Questions about the corona virus (COVID-19) and vitiligo: what does that mean for me?

It is logical that everyone is concerned and the question soon arises: am I now extra sensitive to the virus?

Vitiligo is an autoimmune condition of the skin, which means that (part of) the immune system does not work properly. The immune system is there to protect you against microorganisms (bacteria and viruses), but also against cancer. People with vitiligo often have a genetic predisposition to respond differently with their immune system. In vitiligo this results in the defense against pigment-forming cells (melanocytes), while there is actually nothing wrong with these cells. So it may sound alarming that the immune system is not working properly, but it is more likely to be overactive than underactive. This is already evident from the lower risk of developing melanoma in people with vitiligo and internal cancers also seem to occur less often in people with vitiligo. You could call it a kind of blessing in disguise. The overactivity of the immune system in vitiligo is a bit like a response to a virus, so it is expected that someone with vitiligo is NO longer susceptible to contracting the Corona virus or another virus. Of course, we do not (yet) have precise data about patients with vitiligo and their risk of contracting the virus and the possible severity of the disease that follows.

Of course there are always exceptions to the rule. There are autoimmune diseases that are more extensive (and can sometimes cause vitiligo) and yet are also more susceptible to certain infections. There are always more complaints than just vitiligo. An example is “common variable immunodeficiency” (CVID), a rare hereditary condition in which complaints of serious and frequent infections usually occur at a young age. In addition to vitiligo, a number of other autoimmune conditions can also occur. If you only have vitiligo and have not had a large number of serious infections since a young age, you most likely do not have CVID.

What can be a problem for people with an autoimmune condition (such as rheumatoid arthritis) is the inhibition of the immune system that arises from its treatment. This includes anti-immune drugs such as methotrexate, prednisone and TNF-alpha inhibitors, but there are many more. People with vitiligo are rarely or never treated with these types of systemic agents. Ointments and UV therapy do not exert a systemic brake on the immune system and can therefore be used safely. If you are being treated with dexamethasone pulse treatment, consult with your treating doctor whether you should stop or not.

New treatments that are used experimentally for vitiligo (such as JAKkinas inhibitors) are not yet used for vitiligo in the Netherlands. If you are being treated experimentally with this drug (for example through a trial abroad), please contact your treating doctor there. These drugs are already being used in rheumatology, so it is possible that there will soon be experience as to whether these drugs pose a problem in viral infections.

In summary, you will most likely not have an increased risk of contracting COVID-19 if you have vitiligo. If you use systemic remedies for your vitiligo, consult your treating physician. Of course, people with vitiligo must also follow the RIVM guidelines to prevent the virus from spreading further: wash your hands regularly, cough into your elbow, do not shake hands and use paper tissues. See:

https://www.rivm.nl/coronavirus/covid-19/vragen-antwoorden#eigengezondheid

This article is loosely based on the article by Dr. John Harris (on his blog, thanks John for looking into this matter. Here is the link to the article by John Harris, (University of Massachusetts Medical School, Vitiligo Clinic and Research Center) for the whole story in English. https://www.umassmed.edu/vitiligo/blog/blog-posts1/2020/03/coronavirus/