If you’ve heard of this chronic skin condition, there’s a very good chance it was in association with Michael Jackson. The King of Pop is reported to have had vitiligo—and other celebrities have it as well, including model Winnie Harlow, who has had an empowering presence of showing the condition’s unique beauty and style. All in all, though, it’s a fairly rare disorder: Approximately .5% to 2% of the world’s population has vitiligo, according to a study in Dermatology Reports. What’s behind this uncommon disease and is there a treatment for it? Here’s what the experts have to say.
What Is Vitiligo?
What is vitiligo exactly? “Vitiligo is mainly an autoimmune disease of the skin that targets pigment-producing cells called melanocytes,” says Bassel H. Mahmoud, M.D., Ph.D., an associate professor of dermatology and member of the Vitiligo Clinic and Research Center at the University of Massachusetts in Worcester. “This results in patches of depigmentation in the form of chalky white areas on the skin which can range from being very small to very large, even covering most of the skin surface.” There are two different types of vitiligo, per the National Institutes of Health. The most common is called non-segmental vitiligo. “This tends to spread slowly with new patches developing off and on,” says Dr. Mahmoud. “Non-segmental vitiligo tends to be symmetric, meaning it appears on both sides of the body, and may stop and start throughout the person’s life.” It usually occurs on one or a few areas of skin, although it can sometimes occur more broadly across the body. The other type is known as segmental vitiligo. “Segmental vitiligo may spread quickly, but it tends to stabilize after six to 12 months and then stop,” says Dr. Mahmoud. Once segmental vitiligo stops spreading, most people do not develop new patches later in life. Vitiligo is an equal-opportunity skin disruptor, affecting both women and men and people of all races. “You might think the disease is more common in the Black community, but that’s only because it is more visible, due to their darker skin,” says Nada Elbuluk, M.D., an associate professor of dermatology at the University of Southern California Keck School of Medicine and director of the USC Skin of Color Center and Pigmentary Disorders Clinic in Los Angeles. “People with whiter skin can get vitiligo as well, the appearance is just not as dramatic.”
Understanding Vitiligo as an Autoimmune Condition
When you think of autoimmune diseases, you might picture lupus or rheumatoid arthritis. With those conditions, the body’s immune system, which normally functions as a barrier to prevent harmful bacteria, viruses and infection from infiltrating the body, turns on itself and begins attacking healthy cells in the body instead. When the immune system begins to attack healthy tissue, it often results in inflamed joints, according to the National Institutes of Health. In cases where the immune system attacks the skin, it can lead to rashes, blisters and color change. The latter is what happens with vitiligo, an autoimmune condition where the immune system’s assault on skin cells results in the loss of pigmentation.
What Causes Vitiligo?
As is the case with many autoimmune conditions, scientists still aren’t sure what causes only some people to develop vitiligo. But certain risk factors make it more likely that you’ll develop the condition than others. For instance, having another autoimmune condition may increase your risk: In a study by researchers at NYU Langone Health in New York City, scientists found more than a two-fold higher prevalence of rheumatoid arthritis and four-fold higher prevalence of multiple sclerosis in people with vitiligo versus the general population. “The condition is associated with other autoimmune diseases as well, such as diabetes mellitus, thyroid disease or alopecia areata (a type of hair loss),” adds Dr. Mahmoud. Addison’s disease, pernicious anemia, psoriasis and systemic lupus are also associated with vitiligo. In one study, 15% to 25% of people with vitiligo had at least one other autoimmune condition.
Is Vitiligo Genetic?
Research in the journal Dermatologic Clinics suggests there may be as many as 50 different genetic variations that contribute to people developing this disease. (It should be noted that genetic predisposition and a hereditary condition are not the same: While it’s true you are at higher risk for vitiligo if one of your parents has the condition, even people without a first-degree relative who has vitiligo may still develop genetic mutations for it.) Regardless, genetic variations alone are not enough to cause the disease—that genetically inclined individual then needs to have a trigger event, Dr. Elbuluk says. “For instance, they might get a sunburn or scrape their skin or even be exposed to a lot of stress,” she explains. “There needs to be something that triggers the onset of vitiligo.”
Can Vitiligo Affect Your Hair?
