Vitiligo: White lies exposed

Vitiligo, Safed Daag, Kod, Phulvari. call it by any name, it is the most socially dreaded condition. The disease itself is simply an appearance of white patches on the skin, which are initially small and slightly lighter than the surrounding skin. The patches may progress to cover large areas and become milky white in colour as the skin totally stops producing melanin pigment in those areas.

Approximately, one per cent of the world population is affected by this disease and the incidence is higher in dark-skinned races. Second only to leprosy, in courting ostracism and social rejection, this disease has probably the most myths and unscientific, untrue beliefs associated with it.

Here we attempt to discredit some of the major ones.

Myth: Vitiligo is caused by the wrath of the gods; it’s a punishment for our sins. Or it’s caused by touching dogs with white patches on their forehead.

Fact: If vitiligo was divine retribution for our sins, all of us would be carrying at least one white patch. But Vitiligo has nothing to do with God or past life, it is caused by antibodies produced by our own cells, which destroy melanocytes [the colour manufacturing cells in the skin].

Another line of study points towards a neurogenic origin i.e. chemicals released at nerve endings block the formation of melanin [brown skin pigment] by melanocytes.

The third reason is an inherent deficiency in the natural protective mechanism of melanocytes due to which the cells are unable to get rid of toxic melanin precursors and thus self destruct.

Myth: Vitiligo is aggravated by sour foods.

Fact: There is actually no relationship of the disease with diet. It is useless to deprive the patients of curd, lemon, pickles and tomatoes in the hope of decreasing the severity of the disease.

Aggravating factors are injuries i.e. new patches appear where skin is subject to friction of trauma like scratches, burns, cuts, and pressure sores.

Patches increase in size when immune levels of the body fluctuate leading to more melanocyte destruction.

Myth: Patients with vitiligo are mentally retarded or have low intelligence and defective systems or poor health.

Fact: Vitiligo has no systemic effects. It is only limited to the skin and does not affect other organs or systems of the body, including intelligence levels.

Myth: Tattooing over a vitiligo patch is a good way to camouflage it.

Fact: Tattooing is actually a bad idea because a phenomenon called ‘Koebnerization’ can occur, in which the injury caused by tattoo needles stimulates the disease, and encourages it to spread.

Also, over a period of time tattoos display something called ‘Tyndall effect’ due to sinking of pigments into the lower layers of the skin. Even perfectly matched skin coloured pigments tattooed in, start looking bluish grey and unnatural in a couple of years due to this.

Myth: Vitiligo runs in the family.

Fact: This is one myth, which has some basis of truth. Different studies report inheritance to be anything from 15/20 – 30/40 per cent. However, it can appear as an isolated case—it is not necessary to have an affected relative. Nor is it necessary that the affected person’s progeny will definitely have the disease.

Myth: Vitiligo is contagious. Those affected must be isolated, as it is a type of leprosy.

Fact: Since it’s not an infectious disease, there is no way it can spread by touching, maintaining close contact with the affected or by sharing towels or bed-sheets used by them. Though light-coloured skin patches may appear in some forms of leprosy, vitiligo is not related to this disease.

Myth: Vitiligo is untreatable.

Fact: Medical science has given us an entire armament to battle this disease—treatments like immunomodular drugs, steroids, ultraviolet A and the newer narrow band ultra violet B. In addition, various surgical options like punch grafting, split thickness grafting or micro fine grafting [suction blister grafting] can be done.

The latest technique is melanocyte transfer in which only melanocytes from normal skin are harvested and inoculated into the vitiliginous patches. Excimer laser is also an excellent treatment modality for vitiligo.

Treatment is no doubt difficult and slow and not all patients respond alike; however, it is more important to treat the stigma than the disease as the mental impact is far more than the effect on physical wellbeing.

Spreading awareness and education is the only tool to counter the erroneous beliefs that still prevail in our society.