STORY BY
It’s black, it’s white
It’s tough for you
To get by
-- Michael Jackson, “Black or White,” copyright 1991 Sony Music
The late pop star Michael Jackson experienced the above words in a way few people do. Diagnosed in 1986 with vitiligo, a condition that left pale, pink-white patches on his coffee-colored skin, he began to wear a single white glove that later became his trademark. The media celebrated his fashion savvy but later questioned his use of heavy makeup and subsequent transformation into a hermit who hid his ghostly pallor beneath parasols and behind sunglasses.
Although vitiligo affects about 1 percent of the population, many people aren’t aware it exists. Pronounced vit-ill-EYE-go, the condition, which isn’t contagious, results when the body stops producing pigment on certain areas of the body, and white patches, or lesions, develop on the outer layer of skin known as the epidermis.
Vitiligo poses no inherent physical harm to people who have it, but it can mean increased susceptibility to skin cancer and can be associated with thyroid conditions, pernicious anemia and Addison’s disease. It’s found in equal proportions among men and women of all races and ethnicities, but is most noticeable when it develops in people of color.
“In people diagnosed with vitiligo, family history is important,” says Adelaide A. Hebert, M.D., professor of Dermatology and Pediatrics at The University of Texas Medical School at Houston. “The prevalence of a family member having vitiligo is 6 percent to 38 percent.”
In the case of Michael Jackson, vitiligo runs in the family of his father, Joseph Jackson, according to news reports.
Rather than conforming to a pattern that is autosomal dominant (in which a gene is inherited from one parent), vitiligo seems to be controlled by a recessive gene in three or four disparate locations, Hebert says.
In addition to genetics, autoimmune and environmental factors are thought to play a part in triggering the condition. “The average age of onset is 20 years of age,” Hebert says. “Many patients attribute the onset to factors such as a physical injury, sunburn, illness or pregnancy.” There’s no scientific proof, she adds, that these factors play a role in causing or precipitating vitiligo.
The following groups offer information and support for people diagnosed with vitiligo and their families.
American Vitiligo Research Foundation
This organization, started by a vitiligo patient, has resources for children and other patients, including information about sun safety and coping skills.
http://www.avrf.org/
National Vitiligo Research Foundation Inc.
The world’s first established vitiligo support group provides basic information about the condition, as well as patient testimonials and information about research.
http://nvfi.org/index.php
Vitiligo Support International
http://www.vitiligosupport.org/
This patient organization offers information about vitiligo treatment, support and resources.
Two types of vitiligo exist, segmental and nonsegmental. Segmental, in which lesions are confined to a certain area of the body, occurs less frequently and is more difficult to treat. The non-segmental form, in which one or more areas loses pigment before the lesions change in formation and expand to other areas of the body, is more common and more treatable.
“Vitiligo frequently is seen around the lips, under the arms, in the groin and genital area, on the hands and feet, and on the knees,” Hebert says. “It can occur in any area. It can also affect the hair and scalp, causing the hair to turn white.”
At one time, Hebert says, vitiligo was mistaken for Hansen’s disease, also known as leprosy. Unlike that condition, however, vitiligo is not bacterial in origin and does not affect the texture of the skin.
“Vitiligo can vary in color depth while you have it, and the disorder can spontaneously go away,” Hebert says. “It is important that areas affected by vitiligo be protected from the damaging rays of the sun.”
Treating vitiligo is an ongoing process. “There’s no single guaranteed therapy that will help everyone,” Hebert says. “Gradual exposure to the sun can stimulate the melanocytes (the skin’s pigment-producing areas) to make the skin color develop.”
Other treatments include:
Although vitiligo has few physical side effects, it can take an emotional toll. “It may be especially troubling for those who have more deeply pigmented skin,” Hebert says. “Generally the lesions are completely asymptomatic, but people with this condition can be very self-conscious.”
Dermatologists experienced in treating vitiligo provide holistic care that focuses on the patient’s emotional as well as physical needs, Hebert says. “We ask questions about impact on the patient. If it is a child who is affected, we want to know if the patient is teased in school, embarrassed to dress in gym clothes, reluctant to take part in social events or physical activities.”
Treatment involves caring for a patient’s current lesions rather than preventing new ones, Hebert says. “When patients respond, color may return in tiny dots of normal pigment, similar to freckles,” she says. “Patients often interpret this appearance as looking worse, when actually it indicates the initial steps of improvement.”
Exposed areas on the face or body can be camouflaged with waterproof cosmetics. Over-the-counter brands such as Covermark and Dermablend can be custom-blended to match a given patient’s skin color.
Depigmentation therapy, also known as skin bleaching, is attempted only in rare cases, Hebert says. “Patients need to understand that if we bleach their skin’s color, it is an irreversible process. The result is not a natural pigment. They are prone to skin cancer, because the treatment leaves them with virtually no pigment at all.”
The procedure, utilizing a topical drug called monobenzyl ether of hydroquinone, or monobenzone (brand name Benoquin), is difficult to obtain due to U.S. Food and Drug Administration regulations.
“This treatment tends to be reserved for patients who have lost most of their pigment in cosmetically sensitive areas,” Hebert says. “Depigmentation would be considered only after other interventions fail to work.”
Most vitiligo treatments are not new. “Less research funding has been devoted to vitiligo in recent years,” Hebert says, “since it does not seriously compromise the health of patients.”
People who have concerns about vitiligo or other skin condition should seek medical care, Hebert urges. “Not every white spot is vitiligo. But if a white spot exists on the skin, patients should visit a dermatologist and have it checked instead of assuming it’s vitiligo and is totally benign.”
Hebert concludes, “It is important that patients diagnosed with vitiligo start treatment. But it is just as important to rule out other skin conditions and even skin cancer.”
Last Updated: 10-28-2009Editorial Board | Legal Disclaimer | Privacy & Security | Contact Us
©2000-2009 Office of Institutional Advancement, UT-Houston
Follow us on:
Dr. Adelaide Hebert is a professor in the Department of Dermatology at the UT Medical School.
See Dr. Hebert also at:
Midlife Fitness
May Equal
Later Memory Fitness
Don’t be a couch potato when you hit midlife if you want to have a clear mind in your later years. Exercising regularly and maintaining a healthy weight during middle age are associated with lower risks for dementia and Alzheimer’s disease in later years, suggest numerous studies. Researchers stress that they have not shown a clear cause-effect relationship. Increased risks may be partly related to other factors like diabetes that affect many who are obese or overweight. Other risk factors to avoid are high blood pressure and high cholesterol.
