Today, Dermatologists across the world will come together to pool their knowledge and research on Vitiligo. Together they will focus their attention this year on what the future holds for people with this rare autoimmune skin condition and reflect on how medical advancements in the field could help mitigate its negative impacts.
Their main objective will be to enable persons with Vitiligo to be able to cope better with their skin condition especially in Sri Lanka as it is still steeped in myths and wrong beliefs despite collective efforts of the Health Ministry and dermatologists resulting in insensitive behaviour towards Vitiligo sufferers in the country.
The Sunday Observer spoke to Consultant Dermatologist, Sri Jayewardenepura Hospital, Dr. Dananja Ariyawansa to shed more light on this silent disease which takes the victim unawares and affects both young and old alike.
Excerpts
Q: World Vitiligo Day falls today ( June 25.) As this is a disease few people understand or have even heard of, could you explain what Vitiligo is?
A: Vitiligo is a long-term condition where pale white patches develop on the skin. It’s caused by the lack of melanin in the skin
Q: What causes it? Are there several causes or just one main cause?
 Dr. Dananja Ariyawansa |
A. We cannot point out a single cause. At the molecular level it is due to the loss or destruction of melanocytes (melanin-producing cells). There are many underlying causes, namely immunological, biochemical, oxidative, and environmental mechanisms that work jointly in those with a genetically susceptible individual.
Q: Why is a special day set aside for this particular skin disease?
A. This is a skin condition which affects a smaller proportion of the community and hence the impact of the disease is not well addressed. However, a person who suffers from this disease would be subject to significant social stigma ending up with withdrawal from society
Q: The theme for this World Vitiligo Day this year is “Vitiligo: Looking Into the Future” . What is the significance of this theme for Vitiligo sufferers in general
A. It implies there are newer therapies that can be offered for patients
Q: What is its significance for Lankans with Vitiligo in particular?
A. As Sri Lankans we are born with a pigmented skin and vitiligo is thus very well highlighted. Furthermore, due to ignorance on this specific health problem, some individuals in our society are still unaware that vitiligo is a non contagious disease
Q: Do you have any rough statistics on how many have this skin condition 1) globally 2) in Sri Lanka
A. According to the Vitiligo Research Foundation of the USA about 100 million people suffer from Vitiligo globally, Unfortunately, we do not have any prevalence studies on this subject in Sri Lanka to assess the gravity of the disease in our country.
Q: What are the main trigger factors that cause it?
A. Emotional stress, pregnancy, oral contraceptives, vitamin deficiencies, and many other factors have been described as precipitating factors for vitiligo.
Q: What about family history ? If a person has a strong family history of Vitiligo will he or she be more vulnerable to getting it? If so what are the chances?
A. Vitiligo runs in families but the inheritance pattern is complex because multiple causative factors are involved. About 1/5th of the people with vitiligo may have one close relative who is also affected.
Q: What are the symptoms to look out for in its initial stage?
A. The onset of vitiligo is usually insidious. The most common presentation is the complete loss of pigment in single or multiple patches of skin, with characteristic chalk- or milky-white colour.
The texture of skin is normal and no itching or any other symptom
Q: How are these patches distinguished from any other skin ailments ,like aluhang for example? What do they look like initially?
A. Aluhan (pityriasis versicolar) has a mild colour reduction whereas in vitiligo its complete absence of colour seen as chalk- or milky-white colour which is well highlighted in pigmented skin which Sri Lankans have.
Q: Can anyone get Vitiligo age wise and gender wise?
A. Some studies have shown, vitiligo can increase with age but as there are many types of vitiligo, its not applicable to all types.
There is no significant gender prevalence.
Q: Who are those most at risk of developing this condition? Middle aged persons? Older people?
A. It can develop at any age but is more common in middle aged persons than those who are older.
Q: Can children get it?
A. Yes they can be seen even at birth which is called congenital vitiligo. The Generalised (nearly all skin parts involved) vitiligo is the commonest variety seen among children
Q: What populations are most affected? All ethnic groups? Or mostly in countries like Africa and Asia where people are dark skinned.
A. Any skin type may be affected but it is highlighted in dark skin and camouflaged in white skin as the spots are milk white
Q: Are there different types of Vitiligo? If so, what are they?
A. According to the distribution of spots, there are different categories
1. Nearly all skin surfaces involved
2. Many parts of the body involved
3. Only one side or part of the body involved
4. One or only a few areas of the body involved
5. Face and the hand involved
Q: Are these types specific to certain countries /regions etc.?
