Vitiligo is a rare condition which can cause significant psychological stress among sufferers. However, dermatologist Lawrence Scerri tells Stephanie Fsadni that it’s not contagious and any stigma should be eradicated.

The physical appearance of the late singer Michael Jackson changed dramatically over the years. When his skin tone changed from medium brown to white, he was accused of bleaching his skin to look Caucasian and boost his career.

Whether the King of Pop went through such a transformation specifically for this reason is questionable but the fact is that he had the skin condition known as vitiligo, which causes the loss of skin colour in batches, and he underwent an extreme treatment to cover it up.

Jackson revealed that he had the disorder in an interview with Oprah Winfrey in 1993, which started a public discourse on vitiligo which was relatively unknown before then. It is, in fact, quite a rare condition as only between one and two per cent of the world population is considered to be affected.

“It is a genetic condition that could surface in younger years or later on in life,” says Lawrence Scerri, chairman of the Department of Dermatology and Venerealogy at Boffa Hospital.

“What happens is that ‘melanocytes’ – the cells that produce pigment – shut down. The patches are not only lighter in colour but totally white.”

The condition can affect all parts of the body but especially the face and neck. It’s also usually symmetrical in fashion but there are exceptions.

Theoretically, the melanocytes are not dead. There’s the possibility they will function again and produce pigment

Vitilgo is an aesthetic problem because it has no other symptoms.

“It’s not itchy and has no other effect,” says Scerri. “But it can, of course, result in psychological stress.”

The condition is obviously more noticeable on darker skin types. In fact, Scerri says that it’s sometimes called “white leprosy”.

The most important thing to note, however, is that it’s not contagious.

Treatment is available and does not have to be as extreme as that pursued by Jackson.

“He used an extreme potent chemical bleach that killed all melanocytes… he thus became very sensitive to the sun and that is why he was wearing protective clothing, hats and sunglasses all the time,” points out Scerri.

Normal treatment involves a long process and results may not be so satisfactory.

“Theoretically, the melanocytes are not dead. There’s the possibility they will function again and produce pigment. So, there’s the chance of reversibility,” explains Scerri. “The long-term outlook is unfortunately not so favourable, yet there are cases when skin colour returns to normal.”

Michael Jackson before and after the extreme treatment he underwent to cover up his skin condition.

Topical calcineurin inhibitors and cortisone creams used with the necessary precautions may help re-pigment the skin. But the further away you go from the face, that is the extremities, the more difficult it is to get the colour back.

Another possible treatment is UV treatment delivered in a photobiology unit. Such a service is available at Boffa Hospital.

“This can cause some reversibility. It’s a very long treatment and one increases the risk of UV damage, although UV is given in very low, controlled doses as part of a therapeutic protocol to stimulate the melanocytes.”

In the long run, however, pigment that returns might just fade away.

“In such cases, you have to accept it and cover up,” says Scerri.

Professional cover-up creams for the face and fake self-tanning sprays for the rest of the body can do the trick.

Scerri is concerned about the stigma people with skin conditions in general suffer.

“We tend to stigmatise anyone who has something visible on the skin, including people with acne and other conditions,” he says. “We have to strive to eliminate ignorance. Educators thus have an important role to play to avoid stigma and social exclusion.”