Misconceptions surrounding vitiligo.

False. While vitiligo was long considered a psychosomatic disease, we now know this is not the case. It is primarily an autoimmune disease, where the immune system attacks the melanocytes, the cells responsible for skin pigmentation. Their destruction leads to the appearance of the specific white patches associated with vitiligo. However, it is true that chronic stress or traumatic events can exacerbate the disease in predisposed individuals by disrupting their immune system.

Note : Even though vitiligo is not a psychological disease, it can have significant psychological consequences and impair the quality of life of those affected.

False. The vitiligo is not considered a hereditary disease in the strict sense of the term, even though there is a strong genetic component in its occurrence. Studies have shown that about 20% of people affected by vitiligo have at least one first-degree relative with this disease. However, there is no specific vitiligo gene, but only familial predispositions, which may explain this paradox. To date, about 50 susceptibility genes have been identified.

False. Contrary to the popular belief in some cultures, vitiligo is not a form of leprosy nor an infection and is not contagious. This misconception is one of the reasons why people with vitiligo are still subject to a certain level of mistrust today. However, vitiligo cannot be transmitted horizontally, whether it be through physical contact, respiratory routes, or even bodily fluids.

False. It is often said that the lack of melanin in the skin of people with vitiligo makes them particularly vulnerable to the sun and requires them to strictly avoid sun exposure. However, this is not entirely true and a gradual and moderate exposure, coupled with the prior application of a sunscreen, can be beneficial. Many patients even report an improvement in their vitiligo following their summer holidays.

While individuals with vitiligo do not need to avoid the sun, it is crucial that they protect themselves with a skincare product SPF 50 at the very least.

False. Reducing vitiligo to a mere aesthetic issue is a mistake that underestimates its impact on the mental and physical health of patients. In addition to their conspicuous nature, which can lead to discrimination and social isolation, the white patches are often a reflection of an underlying autoimmune imbalance. That's why vitiligo is frequently associated with other autoimmune diseases, such as thyroid insufficiency. Therefore, it should not be considered as a simple aesthetic concern.

True. As previously stated, numerous scientific reports indicate that vitiligo is often associated with other autoimmune diseases, particularly thyroid disorders. Hashimoto's thyroiditis, Graves' disease, or even subclinical thyroid dysfunctions tend to be more common in individuals with vitiligo. This is due to similar autoimmune mechanisms between these various diseases. Therefore, it is important for those affected by vitiligo to monitor their thyroid function and to be vigilant if symptoms such as extreme fatigue or sudden weight changes occur.

True. In some forms of vitiligo, the skin is not the only area affected. The melanocytes in the hair follicles can also be impacted, leading to a depigmentation of the hair and body hair in the affected areas. This is then referred to as follicular vitiligo, or leucotrichia. It's also worth noting that it is often more difficult to repigment hair than skin.

False. There are not yet any biological markers of vitiligo activity that allow for the disease to be diagnosed with a blood test. Its identification relies primarily on a clinical examination and the use of the Wood's lamp, a radiation device that emits long UVA and violet-blue light. This allows for the identification of focal loss of melanocytes and the detection of depigmentation areas that may not be visible to the naked eye, particularly in individuals with very pale skin.

True. It is now possible to partially or completely repigment areas affected by the vitiligo. To do this, it is common to use controlled phototherapy coupled with topical calcineurin inhibitors or dermocorticoids. It is also possible to resort to melanocyte grafts. It should be noted that the repigmentation of vitiligo is a lengthy process that most often requires between 6 and 24 months of treatment.

False. This common misconception is entirely unfounded. Vitiligo is an autoimmune disease that has no connection with hygiene habits. The appearance of depigmented patches results from the destruction of melanocytes by the immune system or other biological factors, not from skin cleansing. Unfortunately, this false belief reinforces the social stigmatisation of people with vitiligo and fuels discrimination, while the frequency of showers and the use of hygiene products have no impact on the onset or progression of vitiligo.

False. The vitiligo can affect all skin colours, but its manifestations are more noticeable on darker skin, due to the stark contrast between the depigmented areas and the surrounding skin. This can give the mistaken impression that the disease is more common in people with dark skin.

True and False. Although it is not the direct cause of vitiligo, stress is often cited as an exacerbating factor, a hypothesis validated in several scientific studies. The link between stress and vitiligo could be explained by an increase in cortisol levels in stressful situations, a hormone that can disrupt the immune system and increase the levels of free radicals in skin cells, unstable molecules that promote the onset of vitiligo.

False. At present, there is no treatment that can completely cure vitiligo. The available therapeutic approaches primarily aim to stabilise the disease, prevent the emergence of new lesions and, in some cases, to repigment the affected areas. However, numerous research studies are underway to better understand the underlying biological mechanisms of the vitiligo and some promising treatments are currently in the clinical trial phase, which gives hope to those suffering from this disease.

False. This is yet another mistaken belief. Vitiligo is neither a contagious disease nor an infectious pathology, and there is no medical contraindication preventing a person suffering from vitiligo from donating their blood or platelets, provided they are aged between 18 and 70 years and weigh more than 50 kg.

• CZAJKOWSKI R. & al. Current aspects of vitiligo genetics. Advances in Dermatology and Allergology (2014).

• BORRADORI L. & al. Dermatologie et infections sexuellement transmissibles. Elsevier Masson (2017).

• VAN GEEL N. & al. Vitiligo: An Update on Pathophysiology and Treatment Options. American Journal of Clinical Dermatology (2017).

• EZZEDINE K. & al. Vitiligo: A Review. Dermatology (2020).

• HARRIS J. & al. Vitiligo: Mechanisms of Pathogenesis and Treatment. Annual Review of Immunology (2020).

• SPRITZ R. & al. The Genetic Basis of Vitiligo. Journal of Investigative Dermatology (2021).

• KOSHI S. & al. Vitiligo: A Narrative Review. Cureus (2022).