A. No
Q: Healthwise, what are the main negative impacts on a person with Vitiligo - 1) Physically? 2) Psychologically ?
A. It’s mainly psychological than physical effects when socialising and in marital relationships. They may have social phobias, depression or anxiety due to their cosmetic appearance
Q: Can Vitiligo affect one’s brain?
A. There have been numerous and well established studies that have demonstrated association of various psychiatric disorders and vitiligo
Q: Can it lead to Alzheimer’s?
A. People with Vitiligo have five times the risk of developing dementia, while in those with Alzheimer’s the risk is 12 fold.
Q: Hair? .Is it true that some persons with Vitiligo grey prematurely?
A. Yes, as both vitiligo and premature greying of hair are both autoimmune disorders.
Q: Eyes? It has been said that some people with the disease lose some of the colour in their eyes and see light spots in the coloured part of the eye. Is this true?
A. Theoretically yes, as melanocyte abnormalities in the eye cause a critical role in eye disease but it’s a very rare association .
Q: Some studies have also found that it sometimes affects one’s hearing if it develops inside the ear? True or false?
A. True (but in a small percentage)
Q: Can a person with Vitiligo work? Marry ? Have children?
A. They can lead a normal life similar to another normal individual, but if outdoor work is chosen as a profession, it’s advisable to take precautions to protect oneself from sun exposure to avoid sun damage.
Q: Treatment wise-Are there different types of treatment since we are now moving into the hi-tech age?
A. There are several modalities that are proven to be helpful in vitiligo. Optimal therapeutic response is often seen with combination therapies with local applications, light therapy, tablets and injections and depending on the severity of the disease, patient’s requirement, availability of therapy
Q: What are the latest methods being used? Are they available in Sri Lanka as well?
A. Biological agents which act at molecular level targeting the problem without harming other organs with minimal side effects, are available as tablets and creams. These tablets are available in Sri Lanka but are very expensive.
Q: How do you treat a patient with vitiligo at Sri Jayewardenepura Teaching Hospital? With drugs? Surgery?
A. At Sri Jayewardenepura hospital we do offer topical creams, different tablets, light therapy, and punch grafts (fixing pigmented skin patches on the light coloured skin)
Q: Are these methods all approved by the Ministry of Health with the stamp of approval from WHO?
A. Yes they are
Q: Can lost skin be recovered with such treatments? What is your success rate so far?
A. There are many factors which determine success rates including activity of the disease, extent of involvement, age and other pre-existing diseases the patient has.
Q: How long will a person who has recovered from vitiligo take to recover completely?
A. ‘As mentioned in the previous question, many factors are involved, patients who respond well to treatment would be: Younger patients, those who have been afflicted by the onset of the disease recently, Darker skin types, and those with lesions on the face, neck, and trunk.
Q: What about chronic patients? Do they have to be on drugs for life? What are the side effects?
A. They do not have to be on drugs life long as some respond well and others may need a low dose of treatment with close monitoring for side effects.
Q: Will prolonged use of steroids complicate their symptoms ?
A. Topical application and tablets of steroids play a major role of treatment for Vitiligo and if the lowest possible concentrations of creams are used to control the disease and steroid tablets used for short term complications can be minimised. I must add that this is well handled by a Dermatologist. However, if very strong topical creams are purchased over the counter by patients themselves, it can lead to adverse effects.
Q: What about home remedies?
A. They are not evidence based
Q: Will exercise help?
A. It helps to relieve stress, but no direct therapeutic effect
Q: Is Vitiligo curable? Or manageable?
A. Curable in some and manageable in others
Q: Do’s and Don’ts to mitigate Vitiligo impacts?
A. Do’s Use sun protective creams or cover the areas with clothing when exposed to sunlight Don’ts Avoid physical trauma.
Q: Your message to all persons affected with Vitiligo?
A. There are many newer therapies for vitiligo and you would be able to lead a normal life with healthy skin.
Q: What are some of the recent steps the Sri Lanka College of Dermatologists has taken towards mitigating the negative impacts of Lankans with Vitiligo ?
A. We have conducted public awareness program in the community and patient education sessions in hospital settings.
Q: Your message to all Lankans affected with Vitiligo?
A. As we now have many newer therapies for vitiligo, there is no need to worry as they will enable you to lead a normal life with healthy skin.