Vitiligo is a complex autoimmune condition characterised by the loss of skin pigmentation due to the destruction of melanocytes, the cells responsible for producing melanin1. Affecting at least 1% of the global population, it manifests as white patches on the skin, often appearing on sun-exposed areas, body folds, and around openings like the eyes and mouth1. While its exact cause remains unclear, research points to a combination of genetic, immunological, and environmental factors1.
The Biological Mechanism
Melanocyte destruction lies at the core of vitiligo. When these pigment-producing cells are damaged or die, melanin production ceases, resulting in depigmented patches1. Potential triggers include:
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Severe sunburn
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Emotional or physical stress
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Chemical exposure
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Genetic predisposition (about 30% of patients report family history)1
Recent studies suggest elevated nitric oxide levels or insufficient growth factors may create toxic environments for melanocytes1. The condition is also linked to other autoimmune disorders like thyroid dysfunction, alopecia areata, and pernicious anemia1.
Disease Progression Patterns
Vitiligo evolves differently across individuals:
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Light-skinned patients often notice patches during summer due to contrast with tanned skin
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Darker skin tones may detect changes year-round
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Cycles of rapid pigment loss followed by stability are common
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Full-body depigmentation is rare but possible1
Stress and illness can accelerate pigment loss, while spontaneous repigmentation occurs in less than 1% of cases1.
Treatment Approaches
Repigmentation therapy combines psoralen drugs with UV-A light to stimulate melanocyte regeneration1. Key considerations:
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Requires 2-5 years of consistent summer sun exposure (11 AM–1 PM ideal)
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75% of patients see partial repigmentation
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Best results in those under 20 with recent onset (<5 years)1
Topical corticosteroids may slow depigmentation but carry risks like skin thinning with prolonged use1. Cosmetic cover-ups and sunscreens (SPF 15+) help manage visibility1.
Debunking Myths
Cultural misconceptions in South Africa include:
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O madi mabi (bad luck)
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Association with witchcraft or ancestral curses
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Belief it signals a calling to become a sangoma (traditional healer)1
These myths compound the psychological burden, emphasising the need for scientific literacy. While treatment remains challenging, ongoing research into melanocyte biology and immune modulation offers hope for more effective therapies1.
