Overview

Vitiligo is a chronic condition in which the immune system destroys melanocytes, causing white or pale patches on the skin. Prevalence is higher in the Arab world and GCC (up to 2-3%). It is not contagious, not caused by poor hygiene, and not life-threatening, but can have a profound psychological and social impact.

Symptoms

• Flat white or milky patches with well-defined edges, may grow over time
• Premature whitening of hair, eyebrows, eyelashes, or beard
• Loss of colour in mouth, nose, or around body openings
• Most common on sun-exposed areas: face, neck, hands

Causes & Risk Factors

• Autoimmune destruction of melanocytes
• Family history of vitiligo; personal history of thyroid disease, type 1 diabetes, lupus
• Psychological stress, skin trauma, or sunburn (Koebner phenomenon)

Complications

• Severe sunburn risk — depigmented skin has no melanin protection, critical in Kuwait
• Depression, anxiety, reduced self-esteem — particularly significant in GCC culture
• Associated autoimmune conditions: thyroid disease

Diagnosis

Clinical exam with Wood's lamp. Blood tests: thyroid function, blood glucose, CBC. Skin biopsy rarely needed.

Treatment

• Topical corticosteroids (first-line); calcineurin inhibitors preferred for face
• Topical ruxolitinib cream (Opzelura) — newly approved, highly effective
• Narrowband UVB phototherapy — most effective for widespread vitiligo
• Oral ruxolitinib (JAK inhibitor); surgical melanocyte transplantation for stable vitiligo

Prevention

• Rigorous SPF 50+ sun protection — essential in Kuwait
• Manage stress; regular thyroid and blood sugar monitoring
• Seek early treatment to slow progression

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