Quality of Life in Vitiligo

The psychological effects of vitiligo

Share

Latte. Caramel. Maple. Almond. Espresso. Mocha. No, these are not the ingredients for a decadent dessert. Rather, they are descriptions of varying foundations and skin-toned makeup. The names are usually associated with specific shades. While determining the appropriate shade for foundation and makeup can be an easy remedy, for some of us it can be a daily challenge and involve precise applications of colors and layering, especially if we have a change in skin pigmentation.[1] 

Vitiligo is a non-contagious disease in which the skin cells charged with producing skin pigment (color) are eliminated and/or lose their ability to produce proper pigment.[2] The end result of this process is loss of color in the skin, known as depigmentation (complete color loss), or hypopigmentation (partial color loss). As the most common depigmenting disorder, it affects all ages and all skin types, with a worldwide prevalence of 0.3%-0.5%.[3] Vitiligo usually appears on the skin between the ages of 10 and 30.[2] While the exact underlying cause of vitiligo is still under research, it is linked to changes in genetics as well as abnormal function of the immune and nervous systems.[4] Factors such as sunburn, stress, and friction can worsen affected areas.[4]

 

Perceptions of Vitiligo

Historically, the name “vitiligo” may have developed from the word, “‘vitium,” meaning spots or blemish.[5] When researchers conducted polls, 20% of the general public incorrectly believed vitiligo to be caused by an infection; most of the individuals who believed vitiligo is caused by an infection were less educated.[6] Approximately 33% of those taking the poll mistakenly believed vitiligo was contagious, and 22.5% believed vitiligo was due to lack of hygiene. Given the negative public perceptions of vitiligo as well as the discoloring nature of the disease, patients suffering from vitiligo often develop an impaired quality of life.[7] These false beliefs of vitiligo (that it is contagious, caused by infection, and unhygienic) have increased the stigma of the disease.[8] In certain parts of the world where leprosy is prevalent, vitiligo can be mistaken for the colorless patches of leprosy. This may lead to unnecessary stress and significant prejudice.[9]

 

The Impact of Darker Skin in Vitiligo

While vitiligo affects sexes and races equally, it is more noticeable in darker-skinned individuals.[10] Melanin is the pigment in the skin produced by skin cells known as melanocytes. While light and dark skin generally have the same number of melanocyte cells, they differ in the amount of melanin produced. Darker skinned individuals produce more melanin than their fair skinned counterparts.[11] In vitiligo, the pale uncolored patches of skin contrast starkly against the darker surrounding skin. This contrast is more obvious and socially embarrassing in those with darker skin, leading to higher levels of psychological distress.[9,12]

  

Improving Psychological Health in Those with Vitiligo

Since visual appearance is often important for making a first impression, negative public assumptions about vitiligo may result in higher risk of depression, more social isolation, and greater anxiety among vitiligo patients.[8,13-16] Most of the bullying and stigma about “being different” starts around the middle and high school years of a child’s life. Medical treatment for vitiligo should not only focus on improving the appearance of the affected areas but also help elevate self-esteem through activities not directly related to outward appearance.[17] Psychotherapeutic techniques such as relaxation techniques, talk therapy, and hypnosis can help improve patient participation in social activities and lessen the social anxiety of vitiligo.[17] Treatment of vitiligo, including topical steroids as well as light/laser therapy can help improve not only the underlying medical condition but also improve the patient’s quality of life.[18,19]

In patients with a similar disease of skin discoloration, albinism, the best approach found to reducing the stigma and the prejudice was through good public awareness.[20] While many treatment options are available to treat the underlying disease, the psychological effects of vitiligo may be best remedied with public awareness.[21] In particular, educating parents can help their children and themselves better cope with the emotional distress of vitiligo.[22] Individuals like Chantelle Winnie, former America’s Next Top Model contestant and successful model, have helped boost awareness, encouraging to “love the skin, you’re in.”[23] While her vitiligo gave her suicidal thoughts as an adolescent, her uniqueness helped her rise to fame as an international model, gracing magazines like Glamour UK and Vogue Italia, successfully overcoming her anxiety about her skin.[24] While vitiligo can be a disfiguring disease, it is not contagious and should be understood – not stigmatized within society.

  

* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

See additional information.