Yes, actually. “If you have vitiligo, your hair can become white,” confirms Dr. Elbuluk. “The same melanocytes that give your skin its color also give your hair its color, so hair can be affected as well.” Not just the hair on your head, either: We have hair all over our bodies, Dr. Elbuluk points out, and people with vitiligo may lose hair color on their arms, legs and other areas. What’s more, “some people also lose color in areas such as mucous membranes, which includes the inside of the mouth, nose and the genitals,” adds Dr. Mahmoud. Mainly though, you’ll notice the condition due to skin color loss in major areas of the body. “Vitiligo can develop anywhere on a person’s skin,” says Dr. Mahmoud. “It usually appears first on the face, hands and feet. Over time, the spots and patches can grow, and then appears on other areas of the body as well.”
Can You Prevent Vitiligo?
Just as there is no single known cause for vitiligo, there is no known way to prevent it from developing either. “We don’t have a way to screen for it in utero or test to see if you might get it later in life,” says Dr. Elbuluk. “There is no way to prevent it if you are genetically predisposed.” The main thing, she says, is to try and reduce exposure to the things experts know can trigger the condition. “For instance, we know that stress can be a trigger event for people who are predisposed to vitiligo,” she says. “So as much as you can improve your emotional balance and psychological wellbeing, it may be beneficial.”
How Is Vitiligo Treated?
There is no cure for this skin condition, but there are effective treatments available and several promising options in the pipeline. Current treatments include:
Phototherapy
This non-invasive approach uses narrowband UVB light to improve the color of depigmented skin. A study in JAMA Dermatology found that 74% of people with vitiligo saw at least 25% improvement in their condition after using phototherapy for six months, while 44% of people saw a 75% or greater improvement in vitiligo on their face after six months. (Notably, study participants did not see a major improvement of the condition on their hands or feet using phototherapy.)
Psoralens plus ultraviolet A light (PUVA)
Once considered the standard treatment approach, PUVA is used less frequently now due to newer methods that have fewer side effects. Psoralens are types of drugs, in topical or pill form, that cause the skin to darken when exposed to ultraviolet A light. This approach is not recommended for women who are pregnant or breastfeeding; it may also raise your risk for skin cancer.
Laser treatments
Research in the Journal of the American Academy of Dermatology found improved skin color in 82% of vitiligo cases after three weekly laser therapy sessions, for a total of 12 treatments total.
Topical steroids
According to a meta-analysis in the Journal of Clinical and Aesthetic Dermatology, 65% of people with vitiligo had improved pigmentation three months after daily use of a corticosteroid cream. (The American Academy of Dermatology notes that this approach may be most successful for vitiligo on the face; it is less effective on hands and feet.)
Surgery
If vitiligo lesions fail to respond to the treatments above, dermatologists refer to it as recalcitrant vitiligo, says Dr. Mahmoud. “The treatment resistance is usually related to a complete loss of the melanocyte reservoir in the affected area,” he says. In these cases, “repigmentation will not be achieved unless melanocytes are harvested from normally pigmented skin then introduced surgically into the affected white area of vitiligo.” Surgery involves either tissue or cellular transplantation procedures. “Melanocyte keratinocyte transplantation procedure (MKTP) is a cellular transplantation technique that is emerging as an important solution,” says Dr. Mahmoud. “MKTP is a precise, fast and safe surgical technique for transplantation that enables treatment of large, depigmented lesions during a single surgical setting.” A recent review in JAMA Dermatology of 8,776 patients who underwent surgery for vitiligo found that 81% of participants experience at least a 50% improvement in their skin pigmentation with surgical intervention.
Depigmentation
A “last resort” option, the systematic removal of pigmentation works best for people who have already lost the majority of their skin color due to vitiligo. This approach uses a cream to remove pigment from the rest of the skin—a process that can take several years of daily treatments to complete. In addition, a class of drugs called Janus kinase (JAK) inhibitors have shown success in clinical trials for treating vitiligo, according to a new study. JAK inhibitors work by targeting and disrupting the signals from specific proteins that trigger the depigmentation process.
Can a Vegan Diet Help Cure Vitiligo?
Given the ongoing, disruptive nature of the disease, it’s natural to wonder if alternative approaches like changing your diet might help reduce the appearance of vitiligo. In a nutshell: Nope. “There are no clinical trials showing direct correlations between diet, exercise and vitiligo,” says Dr. Elbuluk. Still, a healthy eating plan may have benefits: “There are some studies that show certain antioxidants may help stabilize vitiligo, so [a] healthy, balanced diet is good—even if there is no hard data that eating certain foods will make a difference.” So ignore what you may have seen on the internet about vegan diets miraculously “curing” the condition: Science does not support it. Recent research in both the Journal of Alternative and Complementary Medicine and Dermatologic Clinics suggests that there is not enough evidence to conclusively say any specific diet can make a major impact on this disease—and if it does, it is in conjunction with traditional medical intervention.
