Nail Clinic: A Vitiligo Voyage

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Understanding this common skin condition can help you provide safer and more sensitive nail services.

You've most likely seen vitiligo before; it manifests itself as light or white splotches of skin. It's one of those conditions that many people recognize when they see it, but few people know the technical term for the disorder, and even fewer understand why it occurs and the process behind its development. Undoubtedly, much of the stigma attached to vitiligo stems from an ignorance on the part of the general population. “Vitiligo can be a very socially stigmatizing disease, especially in patients with naturally darker skin types,” relates Seemal R. Desai, MD, FAAD, dermatologist in private practice at the Center for Skin & Cosmetic Dermatology in Dallas and diplomate for the American Board of Dermatology. “In some cultures, patients with vitiligo are ostracized from society, even though vitiligo isn't a contagious disease.” As a nail technician, you may come across this skin condition, and knowing more about it can greatly improve your services for these clients and put them at ease.


Vitiligo 101

Vitiligo is an autoimmune disorder that is easily noticed because it affects levels of pigment in the skin. “Vitiligo is becoming an increasingly common skin disorder, and is characterized by the body's immune system attacking melanocytes, or pigment-producing cells,” says Desai. The attack on healthy pigment-producing cells leads to patches of skin that lack color, meaning affected areas turn completely white. “It often starts in childhood, and is usually associated with other autoimmune diseases, including lupus, hair loss/alopecia, thyroid dysfunction and more,” Desai explains.
Once the symptoms of the condition start to materialize, it's a painless process to determine the condition. A dermatologist can easily diagnose vitiligo with a simple clinical examination, which requires no biopsy, explains Robert T. Brodell, professor of internal medicine, dermatology, at Northeastern Ohio Universities College of Medicine in Rootstown, Ohio. Once vitiligo is diagnosed, there are several methods of treatment available depending on the severity of the case or the client's preference. “The first level of treatment involves applying sunscreen so the adjacent skin doesn't tan and highlight the problem, as well as using cover-up cosmetics,” Brodell says. “The second level of treatment is administration of the drug Psoralyn in combination with UVA light treatment (known as PUVA therapy) to try to stimulate pigmentation, or a UVB laser to try to induce more pigment to develop in these spots. The third level is depigmentation therapy, where the normal skin is bleached to match the skin affected by vitiligo.”
According to the National Vitiligo Foundation (NVF), patients who undergo the second level of treatment (called repigmentation therapy) can expect to gain back pigment on only about one-eighth to one-quarter inch of skin during each year of treatment. However, the decision to undergo depigmentation therapy (the third line of treatment) is a serious one, since it permanently removes pigment from all skin on the body. Unfortunately, no single cure exists for vitiligo.

A Few Simple Steps
Nail technicians are especially prone to seeing vitiligo in the salon, since “this disorder, in its generalized form, often affects the skin color on the hands, especially the fingers,” relates Nanette Silverberg, MD, director of pediatric and adolescent dermatology at St. Luke's-Roosevelt Hospital Center in New York. You'll notice that clients who have had vitiligo for years are likely already aware of the ways in which they can make it less noticeable. Many use self-tanners or other skin-blending makeup to disguise the patches of unpigmented skin.
Before performing services, you should ask if the client is allergic to any substances; Desai notes that irritants may cause skin injury and should be avoided. Silverberg agrees that nail techs should avoid harsh chemicals and practice gentle skin care when working on clients who have vitiligo. For example, during the massage portion of services, use lighter pressure. As always, when in doubt, your client can ask her dermatologist if certain procedures are safe.
For clients with vitiligo, it is to your benefit to be very cautious when grooming cuticles. For their safety, do not cut any skin and gently push back cuticles. “Trauma, such as overmanipulating the cuticles or accidentally causing cuts, can worsen the disease,” says Silverberg. While you're used to keeping your implements clean and sterilized, that's not enough for clients with vitiligo. Even a perfectly sterilized implement can have a negative effect, so it's more important than ever to keep your focus!
Another important precaution clients with this disorder should take is to avoid sun exposure. “In general, patients with vitiligo should avoid excessive sun exposure that would cause their skin to burn, and thereby injure the delicate healthy skin and the areas of depigmentation,” advises Desai. “Skin damage can cause a tendency toward progression of the disease process.” One way you can assist these clients is to apply sunscreen following every manicure or pedicure service.
Unfortunately, many clients who have vitiligo are self-conscious about their appearance, and—just like any client—when they enter your salon they're looking for relaxation, understanding and the appropriate amount of attention. Because this condition has noticeable cosmetic effects, your services can be crucial in lightening a client's mood and raising her self-confidence. By following the few precautions when performing manicures and pedicures, you can offer these clients beautiful nails and safe services.

Tracy Morin is a freelance writer and editor based in Oxford, MS.