Last Updated on 8th January 2022 by Caroline Haye
Is pigment loss really so hard to treat?
The first blog post of a new year deserves a meaty topic. So today I am going to try tackling a question that has frustrated millions of people around the world for generations. Namely, why is there no cure for vitiligo yet?
I don’t mean this topic to sound pessimistic. In reality I am extremely optimistic about the progress that scientists and practitioners are making towards better medical treatments for vitiligo. I’m also very upbeat about the effectiveness of existing therapies, like nutritional protocols and phototherapy. (Especially as these worked so well for me.) But I can’t help wondering at the fact that there is still no definitive cure… Not even a treatment that reliably halts or controls the condition in the majority of people. Why is that?
A natural question to ask
It’s a natural enough question to ask. After all, humankind has achieved so many seemingly impossible feats… From splitting the atom and landing people on the moon to inventing the internet and creating artificial intelligence. In fact, it sometimes feels like we are living our lives in a sci-fi fantasy. (What with driverless cars and robots at work and in the home.) And, in the field of medicine, it’s tempting to think there is nothing that genetics, modern drugs and surgical methods cannot fix.
Vaccines famously eradicated the deadly disease of smallpox decades ago. And, in a relatively short space of time, AIDS research turned something that used to be a virtual death sentence into a treatable condition. More recently still, one of the biggest medical achievements of the past two years was the development of a COVID vaccine… In fact, not just one, but several, in a matter of months… A task that would normally take at least a decade to accomplish. So why is it that vitiligo is proving to be such a hard nut to crack? Well, you can read an expert’s answer to this question in Dr John Harris’ blog. And for my thoughts on the subject, such as they are, please keep reading…
Vitiligo has been a low priority compared to other diseases
Of course the successful and speedy development of COVID vaccines (and better treatments for the virus too) should give us hope. Why? Because this proves that almost anything is possible if it is a high enough priority and enough resources go into it… A fact that is, in itself, one answer to our question, why is there no cure for vitiligo yet? Clearly not enough time, money and human resources have so far gone into finding one.
This is just a fact, not a gripe. After all, it is reasonable that vitiligo should assume a lower priority than a global pandemic. And it is right that research into heart disease and cancer treatments should receive bigger budgets and more urgency than a skin condition. Clearly, they affect far more people and in a more drastic way.
But there is no doubt that the suffering vitiligo can inflict should not have been underestimated as it has been for so long. There is still a perception that it is just a cosmetic problem. Whereas, in reality, it is associated with many other physical health issues. Not to mention psychological and cultural ones. Just because the condition is not directly life-threatening does not mean it hasn’t robbed millions of their mental health and quality of life. Nor does it mean that it does not deserve the same level of attention as other skin conditions.
Vitiligo research is less profitable for the drug companies
Medical research and development is an expensive business, to say the least. So securing funding for work on lesser-known diseases is not easy. And since only two percent, or less, of the population has vitiligo, I’m guessing the return on investment for drug companies is probably not very attractive… At least, not when compared to developing treatments for other, more common or potentially fatal conditions.
From what I have read on the subject, the process of getting research funding is rigorous. Not to mention lengthy, expensive and competitive. And, even to get to the application stage, there is a massive amount of hard grind involved. (And, no doubt, some salesmanship too.) Which brings me on to the next point… It’s harder to sell the idea of a cure if hardly anyone has heard of the disease.
For too long vitiligo was a “secret disease”
When you think about it, public awareness of vitiligo is a recent phenomenon, really only made possible by the advent of social media. For most of my life I had never knowingly met – or even heard of – anyone else who had vitiligo. And this was probably because virtually everyone else who had it was doing the same thing as me: keeping it a secret.
Happily, things have moved on since then. There is now a visible and vocal worldwide vitiligo community online, backed by some great vitiligo advocates and celebrity ambassadors. And there is a significant number of dedicated and passionate doctors globally who are intent on solving the vitiligo riddle and delivering better treatments soon.
Vitiligo is a complicated condition
But the slow rate of progress is not just because vitiligo has been a low priority or lacked publicity. It is also down to the fact that it is a complex condition with multiple causes. So finding a cure was never going to be an easy task.
Vitiligo is what doctors like to call “multifactorial”, which is really just another way of saying that it is complicated. It means that multiple different factors are involved in its cause and its progression. So getting to the bottom of a multifactorial condition must be like trying to troubleshoot a seriously messed up computer… One that has corrupted software, multiple viruses and all the keys on the keyboard wrongly marked.
Research so far has shown that genetics, environment, stress and autoimmunity all play a part. And latest discoveries indicate that an abnormal gut microbiome is also involved. Add to that the fact that different factors seem to apply to different vitiligo sufferers – which is no doubt why not all treatments work the same for everyone – and you start to see how complex the problem is.
For generations there were vastly differing theories about what causes vitiligo and how best to treat it, if at all. And it is only in the last decade that researchers have really zeroed in on the various factors that influence its onset and development. This progress has enabled them to come up with potential treatment ideas. But of course it takes time and money to develop, test and review these ideas. And to get them to the clinical trials stage before being authorised (or not) for use. So it’s hardly surprising that the wait for a cure continues.
Cultural factors have influenced vitiligo treatment
All of the above are most likely the main reasons why there is no cure yet for vitiligo. But it also occurs to me that there have been cultural factors at play too. And these factors may have more to do with skin colour in a broader sense, rather than just in the context of vitiligo.
It should come as no surprise that nations whose populations typically have more deeply pigmented skin tend to have a longer and more developed tradition of treating vitiligo. And these usually involved herbal and other alternative therapies. Many of these countries historically lacked the wealth to fund expensive medical research. So they have clung to their traditional vitiligo medicines.
Nations with predominantly fair-skinned roots, on the other hand, do not have the same history of using traditional remedies to treat vitiligo. This may be partly due to the fact that the visual impact of pigment loss is less in peoples with white skin, so demand for remedies was less urgent. And, also perhaps, because western medicine demands expensive clinical research, meaning that vitiligo missed out on the list of priorities for so long.
I don’t want to insult anyone by suggesting that there may even be an unconscious racial element to the lack of urgency in finding better medical vitiligo solutions. But I do wonder if western research might have progressed faster if vitiligo had been a condition that caused dark patches to appear on white skin instead of the other way round. (Just a random thought!)
Just one vitiligo cure… or a combination of therapies?
When all is said and done, curing such a complex disorder as vitiligo was never going to be a walk in the park. And, in reality, drugs rarely cure diseases completely anyway. Even the most effective medications usually just alleviate symptoms. So maybe the word “cure” is inappropriate. Maybe the old-fashioned words “remedy” or “therapy” are more in keeping with what we should expect. And maybe combinations of treatments, and a more holistic approach, will prove necessary.
So, while I am very optimistic that new vitiligo drugs will soon be available*, it seems unlikely that any single one will be able to completely solve this complicated illness. Even a reliable cosmetic solution for pigment loss would not necessarily solve other aspects of the condition. (For example, other melanocyte-related issues, autoimmune associations, inflammation, and so on). And, because vitiligo has a “memory” that causes it to recur when therapies come to an end, one course of treatment may not be enough.
So, until such time as scientists can genetically engineer vitiligo out of our DNA, my guess is that it will always require ongoing management… Probably a mix-and-match approach of some sort. And, based on my own experience, I’m inclined to think that including natural and traditional therapies alongside medications may achieve a more complete cure. After all, a multifactorial condition most likely requires a multifactorial solution.
*You may also like to read The Race For a Vitiligo Cure.
