What Is Vitiligo? We Find Out From A Board-Certified Dermatologist

When Angel Aquino, actress, model, and legendary morena beauty, sat down with Allure Philippines during the Beauty of Brown shoot, she held out her hands to show us that there were white patches on her celebrated dusky skin.

It was, she said, vitiligo, an auto-immune condition which she had been recently diagnosed with, and was in the process of learning to accept.

“At first, it was just one uneven spot on my hand during the pandemic, and then I started seeing more of it,” Aquino shared. “So I went to the dermatologist. They said it was vitiligo, and there is no cure for it.”

Aquino explained autoimmune conditions to us as “my healthy cells destroying other healthy cells,” and shared that doctors told her that there was no cure for vitiligo and its manifestations of white patches on her skin—no ointments and no medicines. All that she could do was manage her general health and stress levels, and continue down the path of acceptance.

Vitiligo is, in fact, a skin condition that is common in darker skin tones. Aquino is not the first morena—nor will she be the last—to be subject to it. To further understand vitiligo—what it is and all its implications—we spoke with board-certified dermatologist Dr. Francesca Sy-Alvarado.

What is vitiligo?

A diagnosis of vitiligo means that the skin loses its pigment, because the body’s immune system attacks pigment-producing cells called melanocytes, explains Dr. Sy-Alvarado. “You can think of melanocytes as factories that produce our skin’s pigment. In vitiligo, the immune system gets confused and attacks these factories of pigment, leading to patches that are devoid of pigment,” she says.

Vitiligo can happen to anyone, of any age, but it tends to turn up in your twenties or thirties, according to Dr. Sy-Alvarado. When the white patches do appear on skin, the size and location vary per person, although they do commonly appear to be symmetrical.

Why does it happen? That’s a question doctors can’t exactly answer. “We don’t exactly know yet,” says Dr. Sy-Alvarado, “but it’s a combination of both genetic and environmental factors.” What they do know, she continues, is that vitiligo “is often associated with other autoimmune conditions, like thyroid abnormalities.”

What are the signs that one has vitiligo? How is it diagnosed?

If you’re seeing white patches or spots, ranging from a few millimeters to centimeters, and with a convex border (meaning it curves outwards, like the curve on a circle), you could have vitiligo. “Common sites are around the face, usually around the eyes and mouth, as well as the neck, the back of the hand, scalp, and trunk. It can also appear in areas that often hit surfaces, like the knees and elbows,” Dr. Sy-Alvarado says. It’s important to note that the patches usually appear symmetrical, and that it’s also possible for them to stay in one specific area of the body.

A board-certified dermatologist should be able to tell you if you have vitiligo during a clinic visit. However, if they note anything unusual, or if they suspect that other conditions may be a factor, they may do a skin biopsy to show patterns that point to vitiligo.

What can be done about vitiligo?

According to Dr. Sy-Alvarado, there’s a wide variety of things that can be done to manage the symptoms of vitiligo—not cure it—but they have varying results.

Creams or lotions

“There are creams or lotions that include anti-inflammatory compounds like steroids, and Vitamin D that can be applied,” she says, adding that topical photosensitizers may also be used in combination with heliotherapy, or sunlight therapy, which involves controlled exposure to sunlight, to harness the effects of UV radiation.

Oral steroids

Patients with acute flare-ups and widespread patches are often given oral steroids, Dr. Sy-Alvarado says. “But patients taking these need to be monitored closely all throughout.”

Phototherapy

For more serious cases, Dr. Sy-Alvarado mentions UV radiation as a possible solution. “Phototherapy falls under UV radiation,” she explains, “and it’s a common method of using precise doses of UVB to stimulate the melanocytes, or pigment-producing cells, to slow the disease and re-pigment the skin. This is most ideal for widespread vitiligo.”

Skin grafting

Dr. Sy-Alvarado mentions skin grafting as a treatment for the loss of pigment, as well. “It involves transplanting healthy, pigmented skin or melanocytes to the affected areas with vitiligo. The transplanted cells or tissue then reintegrate with the cells already there, and re-pigmentation in the patches can take place over time.”

In extensive cases of vitiligo, she shares that another pathway would involve the opposite—depigmentation of the unaffected skin all over the body.

Zooming out to see the big picture

Dr. Sy-Alvarado also adds that other medications that target the immune system are emerging for vitiligo, but they need to be studied further, and are not yet available in the Philippines.

It should be remembered that vitiligo, although it manifests on the skin, is an autoimmune condition, above all. Treatment and management of symptoms, then, require a more holistic approach, such as stress management, and a healthier lifestyle—two solutions of Aquino that she shared with Allure Philippines. And although vitiligo may be difficult to come to terms to with, as Aquino herself also shared, it is still possible to live a full and happy life with it—white patches and all.