SINGAPORE — Appearance should not matter when professional capabilities fit the job role.

However, after repeated unsuccessful attempts to secure a frontline position in the finance sector, a business analyst believes that his unusual appearance might have something to do with his botched job opportunities.

The 32-year-old, who wanted to be known only as Mr Cheng, has a skin disorder called vitiligo (pronounced vit-ih-lie-go) that causes pale or white patches to appear on his skin. The late pop singer Michael Jackson was found to have this condition in his autopsy report.

Mr Cheng agreed to the interview with TODAY because he wants more people to know about this skin pigmentation disorder, but declined to use his full name or be photographed because he is unable to get past the “mental barrier”.

“I want to be ‘heard’ but not ‘seen’,” he said, adding that living with the visible skin condition has affected his self-confidence.

“I know people asking about my skin may not be coming from a judgemental place, but it still impacts my self-esteem. So I prefer to either stay at home or hang out with people whom I’m familiar with.”

The stigma that sufferers face are real, with people often making insensitive remarks or staring rudely.

The skin disorder affects an estimated 100 million people around the world, and it occurs when pigment-producing cells called melanocytes die or stop producing melanin, which gives skin its colour.

One of the major misconceptions that people have is that vitiligo is contagious when it is not.

It also does not usually cause physical discomfort to the person who has it.

Mr Cheng’s skin started losing pigment 14 years ago in his teens, leaving uneven pale patches around his eyes and body.

It began as a small white patch on his left upper eyelid. Over the years, it progressed to both eyelids, the side of his eyes and other parts of the body including the pelvic area, back of the neck and legs.

At first, the loss of skin pigment did not bother him. But as the disease progressed, the unwanted stares in public and the subsequent roadblocks in his career became increasingly demoralising. 

He had worked in a backend role on his job for three years but decided he wanted to take up a frontline position

He said: “Being exposed to different roles gives me a more holistic view of a business and opens up my career path and opportunities.

“In the frontline jobs that I applied for, I noticed (the interviewers) specifically asked what is wrong with my skin. I can understand why they would ask.

“After all, the job would require meeting clients and they may not be so accepting of my skin condition. If the clients are not happy with how I look, then they would not give me the opportunity even though I have the capability,” he said.

There are no official numbers on vitiligo prevalence in Singapore. Doctors estimate that the skin disease affects under 1 per cent of the population.

The National Skin Centre runs two specialised clinics for vitiligo every week, and around 30 to 40 patients attend each session.

At the Vitiligo, Psoriasis & Skin Clinic by DTAP, a private clinic located on Scotts Road, Mr Cheng is one of the 20 vitiligo patients who have sought treatment there in the last three months.

While most people living with vitiligo are usually physically well and do not feel any discomfort on their skin, Dr Lim Chun Siong from the DTAP skin clinic said that the emotional and psychological impact can be hard on them as they may endure discrimination, struggle with self-acceptance and other social challenges. Dr Lim is now treating Mr Cheng.

It does not help that vitiligo may be misunderstood to be a contagious disease. Dr Lim said that its appearance can resemble the early stages of leprosy, an infectious disease.

In a Singapore study published online in the Journal of Clinical Nursing in 2012, around 17 per cent of vitiligo patients were identified as depressed.

A GENETIC AND ENVIRONMENTAL LINK

It is unclear why pigment-producing cells die or stop producing melanin in some people.

Dr Lim said that the process is thought to be related to a combination of factors such as autoimmunity, nerve cell dysfunction and oxidative stress on the melanocytes, for instance.

Associate Professor Steven Thng, senior consultant at the National Skin Centre, said that vitiligo is associated with autoimmune diseases such as autoimmune thyroid disease and so, many consider vitiligo an autoimmune disease.

There is a strong tendency for vitiligo to run in families, which is why it is common for people with vitiligo to have relatives with the condition, he said.

Dr Lim said that up to half of people with vitiligo have relatives with the same condition and about 6 per cent have siblings with vitiligo, suggesting that both genetic predisposition and environmental factors later in life contribute to the development of the disease. 

