What Is Vitiligo?
Skin, as the largest organ of our body, is susceptible to damage and disease. Hundreds of different skin diseases have been identified so far. Some of these disorders are easy to manage while others require more effort.
Their severity varies greatly from one person to another and depending on the nature of the specific disease. Chances are high you have probably come across vitiligo, and although we know the disorder exists, it is still largely misunderstood.
Table of Contents [Show]
- What is vitiligo?
- Vitiligo through history
- How common is vitiligo?
- Types of vitiligo
- Causes of vitiligo
- Risk factors
- How is vitiligo diagnosed?
- How is vitiligo treated?
- Is there anything I can do?
- Vitiligo and mental health
- Vitiligo and your thyroid
- Celebrities with vitiligo
This post sheds more light on vitiligo, its causes and so much more.
Vitiligo (vit-ih-lie-go) is a skin disorder wherein white patches of skin develop on different parts of the body. The term vitiligo itself is believed to be derived from the word vitium meaning blemish or defect.
Another theory is that vitiligo originates in Latin word vitelius used to describe the white flesh of calves. The term vitiligo was coined by Aulus Cornelius Celsus who used the word in his book De Medicina in the 1st century AD.
Patches that appear are significantly lighter than the natural skin tone. While some people develop only a few vitiligo-caused white patches, others lose more skin color. The disease affects different parts of the body including hair, inside of mouth, and eyes in some people.
Vitiligo affects people of all races, even Caucasians, but skin discoloration is more visible among persons with darker skin tones.
Even though vitiligo is not a life-threatening skin disease, it still has a major impact on an affected individual and his/her quality of life. Developing white patches, particularly in visible areas of the body, can have an impact on a person’s confidence and mental health.
Treatment options for vitiligo do exist, and although they may restore color to the affected skin, they don’t prevent continued loss of skin color or reoccurrence.
Vitiligo Through History
Vitiligo is not some modern-day skin disease. In fact, it has been around for centuries. The very first descriptions of the disease date back more than 3000 years to the earliest mentions in Egyptian and Vedic texts.
Even though the disease has been recognized since ancient times, the confusion with other disorders (primarily leprosy) persisted throughout the history.
The Ebers Papyrus from 1550 BC mentioned two types of depigmentation that could be understood as depigmentation resembling vitiligo or leprosy. In 1400 BC, white leprosy spots were called Sveta khushtha in the Atharva Veda.
By 1200 BC the similar depigmentation was referred to as Amarakosa in Japanese Shinto prayers. A compendium of the Ayurvedic system, the Ashtanga hridaya, explained prognostic factors of skin depigmentation in 600 BC.
The Vedic myth dictates that anthropomorphic deification of the sun, Bhagavatam, developed vitiligo after his illegitimate son gazed upon him.
Ptolemy II translated the Bible from Hebrew to Greek in 250 BC and in the Old Testament, Leviticus XIII, the term Zara’at referred to skin conditions and its translation was lepros or scales. Later on, the term was misinterpreted as leprosy.
At that time, hypopigmented disorders such as vitiligo were considered unclean diseases. Besides Bible, Quran also mentions vitiligo, the term used to describe this disease in Islamic holy book was alabras.
The Greek historian Herodotus noted white spots on foreigners and claimed they sinned against the sun and, therefore, must leave the country.
While in most cultures, individuals with vitiligo were discriminated, Korea is an exception. In the 17th century Korean Yi dynasty, the medical textbook Doney Bogam describes skin disorders such as vitiligo, albinism, and others as a single hypopigmentary disorder.
Socially, Koreans were highly tolerant of pigmentation diseases like vitiligo, which is also shown through a portrait of Chang Myeong Song, a government official from Yi dynasty. The portrait shows Song with vitiligo-resembling depigmentation of the face and neck.
