Understanding Vitiligo Beyond the Spots

People who have vitiligo — a chronic disease characterized by white spots on the skin — face a lot of rejection from society, but it must be stressed that it is not contagious.

This is stated by the academic from the Faculty of Medicine (FM) of the UNAM and member of the FM Oncodermatology Clinic at the General Hospital of Mexico, Ana Florencia López Ornelas, who calls for respect and inclusion of patients with this condition, who are estimated to represent between 2 and 6 percent of the Mexican population.

"The most important thing is to understand that it is not contagious, that there are people who, no matter how much treatment they receive, will not improve and are very valuable. As doctors, we know that nothing happens, each person has unique characteristics, and we have to make them feel that they have something that makes them different, but it is not bad," emphasizes the specialist, on the occasion of World Vitiligo Day, which is commemorated on June 25.

She also emphasizes that it is significant to make their emotional health visible because the rejection they suffer affects their quality of life. “There are patients with very white skin, whose spots are practically invisible, and yet, they isolate themselves because everyone questions or attacks them,” he says.

Vitiligo, he continues, is part of the group of conditions known as psychodermatoses, which are “like a vicious circle.” Patients have a genetic load that makes them have vitiligo, which stresses them and certain hormones increase in their body that make their immune system more active and worsen.

“Sometimes doctors forget that we have to work as a team and patients are afraid when we talk to them about a psychologist or psychiatrist, and they refuse to go, but it is important to give this complete treatment because if not, they can spend thousands of pesos on medications; it will not improve until we see the emotional part,” he adds.

López Ornelas explains that this is a disease whose exact causes are unknown. What is known is that a person with parents or siblings with it has a higher risk of suffering from it, although those who do not have any family history also have it.

In addition, environmental factors such as contact with certain chemical products, such as hydrocarbons, have an influence. Today there are studies that indicate that certain hair dyes could cause it.

Similarly, physical stress is among the causes of this condition. “Melanocytes, which are the cells that produce pigment in our body, do not have the same capacity to adapt to oxidative stress, which is when these cells are exposed to certain stimuli, such as solar radiation, chemicals, among others.

“Normally, the body can repair the damage that occurs, but people with vitiligo have a certain inability to make those repairs,” explains the specialist.

Early care

The condition, she says, is characterized by the appearance of white spots and occurs because T lymphocytes “get confused” and attack melanocytes.

The expert points out that worldwide, between 1 and 2 percent of the population suffers from this disease. India is the country where it is most frequently recorded, followed by Mexico and Japan.

In addition, it is recorded in people of all ages, although it most commonly appears between 10 and 30 years of age. “Many times they may have a single episode, it is controlled, but there is already a history and at any other time in life it can be triggered. There are patients who, once they start, continue their whole life with spots.”

Therefore, the university student emphasizes that in the event of any change in the skin that persists for more than two weeks, you should go to the primary care physician or dermatologist, because the sooner you receive care, the more possibilities there are of removing them.

“We know that when people have had these spots for more than six months, the probability of repigmenting the skin is less than 50 percent,” he reiterates.

The treatment depends on the stage of the disease in which they are: cortisone cream or oral cortisone can be prescribed, lemon derivatives called psoralens, among others. In patients with many outbreaks of vitiligo or who do not respond to treatment, thyroid studies are performed, to rule out that diseases of this type are causing them.

“There are certain subtypes of vitiligo that do not respond well to treatment: when it is in a single segment; when it appears on the tips of the fingers, they do not repaint; around the mouth it is also very difficult to repigment,” he points out.

He emphasizes that patients with this disease are at greater risk of developing skin cancer, which is why they have to use sunscreen and should not expose themselves to solar radiation.

López Ornelas states that using sunscreen should be a habit, a self-care measure for the entire population, since it is the only thing that can be done to prevent skin cancer. In addition, it is the best anti-wrinkle and anti-stain cream. It should be applied, ideally, three times a day: 08:00, 12:00 and 16:00 hours.

In Mexico, he details, sunscreens indicate that they have 50+ protection factors since those with 100 factors are no longer sold because people trusted that they would protect them throughout the day and this is not the case.

He also recommends that when in swimming pools or on the beach, “water-resistant” sunscreens should be applied every 40 minutes and every 80 minutes if they are very “water-resistant.” There are no products that are “waterproof,” he warns.