Will vitiligo cure be a magic bullet?
Last month I wrote about the exciting progress being made towards an eventual cure for vitiligo by Dr John Harris and his team at the Vitiligo Clinic and Research Center at the University of Massachusetts Medical School. In particular, I celebrated Dr Harris’ unequivocal assertion that the damage caused to pigment cells in vitiligo is fully reversible. To me, confirmation of this fact from such an eminent expert was more thrilling than any of the detail about experimental drugs currently being trialled. I found it thrilling because it not only reinforced my own experience of vitiligo reversal but it was a clear indication that it is no longer a question of whether a vitiligo cure will be developed, but rather when.
The fact that clinical trials are actually going on now and that the first generation of drugs is likely to emerge within the next couple of years is obviously good news. These medications promise to be a godsend to the millions of people around the world for whom pigment loss can be psychologically devastating and socially disabling. Getting rid of the white patches that are the only obvious sign of illness in vitiligo has been a shared dream for countless sufferers, therapists and researchers alike. And it now seems highly likely this dream will be realised within the next few years.
I, for one, am delighted at this prospect. It has the potential to change the lives of an estimated 1- 2% of the world’s population for the better. And, whilst my own vitiligo has virtually disappeared, I am always aware that the condition could return if I were to stop the nutritional therapy that has reversed it or else expose myself to certain triggers.
The research so far has identified what appears to be the core pathway for the development of vitiligo, which involves destructive autoimmune activity and an abnormality of the melanocytes (pigment cells). The aim is to pinpoint (or at least narrow down considerably) the process by which the immune system attacks melanocytes, as opposed to other parts of the body, and turn that particular “switch” off without deactivating the whole immune system. But Dr Harris makes no secret of the fact that these initial medications will not offer a perfect cure.
If I understand what I have read on this subject correctly, it is not yet possible to produce a drug that targets the autoimmune threat to pigment cells with pinpoint precision. So the best that can be expected of the first wave of medications is that they will halt and reverse vitiligo but may also increase susceptibility to certain other conditions such as shingles.
What do we mean by "a real cure"?
This begs the question: what do we really mean when we talk about a vitiligo cure? So-called magic bullets rarely, if ever, perform perfect medical miracles. Drugs usually come with various limitations, side effects or other unintended drawbacks, which may or may not later be minimised through continued research and development. And, of course, they always come at a price because medical research is an expensive business and pharmaceutical companies are not generally known for their charitable work. So, optimistic though I am, I am also aware that the first new treatments your doctor is likely to prescribe for your vitiligo will not be perfect and they will not be cheap.
In a sense, you could say that this is no different from the current state of affairs. We already have access to numerous imperfect vitiligo treatments and none of them (except for sun exposure) is free. So, as long as the new drugs prove to be better at re-pigmenting vitiligo lesions than current options, then at least modern medicine will have succeeded in alleviating a lot of psychological suffering by providing a cosmetic solution to the problem. And that is good. But I very much hope that vitiligo research will not stop there. Because I do not believe that eradicating skin de-pigmentation is necessarily the same thing as curing a patient. And, as patients, I think we need to be aware of that concept so that we don’t find ourselves relinquishing all responsibility for our wider health just because our skin reverts to its normal colour. I believe we will still need to ask two important questions: what caused the pigment loss in the first place; and has the drug fixed that?
Curing white patches or curing people?
Five years ago in this blog, I posed the question: is vitiligo a disease or a symptom? If it is a disease, then any treatment that succeeds in permanently eradicating de-pigmentation will, deservedly, be hailed as a cure. But if it is (as I believe) a symptom, then it will only have succeeded in providing a cosmetic solution. It will not have addressed the reason for the symptom. And, whilst that would still be a life-changing achievement for millions, it is worth being aware that this could present additional risks, aside from the kinds of side-effects that might be considered acceptable (like the odd case of shingles).
Not being a scientist myself, I can only use my common sense and limited knowledge to speculate as to what these risks might be but an increased susceptibility to various pathogens (and maybe not just minor ones) is evidently one. For another, I imagine that blocking autoimmune attacks against melanocytes is not the same thing as curing autoimmune disease so it might cause the immune system to redirect its attacks to other healthy cells instead. And, as I indicated earlier, eradicating a symptom like pigment loss may be a bit like removing the safety warning signs from a faulty piece of equipment. It may give us a false sense of security about the state of our health.
Am I pouring cold water on the prospect of a "vitiligo cure"? No -absolutely not. It is what I have spent the major portion of my life hoping and praying for. And I am still eagerly looking forward to the day when doctors will be able to offer vitiligo patients a reliable way of reversing their pigment loss. But I am just sounding a warning note that using drugs designed purely to return the skin to its normal colour will not necessarily be the same thing as restoring the individual to health.
Experts agree that vitiligo is a multifactorial condition. In other words, a complex combination of factors are involved in its development and these are not even necessarily the same in every case. For myself, and many others I have come into contact with over the past 8 years, an underlying cause of our vitiligo is evidently poor nutritional absorption, due to digestive abnormalities. And these will still need to be addressed if we want to be free of all autoimmune diseases and enjoy full health.
So, whilst I am very excited to think that we are about to enter a pioneering stage in medical vitiligo treatment, one that promises to provide the best cosmetic solution to date, I anticipate that the underlying health problems that cause de-pigmentation in the first place will still need to be addressed before these medications can truly be called a perfect cure.
My name is Caroline.