THE KING of Pop Michael Jackson suffered from vitiligo, a condition that causes skin discoloration especially among areas of the skin with too much exposure to the sun. Few were aware that his vitiligo, which he claims to have inherited from his father’s family, was an offshoot of lupus erythematosus, a disease characterized by inflammation of tissues and joints due to the immune system attacking the body’s own tissues.

“An autoimmune disease is when the body is being attacked by its own immune system because it thinks that the body’s tissues are foreign,” said Dr. Ma. Angela Cumagun of the UST Hospital’s department of dermatology.

Vitiligo is a chronic skin condition caused by the autoimmune destruction of melanocytes—cells responsible for skin pigmentation. Cumagun said the cause of vitiligo is still unknown.

“Vitiligo can be caused by a combination of genetic and environmental factors like sun exposure and stress,” she said.

Signs of vitiligo include appearance of white patches on the extremities, which are likely to spread to other areas of the body once the disease worsens.

Karen Faye, Jackson’s makeup artist, said in a television interview that the singer had discolored skin on his arms, legs and face, which he tried to hide by using layers of make up.

Cumagun said that “the disease is incurable although its symptoms can be controlled.”

The use of corticosteroids and PUVA therapy, a method that uses a combination of medications and ultraviolet A therapy to repigment the white patches, is effective if the spread is mild. If more than 50 percent of the body have vitiligo patches, the treatment should include grafting of skin, melanocytes, and chemical depigmentation.

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While vitiligo is not a lethal disease, Cumugan said it can have a dramatic effect on the patient’s lifestyle.

“The disease itself is socially and psychologically depreciating because of its effect on the patient’s appearance. In Jackson’s case, he had to use monobenzyl to cover up his vitiligo because of his celebrity status. If people see him with vitiligo, it can affect how the media see him,” she explained.

Discoid lupus erythematosus (DLE) made Jackson’s vitiligo worse. An autoimmune disease like vitiligo, DLE is caused by the overproduction of defensive antibodies that begin targeting healthy tissues.

Dr. Helmar Soldevilla, fellow at the hospital’s department of internal medicine, said that the occurrence of vitiligo along with lupus, such as in Jackson’s case, is possible because of the nature of the two diseases.

“Any autoimmune disease can precede each other. It’s either the lupus or the vitiligo arrived first,” she said.

Soldevilla said that there are two kinds of lupus. The first is the cutaneous lupus, which includes DLE. It produces lesions leading to scarring, hair loss, and skin patching on exposed areas like the face and scalp.

“Its manifestations, however, only show on the skin. But there is still a big chance for DLE to eventually evolve into systemic lupus,” she said.

Another is systemic lupus erythematosus (SLE), which is considered the most common type of lupus. Kelley’s Textbook of Rheumatology stated that one in every 1,000 people has SLE, mostly women. SLE’s onset can be acute, with symptoms manifesting within six months, or chronic, if the condition lasts for more than six months.

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“Systemic lupus can manifest in a variety of ways.” Soldevilla said. “Because of abnormal signals from an already hyperactive immune system, any tissue in the body can be attacked.”

Common SLE symptoms include swelling and scarring of joints, pericarditis or the inflammation of the sac surrounding the heart, high blood pressure, kidney damage, and nervous system damage.

To diagnose lupus, the patient’s medical history, and physical assessment need to be obtained. Laboratory tests should be conducted.

“Early diagnosis of lupus is difficult because not all the symptoms manifest, and because all lupus patients are unique,” she said. “The doctor must have a good index of suspicion and must be alert for the manifestations characteristic to lupus like the malar, or butterfly rash.”

Lupus is also incurable. Management of the acute and chronic symptoms can only be through anti-inflammatory drugs, and immunosuppressive agents. Soldevilla stressed that the main goal of the treatment is only to control the symptoms of lupus.

“There is no real cure for lupus. And because there are many different forms and manifestations of the disease, cooperation and dedication of both the patient and doctor are important,” she said.

Anti-neo plastic agents (which are also used in treating cancer) to stop the hyperactivity of the immune system, may also be used, she added.

But while lupus may appear to be a difficult disease, Soldevilla stressed that symptoms can be controlled if the patient complies with the treatment. “If the patient can follow the treatment plan and report to the doctor regularly, then the current symptoms can be controlled and fatal symptoms can be avoided.” she said. Julienne Krizia V. Roman

3 COMMENTS

  1. I’m quite surprised to find such an in depth article on MJ’s autoimmune disease here. Many people, especially Lupus sufferer & MJ fans it seems suspect he my have had SLE rather than DLE. Everything fits into this picture, the weirdness, the lung issues, the long years of breaks between albums, his sometimes bloated appearance, particularly in 2001, etc etc.

    This is a very interesting blog from a Lupus sufferer you might find of interest: http://stateandlake.net/wp1/2009/06/did-michael-jackson-have-discoid-or-systemic-lupus/

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