References

  1. Seite S, Deshayes P, Dreno B, et al. Interest of corrective makeup in the management of patients in dermatology. Clin Cosmet Investig Dermatol.2012;5:123-128; PMID: 23055760 Link to research.
  2. Yaghoobi R, Omidian M, Bagherani N. Vitiligo: a review of the published work. J Dermatol.2011;38(5):419-431; PMID: 21667529 Link to research.
  3. Birlea SA, Spritz RA, Norris DA. Chapter 74. Vitiligo. In: Goldsmith LA, Katz SI, Gilchrest BA, et al., eds. Fitzpatrick's Dermatology in General Medicine, 8e. New York, NY: The McGraw-Hill Companies; 2012.
  4. Vitiligo | DynaMed Plus. 2017; Link to research.
  5. Kopera D. History and Cultural Aspects of Vitiligo. Vitiligo;10.1002/9780470760116.ch3: Blackwell Science Ltd; 2008:13-17.
  6. Alghamdi KM, Moussa NA, Mandil A, et al. Public perceptions and attitudes toward vitiligo. J Cutan Med Surg.2012;16(5):334-340; PMID: 22971308 Link to research.
  7. Amer AA, Gao XH. Quality of life in patients with vitiligo: an analysis of the dermatology life quality index outcome over the past two decades. Int J Dermatol.2016;55(6):608-614; PMID: 26749040 Link to research.
  8. Hedayat K, Karbakhsh M, Ghiasi M, et al. Quality of life in patients with vitiligo: a cross-sectional study based on Vitiligo Quality of Life index (VitiQoL). Health Qual Life Outcomes.2016;14:86; PMID: 27267598 Link to research.
  9. Catucci Boza J, Giongo N, Machado P, et al. Quality of Life Impairment in Children and Adults with Vitiligo: A Cross-Sectional Study Based on Dermatology-Specific and Disease-Specific Quality of Life Instruments. Dermatology.2016;232(5):619-625; PMID: 27603174 Link to research.
  10. Wohlrab J, Klapperstuck T, Reinhardt HW, et al. Interaction of epicutaneously applied lipids with stratum corneum depends on the presence of either emulsifiers or hydrogenated phosphatidylcholine. Skin Pharmacol Physiol.2010;23(6):298-305; PMID: 20523109 Link to research.
  11. Osborne DL, Hames R. A life history perspective on skin cancer and the evolution of skin pigmentation. Am J Phys Anthropol.2014;153(1):1-8; PMID: 24459698 Link to research.
  12. Linthorst Homan MW, Spuls PI, de Korte J, et al. The burden of vitiligo: patient characteristics associated with quality of life. J Am Acad Dermatol.2009;61(3):411-420; PMID: 19577331 Link to research.
  13. Lai Y, Yew YW, Kennedy C, et al. Vitiligo and Depression: A systematic review and meta-analysis of observational studies. Br J Dermatol.2016;10.1111/bjd.15199PMID: 27878819 Link to research.
  14. Silverberg JI, Silverberg NB. Association between vitiligo extent and distribution and quality-of-life impairment. JAMA Dermatol.2013;149(2):159-164; PMID: 23560296 Link to research.
  15. Salman A, Kurt E, Topcuoglu V, et al. Social Anxiety and Quality of Life in Vitiligo and Acne Patients with Facial Involvement: A Cross-Sectional Controlled Study. Am J Clin Dermatol.2016;17(3):305-311; PMID: 26818062 Link to research.
  16. Ahmed I, Ahmed S, Nasreen S. Frequency and pattern of psychiatric disorders in patients with vitiligo. J Ayub Med Coll Abbottabad.2007;19(3):19-21; PMID: 18444584 Link to research.
  17. França K, Jafferany, M. Stress and Skin Disorders. Switzerland: Springer International Publishing; 2016.
  18. Al-Shobaili HA. Treatment of vitiligo patients by excimer laser improves patients' quality of life. J Cutan Med Surg.2014;18(5):1-7; PMID: 25278010 Link to research.
  19. Parsad D, Dogra S, Kanwar AJ. Quality of life in patients with vitiligo. Health and Quality of Life Outcomes.2003;1(1):58; PMID: Link to research.
  20. Mponda K, Moser R, Klein GF, et al. Good public awareness about albinism is key to reduced psychiatric distress in African people with albinism. J Eur Acad Dermatol Venereol.2016;30(4):697-698; PMID: 25651305 Link to research.
  21. Recognizing the mind-skin connection - Harvard Health. Harvard Health Publications. 2006. Link to research.
  22. Amer AA, McHepange UO, Gao XH, et al. Hidden victims of childhood vitiligo: impact on parents' mental health and quality of life. Acta Derm Venereol.2015;95(3):322-325; PMID: 25110968 Link to research.
  23. Barlow E. Chantelle Winnie: ‘I’m proud of my skin’. 2015-02-15, 2015;Fashion.
  24. Rodney D. From Suicide Thoughts To Finalist In America’s Next Top Model. The Jamaican Gleaner2014.