Vitiligo and COVID-19: Are you at risk?
by: John E. Harris
Many people are asking whether individuals with vitiligo are at higher risk for contracting the novel coronavirus, COVID-19, which is responsible for an ongoing pandemic. In general, the answer is no.
Vitiligo is an autoimmune disease of the skin, which means that someone with vitiligo has an immune system that is malfunctioning in a small way. The normal role of the immune system is to protect you from infections and cancer. Just like any trait that you may have (height, weight, hair color, etc), your genetic makeup can influence the quality and strength of your immune response. In vitiligo the immune cells are attacking the melanocytes, or pigment cells, even though the cells are not dangerous.
So just like some people are very tall, some are very short, and most are somewhere in the middle, some people have an immune system that is very strong in one area, very weak in an area, or somewhere in the middle. Individuals with vitiligo have an immune response that is too strong against their melanocytes, which results in these normal cells being killed and white spots appearing where that happened, because they can’t make pigment anymore. This is actually good from one perspective, because it means they have a lower risk of developing melanoma and other skin cancers (that’s what that part of the immune response is supposed to be doing – protecting from melanoma). So that “malfunctioning” immune system is causing white spots on your skin, but also decreasing your chances of getting skin cancer – I guess whether this is “good” or “bad” depends on your perspective.
But in any way you look at it, it doesn’t mean that your immune system is weak because you have vitiligo. It actually means that it’s a little too strong, so you are most likely NOT more susceptible to coronavirus or any other virus. Some of my patients report that they get fewer infections than their friends and family, and this may reflect the fact that the immune system is a little overactive. But just because the immune system is overactive in one small aspect (against the melanocytes), it doesn’t necessarily mean that it’s strong in every aspect, so everyone is probably a little different. But overall the take home message is that having vitiligo does not mean your immune system is weak, or that you are more likely to get an infection.
Of course, there are always exceptions to the rule. In very rare cases, patients get autoimmune diseases because their immune system has a more significant malfunction that can make it more likely to get both vitiligo (or other autoimmune diseases) AND infections. This is not the case for most people, and if you had one of these syndromes you would probably know it by now.
Another caveat to think about is when vitiligo patients are using treatments to either prevent the spread of their disease or to reverse it. Most of these medicines suppress the immune system in some way, since the central cause of vitiligo is autoimmunity, or overactivity of the immune response. In fact, that’s why they work. Many are using topical ointments or creams, and these have a VERY low (or NO) risk of affecting your ability to fight infections, since very little, if any, of the drug goes beyond the skin. In addition, many are using narrow band UVB light treatments, which again only affect the skin and this is no more dangerous than going out in the sun (actually much LESS dangerous, but that’s another topic).
In summary, in most cases, you are not at a higher risk of getting COVID-19 if you have vitiligo. If you are taking medicines for vitiligo and are still concerned about how it may affect you, talk to your doctor. Please do your part to prevent the spread of the virus during this pandemic, by washing your hands, not gathering in large groups, and meeting with people over the phone or videoconference instead of in person when possible. There are 3 things that affect the spread of the virus:
how many people have it today,
how many people that they come into contact with each day, and
how quickly the virus is able to spread.
You can affect two of those variables by limiting contact with others and washing your hands regularly. Stay safe!