Why cold weather may cause pigment loss
Just three weeks ago I was waxing lyrical about the golden beauty of the countryside in Autumn. But the weather reports this week have been warning of snow and my daily walks over the past few days have seen me swap a thin fleece for my warmest jacket, scarf, hat and gloves as the slide from one season into the next picks up pace.
I recognise that not all readers of this blog live in countries that have cold seasons, but I know that a lot do. And, whilst our Antipodean #vitiligo-friends are gearing up for their Summer and all the difficulties that this entails for people with skin that does not tan normally, we in the UK (and the rest of northern Europe and North America) are about to be plunged into a prolonged period of cold weather.
I used to look forward to Winter
I can remember how I used to feel at this time of year B.R. (Before Re-pigmentation!). As the first frosts started to bite I used to breathe a sigh of relief that, for the coming few months at least, I would no longer have to mess about with fake tans, a full face of make-up and impossible decisions about what clothes I could wear to keep cool and fashionable without exposing my white patches. Life was about to become less complicated and less stressful. And the greatest luxury of all was that I could almost completely forget about my vitiligo. I could behave and feel the same as everyone else around me. It was as if the Summer had left me exhausted from fretting and focusing on my skin all the time and now, finally, there would be some respite from my constant state of awareness of my condition. Nowadays, I am sad to see the end of Summer and find myself looking forward to taking a Winter break somewhere hot because regaining my normal colour has changed everything.
So, if you have vitiligo and live in the northern hemisphere, the good news is that you are about to be able to hide your skin under layers of fabric and the decreased levels of UV will probably also lessen the contrast between your normal skin and the vitiligo patches as the weeks go by. That's the good news...
Can cold weather cause vitiligo to spread?
But, on the other side of the coin, what I also remember experiencing (B.R.) was anxiety as I emerged from “hibernation” the following Spring, wondering whether new vitiligo lesions would have developed below the surface, waiting to appear as soon as I exposed any flesh to the elements and dreading the intrusion on my life once again of this condition that would continue to preoccupy my every moment. More often than not, I discovered at this stage that my vitiligo had indeed spread. It was not always apparent until I had had some sun exposure but it seemed that I started every Spring/Summer with less pigment than I had ended with the previous Autumn. So, does this mean that the winter is in some way harmful for vitiligo sufferers? And, if so, why?
I have blogged before on the question of how much sunshine is too much and concluded that UV exposure is an important component of every successful vitiligo treatment I have ever come across (including my own) but that excessive exposure, resulting in sunburn, often causes further pigment loss. So it is a question of moderation. Of course, it is simple enough to be sensible about how much sun exposure we choose to get during the Summer (well, perhaps that's debatable if you live in England) but many of us have little choice during the Winter - unless we have access to a UV device. We are simply stuck with the weather we are given. This made me wonder if there is a difference between the incidence or severity of vitiligo in different parts of the world based on the amount of UV they are exposed to.
Vitiligo is less severe in sunny climates
The evidence I was able to find suggests that there is no variation in the geographical distribution of vitiligo around the world but that vitiligo sufferers who live near the equator tend to have less widespread lesions than those who live further away from it.
Since the most obvious common denominator between countries near the equator is their consistenly sunny climate, this would seem to be in line with my belief that regular sun exposure is good for controlling the condition.
It is unfortunate for those of us who live in countries with distinct seasons that we are deprived of significant sunshine for several months at a time. For us, it is either feast or famine, when it comes to UV exposure. And, knowing that my recovery involved regular sun exposure during the Summer and phototherapy through the Winter, instinct tells me that long-term fluctuations in UV are probably counterproductive for anyone wanting to restore and keep lost pigment. I'm inclined to think that the cool, dull conditions that interrupt our exposure to the sun could actually be a major reason why many vitiligo sufferers living far away from the equator see their pigment loss spread each year by comparison to their equatorial counterparts.
It is not difficult to understand why sunshine (in sensible moderation) is good for vitiligo. Everyone knows that UV light stimulates the production of vitamin D (in which vitiligo sufferer's tend to be deficient) and that UV light is what triggers the tanning process. But the fact that a lack of UV – as experienced during Winter - does the opposite is perhaps not something we think much about, even if it is entirely logical.
In a sense, the long, dark Winter after the bright Summer months is similar to night-time after the day. The relative darkness reduces levels of the hormone serotonin in the brain, raises levels of melatonin and reduces our production of Melanocyte-Stimulating Hormones (MSH). These hormonal changes are usually kept in balance in the context of day and night. Serotonin is needed, amongst many other functions, to wake us up and melatonin helps send us to sleep. But a virtual night-time that lasts several months (i.e. Winter) may well upset the balance of hormones in the pituitary gland causing some people to suffer from Seasonal Affective Disorder, or SAD, some to lack vitamin D and some to lose pigment.
"Hibernation" can make us compLacent
Winter also presents another, unrelated, danger to the vitiligo sufferer and that is that we can be lulled into forgetting about our skin to the extent that we stop being careful about avoiding potential vitiligo triggers.
One of the first things that can go out the window is a healthy diet. It's easy to eat like a caveman and consume salads, fresh vegetables and unprocessed meats in the Summer but when it's snowing outside and dark by 4pm we find ourselves craving comfort foods and drinks, many of which are low in key nutrients (often ones that we already lack) and many of which contain ingredients that may aggravate the digestive system, causing vitiligo to spread.
It is also a time of year when we reach for heavier garments with necklines and cuffs that can increase friction to the skin and darker coloured fabrics containing stronger dyes, which typically contain a variety of chemicals that can potentially trigger de-pigmentation in susceptible individuals.
What I am saying is that, whilst the colder weather can be a wonderful opportunity for people with vitiligo to forget their troubles and simply get on with life (which is clearly a very positive thing to do), I believe that it is a mistake to take our eye off the ball altogether. I have come to the conclusion that it is just as important during this season to stick with any treatments and protocols that have proved beneficial during the rest of the year and, ideally, to find a way to include UV exposure if at all possible. So here's to either living somewhere that has winter sunshine, owning a UV lamp or – best of all – taking lots of sunny vacations!
But, above all else, we know that stressing over all of this can also be counterproductive. So, whatever else you do to keep your vitiligo in check, my advice is to...
... LOOK AFTER YOUR SKIN THIS WINTER!
My name is Caroline.