How Can People Cope With the Emotional and Psychological Aspects of Vitiligo?
While vitiligo is usually not harmful medically, its emotional and
psychological effects can be devastating. In fact, in India, women with the
disease are sometimes discriminated against in marriage. Developing vitiligo
after marriage can be grounds for divorce.
Regardless of a person’s race and culture, white patches of vitiligo can
affect emotional and psychological well-being and self-esteem. People with
vitiligo can experience emotional stress, particularly if the condition
develops on visible areas of the body, such as the face, hands, arms, and
feet; or on the genitals. Adolescents, who are often particularly concerned
about their appearance, can be devastated by widespread vitiligo. Some
people who have vitiligo feel embarrassed, ashamed, depressed, or worried
about how others will react.
Fortunately, there are several strategies to help people cope with vitiligo.
Also, various treatments—which we will discuss a bit later—can minimize,
camouflage, or, in some cases, even eliminate white patches. First, it is
important to find a doctor who is knowledgeable about the disorder and takes
it seriously. The doctor should also be a good listener and be able to
provide emotional support. You must let your doctor know if you are feeling
depressed, because doctors and other mental health professionals can help
people deal with depression. You should also learn as much as possible about
the disorder and treatment choices so that you can participate in making
important decisions about medical care.
Talking with other people who have vitiligo may also help. The National
Vitiligo Foundation can provide information about vitiligo and refer you to
local chapters that have support groups of patients, families, and
physicians. Contact information for the foundation is listed at the end of
this brochure. Family and friends are another source of support.
Some people with vitiligo have found that cosmetics that cover the white
patches improve their appearance and help them feel better about themselves.
You may need to experiment with several brands of concealing cosmetics
before finding the product that works best.
What Treatment Options Are Available?
The main goal of treating vitiligo is to improve appearance. Therapy for
vitiligo takes a long time—it usually must be continued for 6 to 18 months.
The choice of therapy depends on the number of white patches; their
location, sizes, and how widespread they are; and what you prefer in terms
of treatment. Each patient responds differently to therapy, and a particular
treatment may not work for everyone. Current treatment options for vitiligo
include medical, surgical, and adjunctive therapies (therapies that can be
used along with surgical or medical treatments).
number of medical therapies, most of which are applied topically, can reduce
the appearance of white patches with vitiligo. These are some of the most
commonly used ones:
Topical steroid therapy—steroid creams may be helpful in
repigmenting (returning the color to) white patches, particularly if they
are applied in the initial stages of the disease. Corticosteroids are a
group of drugs similar to hormones such as cortisone, which are produced by
the adrenal glands. Doctors often prescribe a mild topical corticosteroid
cream for children under 10 years old and a stronger one for adults. You
must apply the cream to the white patches on the skin for at least 3 months
before seeing any results. Corticosteriod creams are the simplest and safest
treatment for vitiligo, but are not as effective as psoralen
photochemotherapy (see below). Yet, like any medication, these creams can
cause side effects. For this reason, the doctor will monitor you closely for
skin shrinkage and skin striae (streaks or lines on the skin). These side
effects are more likely to occur in areas where the skin is thin, such as on
the face and armpits, or in the genital region. They can be minimized by
using weaker formulations of steroid creams in these areas.
Psoralen photochemotherapy—also known as psoralen and ultraviolet A therapy,
or PUVA therapy, this is probably the most effective treatment for vitiligo
available in the United States. The goal of PUVA therapy is to repigment the
white patches. However, it is time-consuming, and care must be taken to
avoid side effects, which can sometimes be severe. Psoralen is a drug that
contains chemicals that react with ultraviolet light to cause darkening of
the skin. The treatment involves taking psoralen by mouth (orally) or
applying it to the skin (topically). This is followed by carefully timed
exposure to sunlight or to ultraviolet A (UVA) light that comes from a
special lamp. Typically, you will receive treatments in your doctor’s office
so you can be carefully watched for any side effects. You must minimize
exposure to sunlight at other times. Both oral and topical psoralen
photochemotherapy are described below.
Topical psoralen photochemotherapy—often used for people with a small number
of depigmented patches affecting a limited part of the body, it is also used
for children 2 years old and older who have localized patches of vitiligo.
Treatments are done in a doctor’s office under artificial UVA light once or
twice a week. The doctor or nurse applies a thin coat of psoralen to your
depigmented patches about 30 minutes before exposing you to enough UVA light
to turn the affected area pink. The doctor usually increases the dose of UVA
light slowly over many weeks. Eventually, the pink areas fade and a more
normal skin color appears. After each treatment, you wash your skin with
soap and water and apply a sunscreen before leaving the doctor’s office.
There are two major potential side effects of topical PUVA therapy: (1)
severe sunburn and blistering and (2) too much repigmentation or darkening (hyperpigmentation)
of the treated patches or the normal skin surrounding the vitiligo. You can
minimize your chances of sunburn if you avoid exposure to direct sunlight
after each treatment. Usually, hyperpigmentation is a temporary problem that
eventually disappears when treatment is stopped.
Oral psoralen photochemotherapy—used for people with extensive vitiligo
(affecting more than 20 percent of the body) or for people who do not
respond to topical PUVA therapy, oral psoralen is not recommended for
children under 10 years of age because it increases the risk of damage to
the eyes caused by conditions such as cataracts. For oral PUVA therapy, you
take a prescribed dose of psoralen by mouth about 2 hours before exposure to
artificial UVA light or sunlight. If artificial light is used, the doctor
adjusts the dose of light until the skin in the areas being treated becomes
pink. Treatments are usually given 2 or 3 times a week, but never 2 days in
For patients who cannot go to a facility to receive PUVA therapy, the doctor
may prescribe psoralen that can be used with natural sunlight exposure. The
doctor will give you careful instructions on carrying out treatment at home
and monitor you during scheduled checkups.
Known side effects of oral psoralen include sunburn, nausea and vomiting,
itching, abnormal hair growth, and hyperpigmentation. Oral psoralen
photochemotherapy may also increase the risk of skin cancer, although the
risk is minimal at doses used for vitiligo. If you are undergoing oral PUVA
therapy, you should apply sunscreen and avoid direct sunlight for 24 to 48
hours after each treatment to avoid sunburn and reduce the risk of skin
cancer. To avoid eye damage, particularly cataracts, you should also wear
protective UVA sunglasses for 18 to 24 hours after each treatment.