Vitiligo was also the subject of many works and theories in Middle Ages and modern history as well. Here are the most notable records of vitiligo and skin pigmentation during those times:
- 1533 – Andreas Vesalius, Flemish/Netherlandish anatomist, physician, theorized skin has two layers and attracted more attention to this subject
- 1618 – Jean Riolan the Younger, French anatomist, separated the skin of a black subject into two layers: horny layer (upper black layer of the skin) and dermis (lower layer white as snow)
- 1665 – Marcello Malpighi, an Italian biologist, and physician, speculated that color of the skin is determined by the granules located in stratum mucosum, not in stratum corneum or dermis as it was believed
- 1819 – Giosue Sangiovanni, an Italian zoologist, was the first person to describe melanocytes. His subject was a squid, and he referred to those melanocytes as chromatophores
- 1837 – Friedrich Henle, a German physician, anatomist, and pathologist, identified pigment-producing cells in the human epidermis. He noticed those cells were identical to pigment cells found in human eyes
- 1879 – Moritz Kaposi, a Hungarian physician, and dermatologist becomes one of the first scientists to observe lack of pigment granules in the rete pegs of vitiligo
- 1917 – Bruno Bloch, Swiss dermatologist, describes the DOPA reaction where enzyme tyrosinase was synthesized by melanin in melanocytes
How Common Is Vitiligo?
The lowest prevalence of vitiligo is in Asia and Atlantic, the second-highest in Africa and Europe, while the highest prevalence of this skin disorder is in Oceania. Numbers show that about 50 million people worldwide have vitiligo and 2-5 million in the US are diagnosed with this disorder.
In addition, 95% people with vitiligo develop their disease before 40th birthday, usually between 10 and 30 years of age. According to the American Academy of Dermatology, nearly half of all people with vitiligo develop their condition before reaching 21st birthday.
Types Of Vitiligo
We can categorize vitiligo into two types: non-segmental and segmental vitiligo.
Non-segmental vitiligo is the most common type of the disease affecting up to 90% of people who have this disorder. This type of vitiligo is primarily caused by the autoimmune loss of melanocytes. Both genetic and environmental factors play a role in the onset of the disease.
Non-segmental vitiligo is frequently associated with autoimmune diseases such as Hashimoto’s thyroiditis the most common form of hypothyroidism, type 1 diabetes, rheumatoid arthritis, psoriasis, lupus, and others.
In patients with this type of vitiligo, the patches often appear equally on both sides of the body with some dose of symmetry. The patches usually form on areas that are exposed to the sun on a daily basis including face, neck, and hands.
That said, non-segmental vitiligo can also develop in the back of the hands, arms, eyes, knees, elbows, feet, and mouth.
Scientists have broken down this type of the disease into four sub-types including:
- Acrofacial vitiligo – primarily on fingers and toes
- Focal vitiligo – one or a few white patches that don’t appear in a specific pattern, i.e., they are scattered. This sub-type of non-segmental vitiligo affects young children primarily
- Generalized vitiligo – the most common type of non-segmental vitiligo, doesn’t develop in a specific area or size of patches
- Mucosal vitiligo – affects mostly mucous membranes and lips
- Universal vitiligo – very rare, most of the body is affected by depigmentation
Compared to the above-mentioned type, segmental vitiligo spreads more rapidly. In addition, it is considered more constant and stable than non-segmented vitiligo. The disease is characterized by an early onset, initial progression followed by stability, the islands of pigmented macules within the vitiligo lesion.
Segmental vitiligo is less common than its counterpart and affects only about 10% of people affected by vitiligo. It is more noticeable in early age groups. In fact, about 30% of children with vitiligo have this type of the disease.
This subtype of the disorder is asymmetrical and primarily affects areas of skin attached to nerves arising in the dorsal roots of the spine. Segmental vitiligo is less erratic and responds well to topical treatments.
Causes Of Vitiligo
The disease occurs when melanocytes (pigment-producing cells) stop producing melanin or die. Melanin is a pigment that gives your skin its natural color. As a result, certain areas of the skin become lighter or white. At this point, the exact cause of vitiligo is unknown.
Scientists have multiple theories about potential causes of this skin condition:
- Vitiligo may be an autoimmune disease, a type of disease wherein the immune system attacks healthy cells and tissues in the body. In this case, the immune system may destroy the melanocytes in your skin
- The disease may be caused by genes, which would explain why it affects family members, in some cases
- Vitiligo may be caused by a trigger event such as sunburn, exposure to industrial chemicals, or stress
- Neural or viral causes
Scientists continually work on new studies that would uncover the underlying cause of vitiligo and white patches that occur as a consequence of the disease. Until then, one thing is for sure – multiple factors play a role in the development of the disorder.
