x Abu Dhabi, UAEMonday 22 January 2018

Beyond the pale: vitiligo

Sophia Money-Coutts talks to Dr Ali Singel about the rare disease vitiligo, which leaves patches of skin without pigment.

Dr Ali Singel checks the arm of Sophia Money-Coutts for patches of vitiligo at the Dermalase clinic in Dubai.
Dr Ali Singel checks the arm of Sophia Money-Coutts for patches of vitiligo at the Dermalase clinic in Dubai.

"You've got some pigmentation there," says Dr Ali Singel, pointing to a mottled spot of skin in the crook of my right arm. "It's coming back again." "But here there isn't any," he then adds, prodding a bright white blob on my right foot. "If you've got it here, then it's a problem. You can't get rid of it."

The "it" in question is vitiligo, the skin disease that leaves patches of your skin without melanin, the substance that gives the skin colour. In other words, it becomes depigmented. The result is white blotches that can strike on any part of your body. Vitiligo on your extremities - such as hands and feet - is apparently more difficult to treat than vitiligo on your core. But, as with much about the disease, no one knows quite why this is.

The disease is thought to affect one to two per cent of the world's population, and it's commonly referred to in the same breath as Michael Jackson, who suffered from the condition and chose to depigment himself entirely. "I don't have the general history of Michael Jackson but I know that he did depigment himself completely," says Dr Singel. "If you've got more than 80 or 90 per cent vitiligo then you've got that option. But it's a big decision, because once you lose it, you can't get it back."

A hereditary condition in many cases (my dad has it), recently pictures surfaced of Jackson's son, Prince Michael, 13, with vitiligo patches on his underarm. It's a condition that has also been back in the news recently following a new study from the University of Colorado, which suggested those suffering from the condition might actually be less likely to develop skin cancer. The study, which used more than 4,000 guinea pigs, found that of the genomes associated with a higher risk of vitiligo, two genetic variations were linked to a lower risk of melanoma too.

Dr Singel looks unconvinced, and suggests another theory on why the incidents of skin cancer could be lower among sufferers. "Lots of people, when they find out they have vitiligo, they avoid sunlight exposure. So that could be one thing." I myself try to be sensible in the sun, covering up with a SPF20 or higher (vitiligo patches have no melanin, making them prone to burning) but living in a country so blessed with sunlight makes it impossible to avoid it entirely, and a tan makes it more visible. My vitiligo first sprouted when I was 13, after a skiing holiday high in the mountains where I was more susceptible to the sun's UV rays, just one of the factors that can trigger vitiligo. First, my eyelashes turned white. Patches then spread, most noticeably across my back, my underarms and around my mouth. But since moving from London to the sunnier climes of the UAE a year-and-a-half ago, it has mutated across my hands, up my arms, on my knees and around my eyes.

It doesn't hurt physically, but the emotional and mental side-effects of vitiligo are often felt keenly, especially for those with dark skin. I am lucky in that I have relatively pale skin, so the patches don't faze me much. "You're skin type two," explains Dr Singel. He is referring to the Fitzpatrick skin scale, according to which there are six classifications of skin types. From type one, which is the pale skin, red-haired sort, to type six which is very deep black. Skin type two means I'm Anglo-Saxon and fair, so my vitiligo doesn't show up too obviously.

This is lucky, because there isn't an absolute cure. "With vitiligo, we never promise them," says Dr Singel. "We say, 'Well, we'll treat you', but you never mention the word clearance. We use the word remission." In reality, very little is known about the disease. It is an autoimmune disorder but no one knows exactly what causes it. Dr Singel draws a medical parallel. "If you've got an infection, you know what's causing it - bacteria. And you've got antibiotics to treat it. When you've got vitiligo you know there's depigmentation, the pigmentary cells are lazy and not producing, but you don't know the cause."

There is often no coherent pattern to its behaviour either. Vitiligo can run in families, but if one parent has it then you won't necessarily inherit it. It will often strike on parts of the body that are injured, or where immunity has been weakened. But it might not. It is often symmetrical on either side of the body (I have patches on both wrists, both elbows and both feet), but it doesn't have to be.

Dr Singel presents the Dubai TV medical programme, Vitamin, and is currently planning a vitiligo special to air after Ramadan. There is not only a lack of specific medical knowledge about the condition, he says, but in this region there's often a high level of ignorance about it too. "People think if they come across and touch vitiligo, they're going to get it. Some people have this thought that it's some kind of punishment, that they did something wrong and that's why they get it."

He says he's seen increasing numbers of vitiligo diagnoses in recent years, which is explained by rising stress levels. Stress, by weakening the immune system, allows vitiligo to strike. Dr Singel says he has seen one baby as young as six months with the condition. "Babies get stressed. When they get stressed they cry. So babies get problems with their immune systems too." Dr Singel himself specialises in localised UV treatment, where patches of vitiligo are exposed to UV rays in an attempt to induce some activity in the cells. "Literally, we try to wake them up," says Dr Singel, while again stressing there is no guaranteed result. This applies to all other possible treatments too. Dr Mahaveer Mehta, another Dubai-based dermatologist, runs me through the most popular of them. "Topical treatment can give results in some early cases with small, localised areas involved," but he then adds that he will avoid naming the solution to discourage self-medication. Skin grafts may occasionally be used and there are various types of laser treatments available, although there is a danger of these causing permanent skin damage. The results can also be patchy, it can take some time for them to show and the expense can mount up.

Dr Mehta's advice if you're worried that you or someone you know is showing signs of vitiligo? "Report early to your dermatologist for the maximum benefit."