Mr Cheng said that he recalled his older brother had the classic white patches of vitiligo in his youth, but his condition was mild and cleared up quickly with the use of steroid cream. 

While the condition may appear at any age, Dr Lim said that the symptoms usually appear around the age of 10 to 30 years. Girls tend to acquire the disease earlier, he added.  

Assoc Prof Thng said: “No one can prevent the onset of vitiligo but one can avoid vitiligo from worsening by avoiding the triggers.

“Stress is a well-known trigger as well as injuries to the skin. We have many vitiligo patients who find their condition worsening during periods of stress.” 

Other known environmental triggers include skin injury, severe sunburn and contact with certain chemicals, Dr Lim said.

NOT PREVENTABLE BUT HIGHLY TREATABLE

Assoc Prof Thng said that another common misconception is that vitiligo cannot be treated and as such, patients may delay consultation.

While the condition cannot be prevented, its progression can be halted.

“Patients do not need to suffer in silence thinking there is no treatment. As long as a patient comes to see us early (less than a month after onset of symptoms), the chances of halting progression and restoring pigmentation to normal is very, very high,” Assoc Prof Thng said.

“We have learnt that as long as we are aggressive with treatment at an early stage, we are able to prevent worsening and restore the patient’s condition back to normal or almost normal most of the time.

“For those with vitiligo for a long time, especially for those on the face, do not despair as we are able to restore the colours back in most of the cases,” he added.

The main aims of treatment are to stop and stabilise the spread of the depigmentation as well as restore pigmentation.

Assoc Prof Thng said that treatment depends on the type, extent and spread of vitiligo:

If the disease is spreading very fast, oral medications may be used to stabilise it and stop its spread. The medications can range from oral prednisolone, certain antibiotics or high-dose antioxidants.

When the disease is stable and limited to smaller areas, topical creams may be used to get the pigmentation back.

For those with widespread vitiligo, phototherapy is used to try to stabilise the disease and to get the colours back. Phototherapy can be successful 70 per cent of the time.

When all else fail, cellular grafts  — which involves transplanting healthy pigment cells over an area with no pigment — may be used to restore the skin colour. This has a success rate of 80 to 90 per cent, depending on the affected sites.

Dr Lim from DTAP Clinic said that the most effective ways of treating vitiligo these days are the use of narrow-band ultraviolet B (UVB) phototherapy and skin grafts.

As a physician attending to vitiligo patients, Dr Lim said that he often witnesses the dramatic change in a patient’s self-confidence before and after treatment.

However, Assoc Prof Thng has encountered patients who choose to live with vitiligo and forgo treatment. He estimated that they make up around 5 per cent of the patients that the National Skin Centre sees.

TIME-INTENSIVE TREATMENTS

In May this year, Mr Cheng decided to start phototherapy treatment because he noticed that the loss of skin pigment had increased in certain areas. The treatment has to be done three times a week for him, though it varies with different patients.

Previously, he used steroid creams but that did not help and he was concerned about long-term side effects, including the thinning of skin.

“With my current more flexible work-from-home schedule, I thought it might be a good time to get treatment. It must be done on a regular basis. Previously, it was simply too difficult for a working adult like myself to commit to regular phototherapy treatments,” Mr Cheng said.

He added that hospitals and centres offering phototherapy for vitiligo patients should consider having after-work hours clinics due to the intensive time commitments involved.

Mr Cheng’s phototherapy sessions, which have already led to some improvements, could take up to six months. He estimated that he would likely spend around S$6,000 to S$7,000 on the six-month treatment.

Phototherapy for vitiligo cannot be claimed under one’s Central Provident Fund’s MediSave account.

For older patients, however, they can claim under Flexi-MediSave, which allows those aged 60 and above to claim for outpatient medical treatments at specialist outpatient clinics and polyclinics in the public sector and general practitioner clinics under the Community Health Assist Scheme, Dr Lim said. The current limit for this is up to S$200 a year.

Mr Cheng said: “To me, it is more than just a “cosmetic” treatment because you can’t put a price on self-esteem.”