Despite the fact everyone can develop vitiligo, some people have a higher risk than the others. Risk factors for vitiligo include:
- Gender – women are more prone to the disease than men
- Age – individuals who are younger than 40 are more likely to develop vitiligo, most patients who notice white patches are between 10 and 30 years old
- Heredity – having a family member with vitiligo increases your chances of developing the condition as well
- Autoimmune disease – since a type of vitiligo has an autoimmune nature, it can affect individuals with rheumatoid arthritis, Hashimoto’s thyroiditis, and other autoimmune conditions
- Skin Injuries – sunburns, frictions, and other injuries can make a person prone to vitiligo, but it doesn’t mean that every person who gets sunburns will automatically develop the disease
- Stress – a common factor for numerous diseases and conditions, plays a role in onset of vitiligo as well
The most distinctive symptoms of vitiligo are white patches, i.e., loss of a person’s natural skin color. In most cases, skin discoloration first shows on areas that are exposed to sun’s rays the most such as feet, hands, arms, lips, and face.
Vitiligo can also affect:
- Rectal areas
- Area around mouth
- The armpits and groin, i.e., the area where leg meets the body
In addition, the disease is also indicated by premature whitening or graying of eyebrows, beard, eyelashes, or hair on the scalp.
At first, vitiligo starts with a single spot that is somewhat paler than the rest of the skin. Gradually, the spot becomes paler until it turns completely white. The shape of white patches is irregular, and in some cases, the edges become inflamed with a reddish tone that may or may not cause itchiness.
It is important to clarify that vitiligo doesn’t induce pain, discomfort, irritations, soreness, or dryness of the skin. Whitening of some areas of the skin is usually the only symptom of vitiligo.
But just because the disease isn’t associated with multiple signs and symptoms, it doesn’t mean its effects should be ignored. Vitiligo can have a deep impact on an affected person’s mental health.
Persons with vitiligo are at an increased risk of:
- Hearing loss
- Skin cancer
- Social or psychological distress
- Iritis (inflammation of the iris) and other eye problems
- Vulnerability to the effects of sun
- Side effects of the treatment, usually itching
If you have vitiligo or you suspect those paler patches of skin could be a sign of the disease, don’t panic and think you’re bound to experience these complications.
Adherence to the treatment recommended by the doctor can help manage the disease and reduce the likelihood of complications.
How Is Vitiligo Diagnosed?
We are usually not inclined to see the doctor when notice changes in our skin until the problem becomes worse. The best way to manage vitiligo and prevent complications is through adequate treatment.
Don’t forget that due to loss of pigmentation, your skin is vulnerable and needs better care. If you notice paler patches on the skin, especially if they keep losing color gradually, make sure you schedule an appointment and see your doctor.
Based on the white patches, your doctor will suspect you have vitiligo, but to be sure he/she will look into your family and medical history, suggest some tests and ask a few questions including:
- Are you sensitive to the sun?
- Did you experience stress or struggle with a physical illness recently?
- Did you have a sunburn, rash, or other skin problem before white patches appeared?
- Did your hair turn gray before you turned 35?
- Do you have family members with vitiligo?
- Do you or your family members have an autoimmune disease?
It is of huge importance to answer these questions honestly.To rule out other medical problems, your doctor may order tests such as:
- An eye exam
- Blood test to look for autoimmune conditions such as diabetes and anemia
- Biopsy by taking a sample from white patch to be examined
The doctor may also use an ultraviolet light for identification of vitiligo, but he/she may also use it during follow-up visits to determine the efficacy of the treatment. When exposed to UV light, skin with vitiligo glows blue, while healthy skin does not show any reaction whatsoever.
How Is Vitiligo Treated?
It is a common belief that vitiligo doesn’t require any specific treatment. After all, what can be done about those white patches? Several treatment options are available for vitiligo, and they work to restore skin color or even out a person’s skin tone.
The success of these treatments varies from one person to another. Additionally, some treatments have serious adverse effects; which is why your doctor may first recommend trying improving the appearance of the skin with makeup or self-tanning products.
When the doctor decides to treat vitiligo with a specific treatment, you should bear in mind it will take many months to see whether the therapy is truly effective. You should arm yourself with patience and stick to the treatment, even when you get impatient.
Skin problems require more time for treatment, it is impossible to magically erase white patches in a matter of seconds. Below, you can see the most common vitiligo treatment options.
