Chemicals can cause vitiligo and also make it worse

Patients with vitiligo frequently ask me why they have the condition. Patients often imply multiple things by this question, as I mentioned in a previous post here. "What causes vitiligo?" is probably the most exact interpretation. While the answer to this question is complex, the short version is "many things." We know, for example, that genes acquired from your parents have a significant impact on the likelihood of getting vitiligo. This is because it's more common in persons who have vitiligo or associated autoimmune illnesses in their families. I'll write a separate blog article about what we've learned recently about the genetics of vitiligo because it's a fascinating issue.

While genes do play a role in the development of vitiligo, they aren't the only factor.

We know this because identical twins, who have nearly identical DNA, don't always develop vitiligo. If one twin has vitiligo, the other is more likely to have it as well, however, this only occurs approximately 23% of the time, and most of the time just one twin develops it. If genes were not involved in the development of vitiligo, the probability of an identical twin of a patient developing the disease would be the same as for anybody else, around 0.5-1 percent So 23 percent is really high, indicating that genes have a significant role. If they were the sole factor, the risk in an identical twin would be 100%, far greater than the current rate of 23%. However, given the probability of vitiligo in twins is less than 100%, we conclude that genes are relevant, but not the whole explanation.

What more is there if genes aren't the complete story?

This question has been raised about various autoimmune illnesses, and the usual response is "environmental causes." But what exactly are these variables? The majority of clinicians and scientists believe these factors are viruses, which we are constantly exposed to and which activate our immune systems, making them suitable candidates. However, we've never been able to confirm a virus as an environmental element, at least in the case of vitiligo, so we're either missing something or need to seek something else.

In reality, in 1939, a substantial proportion of manufacturing workers who acquired vitiligo had one extremely noteworthy environmental component. Rubber gloves were worn by these manufacturing workers to protect their hands from the chemicals employed in the procedure. However, it was discovered that the gloves themselves contained a toxin that caused their vitiligo. Monobenzyl ether of hydroquinone, or monobenzone, is the chemical's name. It worked so well, in fact, that we now use it to remove the remaining pigment from the skin of people with widespread vitiligo in order to even it out. Benoquin cream is the name given to it by dermatologists.

This incidence strongly implicated chemicals as probable vitiligo-inducing environmental factors.

It also made people wonder if there are additional compounds that can do the same thing, and if so, what goods might contain them. Yes, other substances such as 4-tertiary-butyl phenol (4-TBP, present in adhesives) and 4-tertiary-butyl catechol have been linked as vitiligo-inducers (4-TBC, found in rubber and other products). All of these substances are phenols, which means they have a benzene ring with a hydroxyl group attached, for the chemists out there reading this. This is significant because they appear to be similar to the amino acid tyrosine, which is also a phenol and is needed by melanocytes to form the pigment melanin. As a result, melanocytes absorb these compounds as if they were the amino acid tyrosine, causing injury and inflammation, as well as autoimmune. This either causes or aggravates vitiligo.

An intriguing illustration of this occurred in Japan in the summer of 2013, when the cosmetics business Kanebo produced and sold an extremely effective skin-lightening product to hundreds of thousands of people. Unfortunately, over 18,000 people acquired vitiligo after using it, prompting the product's recall. It indicates that rhododendron, a phenol that resembles tyrosine and is an active element in the product, is responsible for causing vitiligo in people who took it. Current research, including our own, is targeted at figuring out how this mechanism works. One main source of concern is that skin whitening is a big business that attracts new products that could be harmful to patients. Here's where you can find out when "skin-whitening sweets" will be available here.

All of this raises the question, "Am I in contact with chemicals in the environment that have caused or may worsen my vitiligo?" There is some evidence that when persons avoid exposure to an offending chemical, their treatment response is much improved, and their vitiligo may be totally eliminated. So, how can we tell which compounds are present? We can't be certain about the ones that have already been identified (monobenzone, 4-TBP, 4-TBC, and rhododendron, as indicated above). We're working on it right now in the lab, and we expect to have an answer shortly. We might be able to prevent outbreaks like the rhododenol-induced vitiligo that occurred in Japan if we could screen compounds for their capacity to generate vitiligo.

There are a number of commercial items that have been reported to cause vitiligo, and the majority of them contain phenols, so until we finish our research on this, there are a number of commercial products that have been reported to cause vitiligo. Here's a link to a study done by an Indian group, as well as a list of suspect goods they found, which includes permanent hair dyes, some detergents, and other ornamental dyes used on the skin. The problem is that it is impossible to avoid all questionable products because it is unclear which products do this and which chemicals are directly responsible. Also, because every chemical is unlikely to have the same impact on every vitiligo sufferer, some products may be detrimental to some people but not to others. That is why the research that we and others are conducting on this subject is so crucial. We will undoubtedly share our findings once we obtain them. Stay tuned!

Consumer products (% of patients reporting exposure)

Hair dye (27%)

Deodorant/perfume (22%)

Detergent/cleanser (15%)

Adhesive “bindi” (12%)

Rubber sandal (9%)

Black socks/shoes (9%)

Eyeliner (8%)

Lip liner (5%)

Rubber condom (4%)

Lipstick (3%)

Fur toys (3%)

Toothpaste (2%)

Insecticide (2%)

Alta (decorative color on feet) (1%)

Amulet string (1%)

Multiple chemicals (68%)

Products related to work

Rubber gloves (12%)

Lubricating and motor oils (7%)

Detergents (5%)

Printing inks (4%)

Laboratory chemicals (2%)

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