Celebrities With Vitiligo
Many people living with vitiligo say the stigma and misinformation spread by the general public make them feel ostracized with this disease. It is not contagious and people with vitiligo have not done anything to bring it on themselves, stresses Dr. Mahmoud. The mental health aspect of the condition is challenging, he adds: “Vitiligo can have a devastating psychological effect on patients and can affect their quality of life.” A growing social movement encourages people with vitiligo to embrace their unique skin appearance, and a growing number of celebrities are opening up about life with this condition. These are some of the public figures who have been associated with vitiligo:
Michael Jackson. Though much was made during his life of an increasingly lighter skin tone, most experts agree that the King of Pop had vitiligo.Model Winnie Harlow. Even after building herself a successful catwalk career, Harlow still finds herself answering questions about her appearance, such as this Instagram post, when a fan mistook her depigmented skin for a white shirt.David Dastmalchian. Hard to believe, but growing up, this handsome Hollywood star was incredibly self-conscious about the white patches on his skin due to his vitiligo, he admitted in an interview with Men’s Health.Joe Rogan. Media personality Rogan has spoken about his battle with vitiligo on his podcast and social media accounts. He credits a “carnivore diet” with helping reduce the appearance of some white patches (though there is no scientific evidence of this or any diet having a profound impact on the disease).Vitiligo Barbie. Yes, the six-decades-and-counting doll features important representation in this space—in 2020, Mattel released the iconic Barbie doll with white skin patches due to vitiligo.
Bottom line? There is nothing easy about living with vitiligo, but there’s no reason to feel embarrassed, either. As more and more celebrities raise their voices and celebrate their skin differences, they’re paving a path for others to do the same. Next up: Protect your skin with the best sunscreen for every type of skin.
Sources:
Bassel H. Mahmoud, M.D., Ph.D., associate professor of dermatology and member of the Vitiligo Clinic and Research Center at the University of Massachusetts in WorcesterNada Elbuluk, M.D., associate professor of dermatology at the University of Southern California Keck School of Medicine and director of the USC Skin of Color Center and Pigmentary Disorders Clinic in Los AngelesABC News: “Exclusive: Photos of Michael Jackson Show Signs of Vitiligo and Needle Punctures.”Sports Illustrated: “Here’s Why Winnie Harlow Doesn’t Want You to Say That She’s ‘Suffering’ From Vitiligo.”National Institute of Arthritis and Musculoskeletal and Skin Conditions: “Autoimmune Conditions.”National Institutes of Health: “Vitiligo.”Dermatologic Clinics: “Genetics of Vitiligo.”Dermatology Advisor: “Study Finds Multiple New Disease Associations With Vitiligo.”Journal of the American Academy of Dermatology: “Comorbid diseases of vitiligo: A 10-year cross-sectional retrospective study of an urban US population.”Dermatology Reports: “Vitiligo: What’s old, what’s new.”Genome Medicine: “The genetics of generalized vitiligo: autoimmune pathways and an inverse relationship with malignant melanoma.”American Academy of Dermatology: “Vitiligo: Diagnosis and treatment.”The Journal of Clinical and Aesthetic Dermatology: “Advances in Vitiligo: An Update on Medical and Surgical Treatments.”Journal of the American Academy of Dermatology: “Treatment of vitiligo with the 308-nm excimer laser: a pilot study.”Journal of the American Medical Association – Dermatology: “Phototherapy for Vitiligo,”Drugs.com: “Psoralens.”Journal of the American Medical Association – Dermatology: “Surgical Interventions for Patients With Vitiligo: A Systematic Review and Meta-analysis.”Frontiers in Immunology: “Janus Kinase Inhibitors in the Treatment of Vitiligo: A Review"Journal of Alternative and Complementary Medicine: “A Systematic Review of Nutrition, Supplement, and Herbal-Based Adjunctive Therapies for Vitiligo.”Dermatologic Clinics: “The Role of Diet and Supplements in Vitiligo Management.”UMass Chan Medical School: “Did Michael Jackson Have Vitiligo?”Instagram: “Winnie Harlow.”Men’s Health: “Dune’s David Dastmalchian Is Ripped, Feeling Great, and in All Your Favorite Blockbusters.”YouTube: “Is the Carnivore Diet Cleaning Up Joe Rogan’s Vitiligo?”CNN: “New Barbie Dolls Feature Vitiligo and Hairless Models in Bid to Boost Diversity.”
