Article written by Charity Nyawira
Medically reviewed by Amit G. Pandya, M.D., President of the Global Vitiligo Foundation
Vitiligo is a skin condition in which people lose skin pigment and develop patches of lighter skin, called macules. These patches, which can be white, pink, red, or brownish in color, can be widespread or may only affect a small area of the body. Vitiligo is not contagious — no one can get vitiligo through physical contact, sexual activity, or sharing utensils with a person who has the condition.
The effects of vitiligo can have a direct impact on the self-esteem of people who are living with the condition, and can lead to anxiety, depression, and relationship issues. Fortunately, there are ways of coping with the effects of vitiligo on self-esteem.
The Impact of Vitiligo on Self-Esteem
A study on the correlation between vitiligo and self-esteem found that the majority of people with vitiligo deal with low confidence and reduced self-esteem. According to the study, 70 percent of women and 54 percent of men who participated experienced self-esteem issues as a result of their vitiligo. The study also showed that self-esteem was significantly impacted among people who had vitiligo on exposed areas of their bodies. Those with darker complexions have also been shown to struggle more with their vitiligo, as the loss of pigment (depigmentation) is more visible on darker skin.
It can be frustrating to feel different because of vitiligo. As one MyVitiligoTeam member said, “Having vitiligo is a daily mind battlefield/rollercoaster. It can tear you into pieces emotionally. There are times when I feel I’m not normal, especially if the flaws are exposed. This disease can consume a person mentally. I also don’t wear shorts. I love the fall/winter season where you can cover up.”
While coping with these feelings can be challenging, there is hope for people who face emotional distress due to vitiligo. One study found that people with vitiligo were better able to cope with their feelings by participating in cognitive behavioral therapy (CBT), a type of therapy that focuses on addressing thoughts and behaviors that have a negative impact on a person’s well-being. This can significantly affect emotional health, because people with higher self-esteem have been shown to cope better with their vitiligo than those with lower self-esteem.
How Vitiligo Contributes To Low Self-Image
People with vitiligo may deal with poor body image and low self-esteem for a number of reasons. One cause involves the unpredictability of the condition. People with vitiligo may worry about their depigmentation worsening because the progression can be hard to predict. Patches of depigmented skin may remain the same for years, or could progress quickly to cover the entire body. As one member of MyVitiligoTeam said, “I don’t think I can live with myself if this becomes worse. I’m in the very early stages, and I don’t see myself being able to live like this!”
In addition, people with vitiligo may try to hide depigmentation using clothing or makeup to avoid comments or unwanted attention. This may cause stress and impact self-esteem. One study found that some people with vitiligo report having strong feelings of dissatisfaction with their appearance, even when patches of lighter skin are covered.
Feeling a sense of disempowerment — having no control over the progression of your depigmentation — is another way vitiligo may contribute to a reduction in self-esteem. Vitiligo is one of many chronic skin diseases that currently has no cure. While some drugs and treatment options, such as phototherapy, can help reduce depigmentation, these treatments do not prevent vitiligo from progressing.
Emotional Impact of Vitiligo on Children and Adults
Both children and adults can face emotional distress as a result of vitiligo. In particular, teenagers between the ages of 15 and 17 were reported to be the most self-conscious about their vitiligo among all pediatric age groups.
Children may face unique challenges, including strained peer relationships, reduced socialization, and social issues that may carry into adulthood. One of the biggest contributors to reduced self-esteem can be a misunderstanding of the condition.
Dr. Lisa Schuster, a licensed pediatric psychologist with the REACH Clinic at Children’s Medical Center in Dallas, Texas, explained that providing basic information about vitiligo will help children and others understand and dispel misunderstandings about the condition. “I think it is important for other children to understand the fact that this is not an infectious disease, because we want them to know that they can have close physical proximity with a child who has vitiligo and it won’t rub off on them,” she said.
Mood Disorders, Low Self-Esteem, and Vitiligo
People with vitiligo may experience psychological stress related to their condition, including depression and social anxiety. One member of MyVitiligoTeam wrote, “Having vitiligo can be very depressing. It has affected me a lot. Mostly when going out, people just look at you or don’t want any skin contact with you. It’s hard being in public.”
Another member described challenges involving covering up their vitiligo: “I have to use lots of makeup on my face to go to work. I start at 11:30 am. I have to start getting ready two hours early just to do my makeup. I’m 49 years old. I never used makeup. Sometimes I feel OK. Other times I feel like I’m wearing a mask.”
Depression and Vitiligo in Children and Adults
Depression affects both children and adults. Even parents and relatives of children with vitiligo may experience anxiety and depression.
Recognizing the signs of depression and other mental health issues is the first step to finding the right treatment and support. Dr. Schuster pointed out some patterns that may suggest a child is depressed:
- Significant changes in mood, including a depressed or irritable mood
- Sudden withdrawal from family and social activities
- Poor sleeping habits
- Changes in appetite
- Self-deprecating comments, such as “I’m worthless”
- Saying they are depressed
Signs of depression in adults may also include hopelessness, suicidal thoughts, losing interest, sadness, self-accusation, and suicidal ideation, among others. Signs of anxiety may include irritability, fear, stress, inability to relax, restlessness, and worry.
Treatment for Depression and Anxiety in Vitiligo
While depression and anxiety can be challenging to live with, these conditions may be treated in a number of ways. Some approaches to improving depression and anxiety in both children and adults with vitiligo include:
- Therapy — Psychotherapy can be an effective way to manage depression and anxiety. Specific types of therapy include CBT and acceptance and commitment therapy (ACT).
- Medication — Several medication options can be used to treat depression and anxiety, including antidepressants and anxiolytics, respectively.
- Proactive management — Working with a mental health professional can help you detect the early signs of anxiety and depression, and prevent progression.
How Parents Can Support Children and Teens With Vitiligo
There are many ways for parents of children with vitiligo to provide support, Dr. Schuster said. Parents must first deal with their own reactions so they don’t pass on stress to their children. “For example, if you are worried or upset, your children will feel upset too,” she said.
Parents should also explain vitiligo to children in such a way that it doesn’t frighten them or cause unnecessary anxiety, she noted. Parents should aim to “increase their comfort with what is going on,” Dr. Schuster advised. Rather than just telling children not to feel embarrassed, parents should allow children to talk about their feelings — if they want to.
When children with vitiligo are entering new environments or interacting with new people, parents should proactively educate the people who will be around their children. Educating others about vitiligo can help avoid social stigmatization and allow children to fit in more easily, Dr. Schuster explained.
Listening to your child and following their lead is crucial in helping them cope. Some children, for example, are not interested in treatment. Instead of continuing to push or pressure them to seek treatment, Dr. Schuster advised parents to allow their children to have a say in whether or not they would like treatment — and, if so, when.
Finding Self-Worth To Improve Self-Esteem With Vitiligo
There are many ways in which adults, teens, and children with vitiligo can help improve their self-esteem. Please realize that your self-worth is not tied to what your skin looks like. Try to find someone or something that brings you joy. Stay in the positive zone.