Vitiligo is a disease responsible for white spots on the skin. Former television host and sportswoman Nathalie Simon has suffered from it for 24 years and has decided to no longer hide it.
Vitiligo is a disease which causes a depigmentation of the skin leading to the formation of white spots on the affected areas. The former television presenter and sportswoman Nathalie Simon has had it for 24 years, as she revealed on France 3 in January 2023: “I developed my vitiligo after the birth of my daughter. I am lucky that‘he only touches my hands. (…) This disease is very little known, so people look at you, ask you if it is contagious… In my shows, (…) It was getting harder and harder to hide. I decided to change my approach to my vitiligo: I will show it !”. Guest on the show “Chez Jordan” (C8) on the 26th septemberNathalie Simon explained that she was following a treatment to repigment the skin on her hands: “Two years ago, my hands were completely white” she said, showing her hands to the camera. Other public figures with vitiligo: the former Prime Minister Edouard Philippe and the singer Michael Jackson.
Definition: what is vitiligo?
THE vitiligo is a skin disease characterized by depigmentation translating to the appearance of white spots on the integument (living tissue that covers the body). Typically, the disease begins to appear before the age of 20. This depigmentation is due to the disappearance of melanocytes, cells responsible for skin pigmentation. All areas of the skin (neck, face, hands) and appendages (hair, nails and body hair) can be achieved. There are different forms of vitiligo:
► Localized vitiligo: Localized vitiligo only affects a small area of the skin.
► Segmental vitiligo : segmental vitiligo is localized on one side of the body, on an area of the face, limbs or trunk corresponding more or less to an innervation zone or to a metamere. It appears more often in children and adolescents. This form is generally not progressive and is very rarely associated with generalized vitiligo. Segmental vitiligo responds very well and in a lasting manner to melanocyte transplantation.
► Mucous vitiligo: Mucous vitiligo concerns the mucous membranes: lips, genitals.
► Generalized vitiligo: Generalized vitiligo is characterized by more or less symmetrical spots affecting both sides of the body (bilateral). The evolution is capricious: the spots can remain localized or spread. In certain cases the depigmentation can ultimately be total, this is then called vitiligo universalis.
► Vitiligo universalis: it is characterized by depigmentation affecting almost the entire integument and appendages
What are the symptoms of vitiligo?
Vitiligo causes skin depigmentation localized, limited to a small area or diffuse and/or a premature depigmentation of hair, eyebrows, beard and other body hair.
What causes vitiligo?
“The origin of vitiligo still remains mysterious, confides Doctor Yvon Gauthier, specialist in pigmentary disorders. Despite everything, within the framework of “convergent theories” we admit that a deficit of melanocyte adhesion (melanocytorrhagia) and a oxidative stress promote the development of autoimmunity in genetically predisposed and often subject to psychological stress“. A fifteen genes susceptibility have been associated with vitiligo: HLA, CTLA4, NLRP1, TYR… Some are involved in skin pigmentation, others are linked to the functioning of the immune system or the appearance of autoimmune diseases.
A person with an affected first-degree relative has a 5 to 8% risk of developing the disease.
This would explain why 15 to 20% of people with generalized vitiligo also suffer fromautoimmune hypo or hyperthyroidism (Hashimoto’s thyroiditis, Graves’ disease). In addition, family predispositions exist: a person with an affected first-degree relative has a 5 to 8% risk of also developing the disease.
White spots due to loss of melanin
The white spots associated with vitiligo are linked to loss of melanin (pigment that colors the skin) due to the destruction of melanocytes, cells that provide pigmentation. In the case of vitiligo, these spots are permanent. This disease should not be confused with the transient depigmentations observed for example in cases of pityriasis verticolor.
Photo of vitiligo on the beard
The diagnosis of vitiligo is a clinical diagnosis based on the presence of skin depigmentation. “A Wood lamp used in a dark room allows a more precise study of the skin in cases where the skin is light and also to detect spots still invisible to the naked eye. In the case of vitiligo the spot appears a chalky white color“, explains the researcher.
Can stress cause vitiligo?
THE stress can promote the appearance or worsening of vitiligo : psychological stress, but also physiological stress linked to pregnancy, to a surgical procedure, to an acute illness… In April 2021, at the microphone of RTL EveningEdouard Philippe explained that whitening his beard “was due to stress and work.” Nathalie Simon, whose vitiligo started after the pregnancy of her daughter Nina, recalled in September 2023 that a “Disease is often triggered by an emotional shock or a hormonal shock such as pregnancy.”
What are the treatments for vitiligo?
“Vitiligo treatments aim tostop the inflammatory process responsible for the autoimmune destruction of melanocytes and on the other hand stimulate repigmentation of spots from residual melanocytes that persist in hair follicles“, explains Dr. Gauthier. “We can first obtain peripilary confetti repigmentation then subsequently a total repigmentation of certain spots which is unfortunately not not definitive“.
► Creams to hide spots : it is possible to use cosmetics such as self-tanning foundations or creams on depigmented areas, which camouflages the discoloration but does not act on the disease. Cosmetics are used around the eyes, where the skin is sensitive and cannot necessarily withstand heavy treatments.
► Phototherapy: Phototherapy has an anti-inflammatory and stimulates the migration of melanocytes by the action of UVB : 2 to 3 sessions are scheduled per week, up to a total of 300 treatment sessions. Repigmentation can be partial and transient. There is also the phototherapy by “PUVA therapy”. This technique combines exposure of the skin to rays UVA and taking (orally, topically or as a bath) psoralen, a substance that increases the skin’s sensitivity to rays. In case of localized vitiligo, treatment can be done with an EXCIMER lamp. It allows very localized phototherapy.
► Corticosteroids, vitamin D. The combination of local corticosteroid therapy and vitamin D or topical tacrolimus may be prescribed for repigment small stains for vitiligo: apply once a day for several months. Their effectiveness is not systematic. There systemic corticosteroid therapy can be discussed but the side effects are significant and explain that it is not often prescribed in this pathology. On the other hand, sequential treatment with minipulse 2 days per week does not present these disadvantages.
► Zinc given in an anti-inflammatory dose can have an effect.
► Depigmentation. “Depigmentation is intended for voluntary patients who have lost all hope of repigmentation and who present with small, very unsightly pigmented islands on the face or back of the hands.“, underlines the specialist. “Depigmentation uses either cryotherapy, laser, hydroquinone monobenzyl ether (less and less used). Chemical derivatives of hydroquinone are contraindicated on large surfaces because they are toxic to the kidneys“.
► Registries. The surgical procedure consists of grafting melanocytes from a donor area onto the depigmented areas. She is widely used in segmental vitiligo affecting the face in patients over 15 years old. It is rarely used and only in the case of stable, small-scale generalized vitiligo.
Thanks to Dr Yvon Gauthier, researcher, former head of consultation for pigmentary disorders, Department of Dermatology Hôpital Saint André Bordeaux and to the French Vitiligo Association.