Sandra Cormier feels her life's
been a living hell since she contracted a life-altering
disease in her teens. It wasn't cancer, multiple sclerosis,
or colitis. She has vitiligo. Now 30 years old, about
60% of her body is affected by the blotchy pigmentation
affliction, and while it didn't cause her any physical
pain, the emotional strain of trying to hide her skin
from prying, horrified eyes has recently taken its toll.
Could a condition that doesn't
affect general health nevertheless be life threatening?
Yes, according to Dr Charles Lynde, President of the
Canadian Dermatology Association and Assistant Professor
of Dermatology at the University of Toronto. "Vitiligo
is not a dangerous condition," he says, but that doesn't
mean it's innocuous � far from it, in fact. "I've had
patients who've committed suicide because people react
abnormally to this disease," he says.
The causes of vitiligo, in which
melanocytes (the cells that produce pigments) stop functioning
and cause white patches on some areas of the skin, are
still up for debate. Most experts agree that it's an
autoimmune disorder that can strike pretty much anyone
at any age. Dr Lynde estimates that between 1-2% of
Canadians suffer from vitiligo.
SHED
SOME LIGHT
Treatment's always been a sore spot for vitiligo patients,
but in the last decade some new approaches have begun
offering a ray of hope. "It's key for the condition
to be treated early on because treatment is more effective
if the inflammation hasn't been there too long," says
Dr Lynde. Some of the newer crop of treatments include
an immunomodulator ointment called Protopic and a cream-based
alternative called Elidel. Both prevent the immune cells
from destroying themselves in affected areas, and can
result in partial to potentially total repigmentation.
Even more efficacious is light
therapy, which is also used for psoriasis and other
skin conditions. Patients stand in a cabinet lined with
fluorescent tubes with the affected areas of skin exposed.
The most promising light therapy is narrow-band ultraviolet
B (NB-UVB), which enables patients to receive radiation
with fewer side effects (usually erythema, pruritis,
malaise, nausea and, in extreme cases, carcinogenesis)
than older light treatments like broadband UVB and psoralen
ultra violet A (PUVA). NB-UVB has a shorter treatment
time but higher intensity, and because UVB penetrates
less than UVA, it is thought to pose a lower skin cancer
risk.
IS
IT WORKING?
Unfortunately it can be difficult to measure how well
these treatments are progressing. A team from the University
of British Columbia has recently come up with an index
to help dermatologists track progress. "Doctors haven't
had a common yardstick until now so we couldn't compare
treatments in a scientific way," says Professor Harvey
Lui, head of UBC's division of dermatology. "This tool
takes the guesswork out of predicting treatment outcomes."
He and his team used the tool, called the Vitiligo Area
Scoring Index (VASI), to assess NB-UVB phototherapy
treatment in a group of 22 vitiligo patients. The index
was found to correlate well with physician observations,
and showed that NB-UVB treatment had a 42.9% success
rate, especially on the trunk, arms and legs. The tool
and research are described in the June issue of the
Archives of Dermatology.
THAT
ST TROPEZ TAN
Sadly, some patients' treatment is all for nought. "There
isn't a lot that can be done for some people," says
Dr Lynde. "Some react better to the treatments than
others, and in some cases there are no changes at all."
If these unfortunate patients aren't interested in total
depigmentation " la Michael Jackson, there's at least
one less high-tech alternative.
Many vitiligo patients have found
that acquiring a "fake tan" can help cover the blotches
and also boost their self-esteem. Self-tanning lotions
have the advantage of being relatively inexpensive and
easy to use, and happily they've come a long way from
the unnatural orange glow they gave off when they first
appeared on the market. While they don't offer a clinical
cure, the effects on the patient's psychological well-being
can be revolutionary.
But this approach is only skin
deep and, as Professor Lui reminds us, "Better treatments
are still needed." Dr Lynde agrees: "In our society,
people who seem different are ostracized and unfortunately,
those that cannot be treated will continue to suffer
because of that."
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