Therapies are usually combined with medications in order to treat vitiligo more effectively. Your doctor may suggest the following:
Phototherapy with UVB light – Affected areas are exposed to UVB lights. As mentioned earlier, this particular approach can be used as a diagnostic tool, a way to get insight into the efficacy of the treatment, and therapy for vitiligo as well.
The process is easy, and patients can do it in the comfort of their homes; all they need is a UV lamp. In fact, home treatments are highly recommended because they are more convenient and patients can perform it on a daily basis
Phototherapy with UVA light – Unlike the previous therapy, phototherapy with UVA light is most commonly performed in a clinic or hospital setting. The therapy involves intake of psoralen, a drug that increases the skin’s sensitivity to UV light.
Then, affected areas are exposed to UVA light, and the progress is noticeable after 6-12 months. Patients usually have therapy sessions twice a week
Depigmentation – The doctor usually recommends this therapy in instances when vitiligo is widespread, and other treatment options were unsuccessful. The process requires applying a depigmenting agent onto the unaffected areas of the skin.
As a result, the skin becomes lighter and blends with white patches. The therapy lasts for about nine months or longer, and it is done once or twice a day. Potential side effects of this therapy include swelling, redness, dry skin, and itching.
Bear in mind that depigmentation isn’t temporary, the result is permanent meaning you will be sensitive to sunlight all the time
First, bear in mind that drugs do not work to stop depigmentation of the skin or block vitiligo. Doctors prescribe them to help restore skin tone. They are either taken alone or in a combination with light therapy.
Medications used for vitiligo are those that:
Affect the immune system – These medications come in the form of ointments that contain tacrolimus or pimecrolimus. They could be effective for areas where depigmentation is small, e.g., on face or neck. Compared to other groups of medications, these have fewer side effects and can be used with UVB light.
It is important to mention that the FDA has warned about a potential link between these ointments and skin cancer, meaning you should consult your doctor about this subject if he/she prescribes this treatment
Creams that regulate inflammation – The most commonly used medicines here are corticosteroids cream that you apply on affected areas in order to restore color. They work best when used in early stages of vitiligo.
Of course, it might take a few months to notice changes in skin color. Although corticosteroid creams are effective and easy to use, they may induce side effects like appearance of lines or streaks on the skin, and skin thinning
Surgery is never the first treatment option that the doctor recommends. Generally, the surgical procedure is a last resort, a solution proposed when other treatments don’t work. In most cases, doctors suggest surgery after unsuccessful light therapy.
The primary objective of these procedures is to restore color and even out a patient’s skin tone. Surgical options include:
- Blister grafting – The doctor uses suctions to create blisters on the pigmented skin and removes tops of those blisters in order to transfer them to a discolored area. Just like other therapies and procedures, this one is also linked to potential side effects like scarring, failure of the treatment, a cobblestone appearance, another patch of vitiligo caused by suction
- Skin grafting – The process involves removing small sections of normal, pigmented skin which are attached to areas with white patches. The procedure is usually suggested when discolored patches are smaller. Possible side effects of this surgery include scarring, infection, spotty color, cobblestone appearance, treatment failure
- Micropigmentation (tattooing) – The doctor implants pigment onto using a special surgical instrument. The treatment is most successful in cases when vitiligo affects inside and around the lips and in individuals with darker skin tone. That said, the treatment may cause yet another patch of vitiligo, and it can be difficult to match the skin color
Vitiligo Treatments In Future
Various treatment options for vitiligo are currently being studies and could change the way this skin disease is managed. They include:
- Afamelanotide – A drug that stimulates melanocytes. The treatment is implanted under the skin in order to promote the growth of color-producing cells
- Prostaglandin E2 – A drug that controls melanocytes. Scientists hope the gel will restore skin color in patients with localized vitiligo, i.e., the condition that isn’t spreading
- Tofacitinib – A drug that reverses a loss of color
- Pseudocatalase – A drug that addresses loss of skin color, recovers pigmentation in the skin and eyelashes
Although you’ll notice attractive claims on the labels, you should never purchase a product before consulting your doctor first.
Is There Anything I Can Do?
Besides the treatment options recommended by the doctor, there are numerous things vitiligo patients can do to manage their condition.
Before we discuss them, let’s clarify something – it is easy to stumble upon some miraculous solutions promised by different websites, but you shouldn’t try them before consulting your doctor.
