Skin condition affects patients inside and out

UC Davis Health System Jul 10, 2019

To the casual observer, the tiny blotchy white spots on Daniel Selby’s nose and ear are not really noticeable. However, they make him very self-conscious, especially when he’s talking with his linen-delivery customers. Selby started noticing the spots about 6 months ago. “When I look in the mirror, I really see it,” he said during his first visit to a UC Davis Health Dermatology Clinic.

Selby is concerned about his skin condition, a disease called vitiligo (vit-ih-LIE-go). It causes skin to lose its color. It usually first appears on the face, hands, feet, and arms. Actors Steve Martin, Holly Marie Combs, and model Winnie Harlow are among those celebrities with vitiligo.

Affecting all skin types

The disease affects all skin types, but it can be more noticeable in people with darker skin. Fortunately, it is not life threatening or contagious. However, specialists like Dr. Victor Huang know that it causes a lot of distress for some people and their families.

“The way vitiligo affects peoples’ lives runs the entire spectrum, from no big deal to thoughts of suicide,” said Dr. Huang, an assistant professor of clinical dermatology. “A lot of it is culturally dependent. It can depend on a person’s skin tone and how noticeable it is. It affects everybody differently.”

Vitiligo causes a person's own immune system to destroy pigment-producing skin cells. That leads to a lack of melanin, the pigment that produces color in skin, eyes, and hair. Huang noted that genetic, autoimmune, and environmental triggers contribute to the development of vitiligo.

“With a possible familial connection associated with vitiligo, we also monitor our patients for diabetes and thyroid problems and ask about any similar conditions within their families,” added Dr. Huang.

Treatment options

There is no cure for this condition, but in contrast to advice many patients receive, it is treatable. Different patients respond differently to treatments, according to Dr. Huang. Each one must be tailored to an individual’s needs.

Treatment options include phototherapy and anti-inflammatory creams and ointments. Huang participated in a pilot study that investigated the use of a topical cream called ruxolitinib. He is optimistic now that pharmaceutical companies are expanding the pipeline of new drugs for treating vitiligo.

MKTP: a surgical option

Another treatment option that Dr. Huang and the UC Davis Department of Dermatology plan to offer is a minor surgical procedure known as melanocyte-keratinocyte transplantation (MKTP). It replaces the melanocytes (which are mature, melanin-forming cells) in the affected areas of patients who have advanced but stable vitiligo. UC Davis Health will be just the fourth site in the United States to offer the MKTP procedure.

“It is done under a local anesthesia,” Dr. Huang said. “The patient is awake the whole time. It’s really no more invasive than having a biopsy and cosmetic resurfacing.” The procedure enables Huang to treat much broader areas of vitiligo with better cosmetic results.

Addressing the stigma

Undoubtedly, the biggest challenge with the disease is the stigma people feel about it. “It’s the hidden pain that’s the hardest to treat,” noted Dr. Huang. “We’re very sensitive about calling it a ‘cosmetic condition.’ Vitiligo affects our patients medically, psychologically, and socially, and has effects beyond what a cosmetic condition would cause.”

Studies have shown that depression and mood disorders often affect vitiligo patients, as well as their families. With more than half of patients being diagnosed before age 20, the toll on families and patients themselves is significant. Up to 26% of parents who have a child with vitiligo suffer depression, and 42% exhibit anxiety. They worry that their child will be shunned or teased because the condition can be so visible.

Often times it affects parents even more than the child, Dr. Huang added. “It can be a very impactful and shameful thing for some families in some cultures.” The dermatology clinic is developing relationships with its psychiatry and mental health colleagues at UC Davis Health. The collaboration will offer more support for patients and family members.

Celebrating vitiligo

The work and activism of the fashion model Winnie Harlow and Detroit news anchor Lee Thomas has begun the process of reclaiming vitiligo as a trait to be celebrated. The goal is to normalize the condition and reduce the shame and embarrassment that some people experience.

“I tell all my patients that we treat to the degree that’s important to them,” Dr. Huang said. “I always strive to understand how vitiligo fits into the patient’s life to find the treatment that is best for them.”

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