Common beliefs

false - Vitiligo is an auto-immune disease, meaning that the defenses of the body (the immune system), wrongly attack the cells that produce the main pigments of the skin (the melanocytes), thus inducing white skin patches. However, as for most immune disorders, a stress (emotional, professional, medical, surgical but also sometimes a pregnancy or a menopause) can induce or worsen vitiligo flares by stimulating the immune system. Unfortunately, taking care of this stress when it is the case (although useful for helping the affected people), does not improve vitiligo.

false - Vitiligo is never contagious. This common belief comes sometimes from its (far) similarity to leprosy that also give depigmented patches. However, vitiligo has nothing else in common with leprosy and is not contagious.

true - Although skin is most frequently the first involved, hairs can also become white. It is more frequent in segmental vitiligo, but it can be observed in all types of vitiligo.

false - Although the main symptom of vitiligo is a depigmentation of the skin (and sometimes of the hairs), vitiligo is a true disease with now well-known mechanisms.

true - It is nowdays well demonstrated that people affected by vitiligo have an impact on their quality of life similar or superior compared to those suffering from psoriasis, eczema but also diabetes, heart diseases and even some cancers. It is thus mandatory to take care of these patients.

false - Many other causes can induce a depigmentation of the skin. In most cases, vitiligo induces a complete depigmentation (the skin is thus ivory white) while most other causes of depigmentation lead to a partial depigmentation (the affected skin is lighter than the non-lesional skin but not completely white). A clinical examination using Wood’s lamp (blue and UV light) is mandatory to study pigmentary disorders and in most cases allows to easily differentiate vitiligo from other causes of skin depigmentation.

false - There is a genetic background in vitiligo that increases the risk of developing the disease, but there isn’t an inherited transmission such as in hemophilia for example. Vitiligo affects from 0.5 to 2% of general population (men and women are equally affected). There is no difference in frequency according to the color of the skin or the ethnic background. The first-degree relatives (children, brothers and sisters) of an affected individual have an increased risk that reaches 5 to 8% (thus about 10 times more than in the general population). However, it is important to note that they still have more than 90% of chances to never develop the disease.

true - People affected by vitiligo have more risks to develop a thyroiditis (auto-immune disorders of the thyroid). Thus, it is recommended to search for anti-thyroid antibodies and to control thyroid hormone levels every 3-4 years. However, these thyroid problems ar easy to treat. Importantly, the treatment of thyroid dysfunction (when it is present) does not help to impact vitiligo. Similarly, treating vitiligo does not decrease the risk of developing a thyroid problem. These are two distinct disorders but developing in the same genetic background.

false - In fact, the exact opposite is true! Studies have clearly demonstrated that patients with vitiligo have less risk of having a skin cancer. The risk to develop a melanoma is 3 times lower compared to the general population. This is explained in part by a more efficient immunity against melanocytes.

false - Here again, the exact opposite is true. Without sun (or ultraviolet irradiation in general), it is almost impossible to repigment vitiligo. The best way to never get repigmented is to avoid sun exposure! However, the exposure to sun has to be reasonable. Sun exposure should be done regularly (if possible every day), without using a sunscreen, until the affected skin becomes pink. When this endpoint is reached, the skin should be protected for the rest of the day by using clothes or sunscreens.

true - It is even one of the best treatment options (especially if combined with topical agents). Here again, doses should be progressively increase aimed to reach a pink aspect of the vitiligo patches for optimal efficacy.

false - Cabins of beauty salons are using UV type A that are much more dangerous for the skin and completely useless for repigmenting vitiligo lesions.

true - It is what is called, the Koebner phenomenon. It is not constant and it is mostly observed in active phase of the disease.

true - An active vitiligo corresponds to phase of the disease when an ongoing depigmentation is observed. This is first noted by seeing an extension of preexisting lesions or by the appearance of new lesions. The dermatologist can also assess the degree of activity thanks to Wood’s lamp examination. Hypochromic (blurry) borders but also a confetti-like depigmentation (multiples tiny spots of depigmentation) demonstrate the activity of the disease and should prompt a rapid treatment to try halting disease progression.

false - At least so far we don’t have any biological marker of the activity of vitiligo.

true - There are therapeutic options (especially UVB and oral mini pulses of steroids) that allow to halt disease progression in active phase. Such approaches give positive results in about 90% of cases.

false - To date, no specific diet or any diet supplements has ever shown in rigorous studies any benefit in vitiligo.

true and false - Active vitiligos are a true therapeutic emergency as it is necessary to halt the ongoing disease progression. However, there is no emergency to repigment a vitiligo and it is possible to repigment even very old lesions of vitiligo (sometimes present for decades).

false - Surgical approaches should only be proposed for segmental and for stable and localized forms of vitiligos. In these cases, the results are usually very good.

false - A complete or almost complete repigmentation can be achieved in 70 to 80% of cases on the face. At the contrary, the extremities of hands and feet remain very difficult to repigment.

true - The repigmentation requires several months to occur. Thus, when a treatment is started for vitiligo, it is necessary to wait 6 months before evaluating if it is effective or not.

false - Children can be treated. It is sometimes to introduce a treatment in emergency if their vitiligo is very active (in children, oral mini pulses of steroids are preferred). However, if their vitiligo is stable, it is important to wait that they specifically ask for a treatment. Indeed, the treatment is long and sometimes tiresome for a child and he should be motivated to do it. There won’t be any loss of chances if the treatment is started later (at the exception of active forms). Of note, clinical trials are conducted first in adults.

false - Marked improvements in the understanding of the pathophysiology of vitiligo have been done these past years. These progresses allow the development of new therapeutic approaches. Clinical trials are now proposed in expert centers.