Michael Jackson and Vitiligo

This week LA Police Department released documents that were unsealed after a legal motion filed by The Associated Press. In these documents it is reported that detectives investigating Michael Jackson’s death found 19 tubes of hydroquinone and 18 tubes of Benoquin, both of which are commonly used in the treatment of the skin condition vitiligo. Jackson has claimed for many years that his lightening skin color was due to the skin disease. This claim was confirmed in the autopsy report after Michael’s death.

What is Vitiligo? (Source: NIAMS)

Vitiligo is a pigmentation disorder in which the cells that make pigment in the skin, called melanocytes, are destroyed. This causes white patches to appear on the skin in different parts of the body. Similar patches can also appear on both the mucous membranes (tissues that line the inside of the mouth and nose) and the retina (inner layer of the eyeball). The hair that grows on areas affected by vitiligo sometimes turns white. It can happen to people of any race, although it is more obvious in darker skinned individuals.

About 0.5 to 1 percent of the world’s population, or as many as 65 million people, have vitiligo. In the United States, 1 to 2 million people have the disorder.

The cause of vitiligo is not known, but doctors and researchers have several different theories. There is strong evidence that people with vitiligo inherit a group of three genes that make them susceptible to depigmentation. The most widely accepted view is that the depigmentation occurs because vitiligo is an autoimmune disease – a disease in which a person’s immune system reacts against the body’s own organs or tissues.

Vitiligo is more commonly found on sun-exposed areas of the body, including the hands, feet, arms, face, and lips. Other common areas for white patches to appear are the armpits and groin and around the mouth, eyes, nostrils, navel, genitals, and rectum. Vitiligo generally appears in one of three patterns:

* focal pattern – depigmentation limited to one or only a few areas
* segmental pattern – depigmented patches that develop on one side of the body only
* generalized pattern – the most common pattern. Depigmentation occurs symmetrically on both sides of the body.

How is Vitiligo Treated?

The main goal of treating vitiligo is to improve appearance. Therapy for vitiligo takes a long time – it usually must be continued for 6 to 18 months. The choice of therapy depends on the number of white patches; their location, sizes, and how widespread the patches are. Medical options include:

  • Topical steroid therapy – Steroid creams may be helpful in repigmenting (returning the color to) white patches, particularly if they are applied in the initial stages of the disease.
  • Psoralen photochemotherapy – Also known as psoralen and ultraviolet A (PUVA) therapy, this is probably the most effective treatment for vitiligo available in the United States. The goal of PUVA therapy is to repigment the white patches. However, it is time-consuming, and care must be taken to avoid side effects, which can sometimes be severe. Psoralen is a drug that contains chemicals that react with ultraviolet light to cause darkening of the skin. The treatment involves taking psoralen by mouth (orally) or applying it to the skin (topically). This is followed by carefully timed exposure to sunlight or to ultraviolet A (UVA) light that comes from a special lamp. 
    • There are two major potential side effects of topical PUVA therapy:
    • (1) severe sunburn and blistering and
    • (2) too much repigmentation or darkening (hyperpigmentation) of the treated patches or the normal skin surrounding the vitiligo.
  • Depigmentation – involves fading the rest of the skin on the body to match the areas that are already white. For people who have vitiligo on more than 50 percent of their bodies, depigmentation may be the best treatment option. Patients apply the drug monobenzyl ether of hydroquinone (monobenzone or Benoquin) twice a day to pigmented areas until they match the already-depigmented areas.  The major side effect of depigmentation therapy is inflammation (redness and swelling) of the skin leading to itching or dry skin. Depigmentation tends to be permanent and is not easily reversed. In addition, a person who undergoes depigmentation will always be unusually sensitive to sunlight and sunscreen is a must.

For more information:

Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.


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