Q&A: Expert discusses causes of vitiligo as Kim Kardashian opens up about son’s diagnosis
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Key takeaways:
- Kim Kardashian stated that she passed vitiligo to one of her sons.
- John E. Harris, MD, PhD, discusses the genetic and environmental causes of vitiligo among children and adults.
With Kim Kardashian speaking out about her son’s experience with vitiligo, Healio Dermatology sat with an expert to discuss the condition in the adult and pediatric populations.
On July 16, Kim Kardashian opened up about her son’s autoimmune disease, which was revealed to be vitiligo, that she claimed to have passed down to him.
“It came from my mom, went to me ... and I passed it on in a different form to my son, who has vitiligo very mildly,” Kardashian said in a People Magazine article.
As Healio previously reported, Kardashian has plaque psoriasis and, based on her statement, she believes her autoimmune disease induced vitiligo in her son.
Healio spoke with John E. Harris, MD, PhD, founding director of the Vitiligo Clinic and Research Center, founding director of the Autoimmune Therapeutics Institute, professor and chair of the department of dermatology at UMass Chan Medical School and a member of Healio Dermatology’s Peer Perspective Board, about the genetic component, environmental causes and prevalence of vitiligo among children and adults.
Healio: Kardashian claims that she passed the condition to her son. Are genetics a factor in developing vitiligo?
Harris: The way Kim Kardashian phrased this is a little confusing. She does not have vitiligo and neither does her mom — they have psoriasis — so she did not pass vitiligo down to her son. It is true that in some cases there are genes that you can pass along that will cause a nonspecific autoimmune disease, but we don’t think there’s much overlap between psoriasis and vitiligo. We just don’t see that.
On the other hand, if you do have vitiligo, it increases the risk for your children getting it as well. The risk for getting vitiligo in the general population is about 1%, but if you have a parent with vitiligo, the risk is about 6%. While this percentage is not high, it does indicate that genetics play a role.
On top of that, if a person’s identical twin gets vitiligo, the risk for developing vitiligo is 24%. Now that is a big jump because they share a lot of genes, which again indicates the importance of genetics. However, genes don’t play the entire role. If it did, the risk between twins would be 100%.
Healio: How common is vitiligo among children?
Harris: It is very common to see the onset of vitiligo occur in children. Fifty percent of people who get vitiligo get it before age 20 years and 80% get it before age 30 years. This doesn’t mean it’s common in children, it just means that of the 1% that have vitiligo, half of them are children.
This is probably because genetics do influence the disease and the immune system is fully created in young childhood. Since vitiligo is an autoimmune disease, it is just a matter of time before the immune system initiates the disease.
Healio: What do we know so far about the factors that cause vitiligo?
Harris: We know a lot actually, a lot more than with other autoimmune diseases, interestingly. When people talk about autoimmunity, they bring up nature vs. nurture and ask themselves how much of this disease is caused by genetics vs. how much of it is caused by the environment. Clearly, we know a portion of it is genetics, but because it is not all genetics, environment must play a role as well.
I would also add a third factor that a lot of people don’t think of called stochastic influences — things that happen by chance. The way I explain it is, imagine you have a deck of cards and your friend has a deck of cards. You can deal a hand from that exact same deck of cards, but the two of you can have different hands. That is what the immune system does.
Your genes make it more likely that the immune system is going to deal you an autoimmune disease, but it is not guaranteed. A good example of this is the identical twins we discussed. They were raised in the same household, have the same exact genes but one gets vitiligo and the other doesn’t. That means there must be some element of random chance.
So those are the three influences: genetics, environment and stochastics.
Healio: What environmental factors cause vitiligo?
Harris: A lot of people, when they think about autoimmunity and the risk for developing it, assume that infections could play an important role. People often remember having been sick a few months before they got vitiligo and believe that the virus triggered their disease. But the truth is, almost everyone has had some sort of cold within the past few months. While a virus could play a role, it is hard to know; but we are conducting an NIH-funded study to answer that question.
On the other hand, we do know a lot about the environmental exposures that cause vitiligo including a number of different chemicals. In the 1930s, half of a group of factory workers got vitiligo from wearing gloves at their job to protect themselves from chemicals to which they were exposed. However, in the glove was another chemical, a rubber accelerator, which was discovered to induce vitiligo.
Another example, and the most common one, is permanent hair dyes. Using a permanent hair dye before the age of 30 for more than 5 years increases the risk for vitiligo by 50%.
Additionally, in 2013 in Japan, a skin lightening cream caused over 18,000 people to get vitiligo. More recently, a patch that delivers methylphenidate — the same stimulant used in Ritalin (Novartis) — can also cause vitiligo. Over 50 kids have gotten the disease from using that patch, with the first spot of vitiligo starting where the patch was applied and then spreading.
So, a common feature of all of these chemicals is that they have a chemical structure that makes them look very similar to the amino acid tyrosine. Tyrosine is an essential amino acid that we all need — it is the building block of melanin. What we think happens is these chemicals mimic that amino acid, confuse the melanocytes and somehow that process induces autoimmunity resulting in vitiligo.
Now, this doesn’t explain why kids particularly get it, and while most of the chemicals I mentioned have been taken off the market for causing vitiligo, the incidence of vitiligo is still increasing. So, there may be unknown chemicals that we just haven’t identified yet.
Healio: Do you recommend your patients stop using the chemicals that are still available?
Harris: Yes, we have that conversation. I can tell you maybe 50% of my patients stop using hair dyes if they’re using it when they hear about this. But the other 50% say “I’ve been dying my hair for 30 years and that would be a huge life change for me” and then choose not to stop using hair dyes.
Either choice is fine, they just have to be aware of the risks. Additionally, I have plenty of patients who dye their hair and respond well to treatment in vitiligo. It comes down to a personal choice.
Editor's note: On Aug. 9, 2024, the statistic on the number of children that developed vitiligo after using the methylphenidate patch was corrected to reflect over 50, not 50%. The editors regret the error.
Reference:
- Kim Kardashian opens up for first time about son's rare skin condition: ‘I Passed It On.’ https://people.com/kim-kardashian-reveals-one-of-her-sons-has-rare-skin-disease-i-passed-it-on-8679957. Updated July 18, 2024. Accessed Aug. 2, 2024.
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