Bridging the disconnect between clinical perception and lived experience: the need for a holistic approach to vitiligo

Vitiligo, a chronic dermatological disorder caused by the autoimmune destruction of melanocytes, leads to patches of depigmented skin.

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Though it poses no direct risk to physical health, its impact on mental, emotional, and social well-being can be deeply disruptive. In clinical settings, vitiligo is still largely treated as a pigmentary issue — a condition of the skin. But for the millions who live with it, the reality is far more complex.In appearance-conscious societies like India, where prevalence rates of vitiligo range from 3% to 8.8%, and where fairness and symmetry are often conflated with beauty, credibility, and even professional competence, visible skin differences such as vitiligo invite intense scrutiny, stigma, and bias. What is routinely dismissed as a “cosmetic” concern becomes, for many, a daily struggle for dignity. This disconnect between clinical perception and lived experience lies at the heart of vitiligo care and is precisely why a holistic approach is not optional but essential.

For individuals with vitiligo, everyday life is often shaped by an unspoken but relentless social gaze. Whether it is unsolicited advice, insensitive remarks, or assumptions of contagion, the emotional costs run deep. Many patients internalise this scrutiny, leading to lasting feelings of embarrassment, social withdrawal, and persistent anxiety.A recent study involving 430 government employees with vitiligo—published in the Annals of Plastic and Reconstructive Surgery—offers a sobering look into this reality. Using four validated psychological tools, the study captured the overwhelming emotional and social burden carried by patients. The majority reported a severe decline in quality of life, with over 80% experiencing significant disruption to daily functioning, and more than half struggling to process or express emotions (a condition known as alexithymia). Every participant reported feelings of embarrassment, frustration, social isolation, and sexual dysfunction, revealing just how deeply vitiligo affects personal and psychological well-being.