Dermatologist Explains Vitiligo with Factory Metaphor

Medically reviewed by Dr. John Harris, dermatologist and Director of the UMass Vitiligo Clinic and Research Center.

What is vitiligo? Do you actually know?

Ever since my first vitiligo spots appeared when I was seven, I knew the basics about vitiligo – it made my skin turn white and I knew I was losing pigment – but I struggled to actually understand why. And then a conversation with Dr. John Harris gave me the “light bulb” moment I had been looking for.

Director of the University of Massachusetts Vitiligo Clinic and Research Center, Dr. Harris is one of the leading dermatologists with the Vitiligo Working Group. At the University of Massachusetts, he works as both a doctor and a scientist, seeing patients and overseeing innovative research into what vitiligo is and what causes it. Needless to say, he knows a lot about vitiligo.

So when I asked Dr. Harris to explain vitiligo, I was expecting a highly technical medical definition filled with words I didn’t know. Instead, I was pleasantly surprised to hear an explanation I could understand – vitiligo as a malfunctioning factory.

How your immune system identifies issues

Since vitiligo is an autoimmune disease – meaning it’s tied to malfunctions of your immune system – Dr. Harris started the conversation by reviewing the basics of your immune system and how it identifies problems.

“The immune system’s job is to protect you from infection and cancer – like viruses, bacteria, and parasites. So how does the immune system know that there is an infection? How does it know the difference between a normal cell and a virus-infected cell? How does it know something is wrong? The first sign is that viruses have proteins that humans don’t, so immune cells can recognize a virus-infected cell as something that is abnormal in the body, that it doesn’t belong. Another red flag is when immune cells sees other cells in your body working extremely hard.”

Your cells are like little factories

Next, Dr. Harris talked about how all of our cells operate like factories.

“All of your cells are always making things – they’re like little factories. If a factory is running beyond its capacity, there will be signs – smoke billowing out, people running in and out, too much electricity being used. Even though you can’t see what’s going on inside, the factory will look like it’s working too hard from the outside. There could be multiple reasons your cells could be overworked – it could be that a virus has infected it. If a virus gets in, it turns the cell away from what it should be doing and makes it a virus factory. When this happens, the cell doesn’t know how to do it well and it makes mistakes and uses a ton of energy. The immune system recognizes that the cell is working beyond capacity and using too much energy and identifies it as a problem.

So what does this have to do with vitiligo?

Stay with me, this is where vitiligo comes into the metaphor.

“Vitiligo affects melanocytes. Melanocytes are very busy protein-producing cells that create coloring. In most people, the melanocyte factory works really hard, but not beyond capacity. In vitiligo patients though, the melanocyte cells can’t handle all the stress of production so they start sending out signals that make it look like it might be infected. Even though it’s not unhealthy – even though it’s not making viruses or cancer – it starts sending out signals that look the same way to the immune system.”

So when do the melanocytes die?

Final step. Here’s where it all comes together.

“When the immune system recognizes that a cell is working too hard and could possibly be a virus, it goes in and kills that cell to protect you. And that’s the problem in this case. Your cells – the melanocytes – are doing what they’re supposed to be doing. So the immune system doesn’t have to kill them, but it mistakes the melanocytes for virus-infected cells and does kill them. We need to be able to help the cells work better so that the immune system doesn’t kill them.”

And there you have it. Our vitiligo cells are like factories that are struggling to operate and the immune system mistakenly comes in to save the day by “putting out the fire” – killing our cells. As a result, you slowly watch your skin turn white as your immune system attacks your cells.

What do you think? Do you have a better understanding of vitiligo now? If this resonates with you, share it to help others understand vitiligo too.