Two weeks ago, I watched in disbelief as a senior Mauritian MP was verbally assaulted by the speaker of the National Assembly on account of his vitiligo. During this altercation, Sooroojdev Phokeer told Rajesh Bhagwan: “Look at your face!” eleven times. Watching this aggressive outburst sickened me not just as a medical specialist, who treats people with skin disorders, but above all, as a human being.

As a consultant dermatologist practising in Melbourne, Australia, I see patients with vitiligo on a weekly basis, and I have witnessed first-hand how psychologically devastating it can be. Sadly, patients with vitiligo are often subjected to bullying and abuse. Discrimination on the grounds of an innate trait, such as sex or colour of one’s skin is bad enough, but to discriminate openly and belittle someone because of his or her medical condition is nothing short of reprehensible. The remark directed at Rajesh Bhagwan illustrates such a lack of empathy, never mind a lack of professionalism.

Vitiligo is the most common depigmenting skin disorder, with an estimated prevalence of 0.5–2% worldwide. It affects people of all ethnic groups and skin types, with no age or sex predilection. Fifty percent of sufferers develop the condition before the age of 20. Vitiligo is a multifactorial disorder characterised by loss of functional melanocytes, the pigment-producing cells, which give the skin its tan. Consequently, destruction of melanocytes results in loss of the skin’s normal colour. Genetic, autoimmune and inflammatory mechanisms have been implicated in its development.

Vitiligo has a distinct appearance, with solitary or multiple white patches, which can involve any part of the body, although the face, neck, hands, armpits, lips and genitalia are more commonly affected. Loss of colour may also affect scalp hair, beard, eyebrows and eyelashes. Although vitiligo sufferers come from all racial backgrounds, it is much more prominent in those with darker skin types due to the sharp contrast between the pigmented and depigmented skin. The localisation of depigmented patches to sensitive areas such as the face, hands and genitalia makes sufferers understandably self-conscious.

There is as yet no cure for vitiligo, but a range of treatment options are available. These include creams and ointments (corticosteroids and calcineurin inhibitors), phototherapy (commonly referred to as “light treatment”) and surgery (skin grafting). In patients with refractory disease, camouflage techniques or even depigmentation therapy (bleaching the remaining pigment to make the skin uniformly white) can be considered. I have been fortunate in my practice to have access to newer treatments, including oral tofacitinib and baricitinib. While these agents are by no means perfect, they have showed promise with high rates of re-pigmentation. I appreciate some of these will not be available in Mauritius, but certainly first-line treatments, such as topical agents and phototherapy, which, if used correctly, can make a significant difference, should be offered to vitiligo sufferers.

Every challenge presents an opportunity for a positive change, and this unfortunate incident may just be the wake-up call that Mauritius needed to raise awareness of skin diseases. I felt a glimmer of hope hearing that former education minister Armoogum Parsuramen and vitiligo sufferer Nitish Nastilli were in the process of setting up a Mauritian vitiligo support group. I congratulate them on this wonderful initiative, and I encourage Mauritians afflicted with other debilitating skin conditions, like eczema, psoriasis and hair loss to follow suit. If I may suggest, all relevant stakeholders, including patients, parents of young children with vitiligo, general practitioners, dermatologists and camouflage or makeup artists, should be invited to join the vitiligo support group. At the end of this article, I have attached a list of vitiligo patient support groups from around the world, which are doing a lot to raise awareness, impart knowledge, sponsor research and alleviate the pain of sufferers. I am sure they would be happy to share any advice on the setting-up and running of their organisations. One of these groups, Vitiligo Support UK, described the speaker’s behaviour as “disgraceful” on social media.

Vitiligo, or any other skin condition, does not define a person. Vitiligo sufferers contribute to society just as much as anyone else. In fact, celebrities with vitiligo, such as the “King of Pop” Michael Jackson, Bollywood icon Amitabh Bachchan and BBC talkshow host Graham Norton, have transcended their medical condition to inspire millions of people. When we think of Michael Jackson or Amitabh Bachchan, it is not their skin that comes to mind.

Discrimination based on skin colour has caused immeasurable damage and suffering in the world. In Australia, the Racial Discrimination Act 1975 makes it unlawful to discriminate against a person because of his/her race, colour, descent, national origin or ethnic background. I would hope that we do not need legislation to tell us how to treat our fellow Mauritians who look different because of a skin condition. Surely, we can find it within ourselves to understand that vitiligo sufferers are equally entitled to dignity and respect.

By Dr Bevin Bhoyrul

Consultant dermatologist, Melbourne, Australia Twitter/ Instagram: @DrBevinBhoyrul

<p>&bull; Vitiligo Association of Australia: vitiligo.org.au</p>

<p>&bull; Vitiligo Support UK: vitiligosupport.org.uk</p>

<p>&bull; Association française du vitiligo : afvitiligo.com</p>

<p>&bull; MyVitiligoTeam: myvitiligoteam.com</p>

<p>&bull; Vitiligo Society: vitiligosociety.org</p>

<p>&bull; Vitiligo Support International: vitiligosupport.org</p>

<p>&bull; Global Vitiligo Foundation: globalvitiligofoundation.org</p>