Treatments for Vitiligo

In the past 2 weeks I have encountered at least 4 patients with Vitiligo. Three of the patients were Caucasian women in their 30’s and 40’s, who were not complaining about the areas of de-pigmentation on their face or bodies. These patients had come to accept the loss of color in patches, at their chests, necks, arms, &hands. My offering of prescriptions for daily use, corticosteroid creams, and the promise that there is a possibility of relief of this condition, that narrow band UVB light sources can many times successfully treat this condition, seems not to interest these patients. They often exclaim that the “vitiligo” doesn’t bother them in the least, no one notices it.
In direct contrast to these 3 was patient number 4, who was brought to the office by her distressed husband. She had a complaint of recent onset of “rash” on the face and body that has been present for about a month. Immediately upon entering the exam room I see the distressed face of a medium brown lovely African American lady patient, a face I’ve seen before, now suddenly with white spots. Large areas of this lady’s face had obvious loss of its lovely brown color revealing white patches and streaks, an affliction which is also affecting her legs. On this patient the conditions is not hidden. This case requires my full attention. This patient needs reaasurance that it appears to be Vitiligo, that it could be treated, that it is an autoimmune condition, like Alopecia Areata, were the body’s own immune system turns against its own cells, and the patient needs a biopsy to prove the diagnosis and perhaps other lab studies. In Alopecia Areata, it’s the hair follicle cells, and in the case of Vitiligo, it’s the pigment making cells, the melanocytes, that the , immune system turns against. Sometimes patients will exhibit both Vitilgo and Alopecia Areata. This can happen in the context of Thyroid disease and or it can be genetic. The point I’m trying to make is that this condition of Vitiilgo affects different people differently depending on the color of their unaffected skin and the location of the Vitiligo on their bodies.
If it’s visible on a darkly colored persons face, it will be readily apparent and could possibly stigmatize this person, marking them for life, and potentially affecting their self esteem and social/professional mobility. In that respect, Vitiligo has a more devastating affect on the darker races than on the Caucasians who have it. Regardless of race, any patch of depigmented skin on whites or blacks, is very vulnerable to sunburn and skin cancer, having no pigment cells within the patch to protect from sunburn and such. If you have loss of pigment, and if you are distressed by it, see a Dermatologist. Treatments can be successful.