As mentioned above, magical solution for vitiligo doesn’t exist and experimenting with dubious solutions can be even worse for your condition. Always try to stick to methods recommended by your doctors or techniques that were confirmed effective and safe.
The best self-management tips for vitiligo include:
- Avoid getting tattoos – If you have vitiligo but would also like to get a tattoo, you should definitely reconsider this decision. Tattoo causes damage to your skin which may result in a new white patch appearing within two weeks
- Conceal affected areas – Concealing products don’t aid the treatment itself, but they help vitiligo patients feel better about themselves and improve their confidence. This is particularly useful when discolored patches are found in the exposed areas
- Connect – Everyone is on the internet nowadays, and you can join one of the hundreds of support groups for patients with vitiligo. You can also find them in your town or city where you live. Connecting with other people who are going through the same thing helps you cope with disease better, get valuable tips, help others, and so much more
- Get informed – A crucial aspect of successful management of the disease is to learn as much as possible about it. In order to do so, check trusted sources only
- Inform the doctor about your feelings – Vitiligo has a major impact on your mental health, but you shouldn’t keep these struggles for yourself only. Inform your doctor about feelings and concerns
- Sun protection – Okay, it’s always important to protect your skin from the sun, even if you’re healthy and don’t experience some problems. In vitiligo patients, the need for adequate sun protection is amplified because the skin is prone to damage.
Use a broad-spectrum, water-resistant sunscreen with the SPF of at least 30. Reapply sunscreen every 2 hours. Don’t forget to wear sunglasses, hats, seek shade, or avoid going out when the sun’s rays are at their highest during summer to avoid severe sunburns that could worsen the condition
Vitiligo And Mental Health
As mentioned throughout the post, although vitiligo isn’t associated with some serious symptoms it affects a person’s mental health significantly. The major source of confidence for most people is their appearance.
Problems affecting the appearance influence our attitude toward ourselves and the others. Developing white patches, particularly in visible areas, can make a person feel subconscious about their appearance. Their confidence takes a major blow, especially if they are subjected to cruel jokes and bullying.
Evidence shows that vitiligo has a major impact on quality of life of patients suffering from the disease. The skin contributes to our self-image, and every change can have deep psychological consequences. It is not uncommon for vitiligo patients to feel stigmatized by their condition or severely distressed.
Due to visible white patches, they attract attention they don’t really want. As a result, many vitiligo patients struggle with depression. Low confidence coupled with negative feelings about the disease, cruel comments, and having to endure these behaviors for ages are just some reasons why patients with vitiligo develop depression as well.
In teenagers, mood disturbances like depression and irritability are common. Individuals with this skin disease are sensitive to the way other people perceive them, and they often withdraw out of fear of being rejected or mocked.
Strangers and the closest friends or family members alike can say hurtful comments. These factors subject vitiligo patients to emotional and mental health disturbances, interference with their employment, and the use of alcohol to feel better.
People with vitiligo often suffer from financial loss because they have to take some time off work to attend hospital appointments and therapies at the doctor’s office. Let’s not forget the fact that discolored white patches, especially on the waist, lower one’s chances of getting hired.
When you don’t get the job you were hoping for, you feel even worse.
Studies show that depression among vitiligo patients is higher in middle and lower socioeconomic classes compared to the upper class. With increasing socioeconomic class, suicidal behavior decreased.
Scientists also discovered that longer the time after the appearance of vitiligo, the lesser the psychiatric comorbidity. Patients who rated their treatment successful have a better quality of life and mental health compared to individuals who describe their treatment as unsuccessful.
A growing body of evidence confirms that all vitiligo patients with dark skin develop depression as well as higher risk of suicide, social phobia, and lower self-esteem compared to lighter-skinned counterparts.
Patients with lighter skin had a better quality of life than people with darker skin. This could be down to the fact that white patches in lighter-skinned vitiligo patients aren’t as noticeable as those in dark-skinned patients.
Bearing in mind that vitiligo has a huge impact on a person’s mental health; many doctors emphasize the importance of getting the necessary help. Sessions at a therapist’s office can play a major role in treatment and management of vitiligo.
A patient talks about the disease, how it affects different aspects of their life, and explains how they feel with white patches. Strong mental health is an incredible coping mechanism, and professional approach is pivotal here.
That’s why you should never ignore the importance of mental health, therapists, and their importance in vitiligo management.
