of disease:

Vitiligo is an acquired pigmentary disorder of the skin associated with the loss of pigment forming cells known as melanocytes which presents as depigmented or hypopigmented chalky white or milky white patches limited to skin without any internal organ involvement. It affects both the sexes equally. Most commonly the disease begins during childhood or young adulthood with onset of 10 to 30 years but can occur at any age. Children usually tend to have localized disease and respond well to treatment. Any part of the body may be affected but areas subjected to trauma like dorsal aspects of hands, feet, elbows, knees and face are frequently affected. Axilla, groins, areola, genitalia, hair and mucosal surfaces may also be involved. Being an autoimmune condition, the course of disease is unpredictable and uncertain. The rate of spread varies among individuals, with some experiencing rapid progression while others have stable patches for years; however, it generally shows a tendency towards slow progression.

Vitiligo is broadly classified into segmental and non- segmental types. Segmental vitiligo follows an early and rapid course and later becomes static while non-segmental vitiligo occurs late and follows an unpredictable course.

Separating Myths from Facts:

There are certain myths and misconceptions prevailing in the society regarding vitiligo like it is a communicable disease while in reality it is neither infectious nor contagious. It’s an autoimmune condition where the body’s immune system attacks melanocytes, the cells responsible for producing skin pigment, leading to depigmentation patches.Rarely, it may be associated with other autoimmune disorders like thyroid abnormalities, pernicious anemia and diabetes.

Another common myth is that it occurs by intake of fish and milk together however, the truth is that it has no relation with intake of milk, fish or both. There’s limited scientific evidence to suggest that specific diets can directly impact vitiligo development or progression. However, a balanced diet rich in antioxidants and nutrientswith adequate proteins, vitamin B-complex, vitamin E and minerals such as copper, zinc as well as iron is advised. These nutrients can be obtained from egg, green leafy vegetables, fruits, dairy products, nuts, beans, lentils and poultry.

There is another misconception that vitiligo is an incurable disease which is not true. In fact, it is curable in majority of the cases especially when diagnosed early. It has been seen that those patients who are treated early in the course of disease have a better prognosis than those presenting late. So, patients should not waste their time in going to quacks and applying indigeneous medicines which can actually hasten the disease course. Upto 70% of the cases can be treated successfully with the available treatment options.

Another myth is that only dark-skinned people are affected by Vitiligo whereas the fact is that the occurrence of vitiligo is not determined by skin colour. It affects individuals of all races, irrespective of their skin tone. However, it may be more noticeable in individuals with darker skin.

How is vitiligo diagnosed?

Vitiligo is usually diagnosed through a physical examination of the skin. A dermatologist may use a Wood’s lamp (UV light) and a dermatoscope to look for patches of depigmented skin for confirming the diagnosis.

Treatment of Vitiligo:

Treatment is based on certain factors like age of patient, the progression of disease, psychosocial considerations and the affordability and availability of treatment forms. The goal of treatment is to stop the disease progression and to induce repigmentation. While phototherapy (narrow band UVB) forms the backbone of the treatment, medical treatment in the form of topical and systemic steroids and other immune-modulators/ immune-suppressants are also used. The advent of treatment modalities like Janus kinase inhibitors, prostaglandin analogues, antioxidants, TNF inhibitors,targeted phototherapy and excimer lasers have revolutionized the therapeutic possibilities offering a ray of hope to the individuals suffering from the disease.Surgical techniques include skin grafting or melanocyte transplants in case of localized and stable disease. Depigmentation therapy remains indicated in very extensive forms (>50% of body surface) where small islands of left normal skin are depigmented to match the depigmented skin for better cosmetic appearance.

Avoidance of sun exposure and religious use of sunscreens is recommended to avoid long term sunlight induced damage and development of skin cancers as the vitiliginous skin is not protected from UV light due to loss of melanin pigment which has a protective effect against sunlight. Patients not eligible or unwilling for these treatments can use camouflage (tanning agents, stains, dyes, etc.) for cosmetic purpose.

While vitiligo primarily affects the skin’s appearance, it can have significant psychosocial impacts, leading to decreased self-esteem and quality of life for some individuals. Balancing the physical and emotional aspects of living with vitiligo is crucial.

Instead of relying on internet searches for solutions, consulting a Dermatologist is the most effective way to address vitiligo and receive personalized care.

(Dr. Shivani Ranjan, is Asstt. Professor and Dr. Devraj Dogra, Professor & HOD, Deptt. Of Dermatology, GMC, Jammu)

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