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.

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.)

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.

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.

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).

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.

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.

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.

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.