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Health // Doctor in the House
Rasa Fournier

Vitiligo: White Patches On Body

Dr. Christina Hardaway
Dermatologist at The Queen’s Medical Center

Where did you receive your schooling and training?

I went to medical school at F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Md. I did my internship at the National Naval Medical Center, also in Bethesda, and then spent three years as a naval flight surgeon. I did my residency at Naval Medical Center San Diego.

How long have you been in practice?

Since 1994.

What are some of the primary skin conditions you treat?

I treat all ages. Diseases of the skin, hair and nails that I commonly see are eczema, psoriasis, vitiligo, acne, infections (parasites, fungal, Hansen’s disease and more), skin cancer, blistering disorders and genetic disorders of the skin. I do surgical dermatology, which includes skin cancer treatment and removal of benign growths. I also do laser and light therapy (UV treatment, use of ablative lasers) and cosmetic dermatology (fillers, botox, sclerotherapy, lipo-suction).

Vitiligo is getting a lot of attention in the press lately, after Michael Jackson’s autopsy confirmed that he had vitiligo. What is vitiligo?

It is a disorder of skin pigmentation that causes flat white patches to appear on the skin as a result of loss of the melanocytes, the pigment cells of the skin. It can affect large portions of the body and it can wax and wane in its extent and severity. It occasionally can cause itchiness. Individuals with vitiligo can experience severe sunburns of the affected areas.

How does someone end up with vitiligo?

It is not well understood, but we believe that is occurs as a result of an autoimmune process in which the body attacks itself. It has a genetic predisposition but not a link to direct inheritance. It has been associated with other autoimmune conditions such as thyroid disease, pernicious anemia, alopecia areata and diabetes.

How prevalent is it in Hawaii?

There is no data specifically for Hawaii, but approximately 0.5 percent to 1 percent of the world population is affected. Almost half are affected before 20 years of age. There is equal prevalence between men and women. There is no difference in rate between different skin types or race.

How treatable is it?

It is not curable, but there are numerous treatments available that can temporarily improve the loss of color. None is 100 percent effective. They include topical creams, UV light therapy, UV light lasers, psoralens (topical and oral drugs used with UV treatments), tar treatments, skin grafting, melanocyte transplantation, use of camouflage makeup, psychotherapy and depigmentation treatments.

How is it different from tinea versicolor?

Tineaversicolor is an overgrowth of normal fungi that live on everyone’s skin. The fungus excretes a mild bleaching agent (azeleic acid), which fades skin pigmentation temporarily. It also can cause mild pinkening or darkening of the skin in a patchy pattern. The distribution is usually limited to the upper body, with occasional spread to the neck, lower face and proximal extremities.

The color change is fainter than that associated with vitiligo, which is complete loss of skin color, often with sharply demarcated borders. Overgrowth is easily controlled with use of antifungal shampoos, creams or tablets.

Vitiligo also can look like Hansen’s disease and is historically considered to be the skin condition referred to as “leprosy” in the Bible.

Anything you would like to add?

Vitiligo is a lifelong disease. The extent and course of the disease is quite variable, and response to treatment is unpredictable. Vitiligo has a serious impact on quality of life for the individuals affected, especially for dark-skinned individuals. It can lead to social exclusion and depression.

rfournier@ midweek.com

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