Vitiligo is a chronic skin condition where the immune system of the body attacks and kills the melanocytes, the pigment cells of the skin. It causes the formation of white patches of pale skin that may appear anywhere on the body. Vitiligo occurs in all races more or less equally but can be more conspicuous—and sometimes more difficult to treat—in darker skin due to the strong color contrast with normal skin. Unfortunately, medical cosmetics and dermatological literature have most often dealt with lighter skin types, leaving both patients and practitioners poorly informed. This article discusses the biology of vitiligo, the way color functions in the skin, and why vitiligo differs in people with darker skin.
What is vitiligo?
Vitiligo is believed to be an autoimmune disease. In other words, the body’s immune system incorrectly attacks the body’s own cells, in this instance called melanocytes. These are cells with a special function in the skin’s lower layer. They produce melanin!
Melanin colors the skin, hair, and eyes. Where melanocytes are lost or are not functioning, the areas involved lose their pigment and turn milky white.
Vitiligo is one of two types: non-segmental (more common and occurs on both sides of the body symmetrically) or segmental (less common and is typically on one side of the body). The disease is neither painful nor contagious but can be devastating to one’s self-esteem.
How Skin Pigmentation Is Formed
In order to find out why vitiligo appears more on darker skin, we have to examine how the skin color is created. Melanocytes produce melanin and package it into small organelles known as melanosomes, which are transported to the surrounding skin cells. We all have roughly the same number of melanocytes, but in darker-skinned individuals, the cells effort more and produce more melanin.
When people with darker skin lose pigment, the contrast between the light spots and the rest of the skin is so much more pronounced. In light skin, the spots may be quite light or pink.
Why Vitiligo Appears So Different on Dark Skin
Dark-skin vitiligo patches tend to be very noticeable and snow white, attracting more attention than they would if they were located on light skin. In fact, most dermatology textbooks and instructional photos of skin diseases show vitiligo in light skin. This contributes to delayed or erroneous diagnosis of the disease in darker patients.
Inequalities in Skin of Color Diagnosis and Treatment
Vitiligo may be misdiagnosed in dark-skinned patients as another skin condition such as tinea versicolor, post-inflammatory hypopigmentation, or chemical leukoderma. This is particularly so for physicians who are not used to dealing with dark skin. After proper diagnosis, treatment may involve creams with corticosteroids, calcineurin inhibitors (such as tacrolimus), and narrowband UVB phototherapy. Depigmentation therapy may be considered for severe cases. But not everyone chooses to get treated. Most individuals would prefer to accept the way they appear and search for makeup products that will enable them to hide their imperfections. Even then, very few makeup or concealer products are suitable for dark skin.
Closing Comments
Vitiligo is not riskier on darker skin but can be readily noticeable, less understood more frequently, and under-treated or mistreated more frequently. Diversity role models, more medical training, and education are the solutions to all of these problems. If you or your relative have vitiligo on darker skin, you need to know that help is growing—and your skin’s narrative needs to be told accurately, sensitively, and with pride.
References
Pietrangelo, Ann. “Vitiligo on Black Skin: What You Should Know.” Medical News Today, Healthline Media, 28 Oct. 2022, https://www.medicalnewstoday.com/articles/vitiligo-black-skin.
Cleveland Clinic. “Vitiligo.” Cleveland Clinic, 13 Oct. 2023, https://my.clevelandclinic.org/health/diseases/12419-vitiligo.
Hitti, Miranda. “What People of Color Should Know about Vitiligo.” WebMD, 6 June 2023, https://www.webmd.com/skin-problems-and-treatments/features/vitiligo-darker-skin-tones.
NHS. “Vitiligo.” NHS, National Health Service UK, 13 Feb. 2024, https://www.nhs.uk/conditions/vitiligo/.
Goldman, Lisa Zamosky. “Vitiligo and People of Color: The Nuances of a Visible Condition.” WebMD, 6 June 2023, https://www.webmd.com/skin-problems-and-treatments/features/vitiligo-poc-nuance.