Connecting with other people serves as yet another coping mechanism. When you connect with other people, you also have the opportunity to improve your mental health because you’re learning to accept your disease and move forward with best hopes for the treatment.
During this process, vitiligo patients learn their disease doesn’t define them. White patches on the skin don’t define your worth, skills, character, personality, and everything else. Instead of bottling down your emotions, be open about them.
Vitiligo And Your Thyroid
The thyroid is a butterfly-shaped gland located in your neck and produces hormones that regulate the metabolism and other functions in the body. As mentioned above, vitiligo is connected with Hashimoto’s thyroiditis, an autoimmune disease and one of the most common forms of hypothyroidism.
Hypothyroidism or an underactive thyroid occurs when the gland doesn’t produce sufficient amount of hormones, thus resulting in a number of consequences. Evidence shows that vitiligo is strongly related to numerous endocrine disorders, especially thyroid abnormalities.
In fact, this relationship was first mentioned in 1941 when Robert P. proposed that vitiligo might be associated with enhanced activity of thyroid gland. He noticed that 10 out of 20 vitiligo patients he examined had a rise in metabolism.
One study discovered the huge relationship between this skin disease and thyroid autoimmunity. In fact, tests used to detect thyroid autoantibodies are also relevant in patients with vitiligo.
In a separate study, about 3.4% of 321 patients with vitiligo also had hypothyroidism which prompted scientists to propose annual screening of thyroid functions in patients with this skin disease. In addition, evidence shows there is a possibility of antigen crossover and oxidative stress between Hashimoto’s thyroiditis and vitiligo.
All these findings show there is a lot we don’t know about vitiligo and thyroid diseases. At the same time, getting more insight into the relationship between thyroid and vitiligo could change the way this skin condition is treated and understood.
Besides Hashimoto’s, vitiligo is also associated with other autoimmune diseases such as:
- Graves’ disease – An autoimmune disease that results in overproduction of thyroid hormones, i.e., hyperthyroidism
- Pernicious anemia – Chronic illness caused by impaired disruption of vitamin B12
- Rheumatoid arthritis – An autoimmune disease and one of the most common forms of arthritis. RA affects the lining of the joints, thus causing pain and swelling as well as bone erosion and joint deformity
- Psoriasis – A common skin condition that speeds up the life cycle of cells and causes them to build up rapidly on the surface of the skin. In turn, scales are formed on the skin in the form of itchy and sometimes painful red patches
- Lupus – A chronic inflammatory disease that affects multiple systems in the body including skin, joints, kidneys, brain, blood cells, heart, and lungs
- Addison’s disease – A disorder that occurs when the body produces insufficient amount of certain hormones secreted by the adrenal glands
Celebrities With Vitiligo
Many celebrities have (or have dealt with) vitiligo, but it didn’t stop them from achieving their goals and living their life to the fullest. These celebrities include:
- Michael Jackson – The most popular celebrity who dealt with vitiligo, the King of Pop was frequently accused of whitening his skin when the real reason for his appearance was this disease
- Winnie Harlow – A top model who didn’t let her skin disease stop her from achieving tremendous success in the industry where people are judged solely based on their appearance. Now, she is a role model to many girls and shows it is perfectly okay to be different
- Holly Marie Combs – Most popular for her role in hit series Charmed and Pretty Little Liars. The star has vitiligo on both her legs
- Jon Hamm – popular Don Draper from Mad Men, has a stress-induced vitiligo that affects his hands
- Steve Martin – The comedian is also one of many celebrities with vitiligo
- Joe Rogan – This standup comedian has vitiligo on his hands and wrists
- Sisqo – The singer has eczema and vitiligo, both of which are stress-induced
- J. D. Runnels – An American football player has vitiligo affecting his face
- Tamar Braxton – Has vitiligo that affects her hands
- Scott Jorgensen – This UFC fighter has vitiligo on most of his body
Vitiligo belongs to the group of skin diseases caused by loss of pigmentation in the skin. The disease is indicated by distinctive white patches. Vitiligo isn’t a life-threatening skin disorder, in most cases, the only symptom is the development of white patches on the skin.
That said, the disease has a huge effect on a patient’s mental health and increases the risk of depression, low self-esteem, and poorer quality of life. Different treatment options are available to manage the disease, help even out skin tone, and potentially restore skin color.
The success of these treatments depends from one person to another.
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