By Stephen Ssenkaaba

I never knew why she kept her sweater on even during the midday sun, until Mina confided in me. “I have a skin disease,” she said. When she pulled the long sleeves of her blouse, I noticed a clean pink arm, as if her hand had been severely burnt.

Mina says she suffered from Vitligo, a condition that leads to peeling of the skin, creating light patches on the body. Considering her deep dark complexion, this young lady’s hand looked unusual.  “It is killing me,” she said. I try to avoid people seeing it.”

Mina says she found out about her condition when she was a teenager. “A medical doctor explained it to me in detail.”

Before that, her family said she had been “burnt by twins (abolongo bamwokya)”. This is a popular myth in some cultures in Uganda, particularly the Ganda culture. They believe that failure by families to observe cultural ceremonies that initiate twins into a family, often result into a serious backlash.

The ceremonies involve gathering clan members and the extended family and holding a dance party to commemorate the birth and dedicate the twins to the gods. Once a family fails to perform this function,one elder says, the twins in vengeance will scald one of the members of the family.

Medical explanation
Skin specialists can now reveal that such explanations are not only backward, but also prevent people from seeking right medical interventions. “Vitligo has nothing to do with twins,” says Charles Simuya, a dermatologist.

Cause
“It is an autoimmune disorder, a condition that occurs when the body’s immune system mistakenly attacks and destroys healthy body tissue,” he says.

Once this happens, the cells that are responsible for the production of melanin — the natural substance that gives colour (pigment) to the skin are destroyed. Such a condition leads to what dermatologists call hyperpigmentation (irregular or patchy discolouration of the skin).

Simuyu says this condition may appear at any age. “Sometimes it is congenital (acquired at birth).For others, however, it comes much later in life.”

The condition presents in very distinct ways. According to the US National Library of Medicine, this condition presents “when flat areas of normal-feeling skin without any pigment appear suddenly or gradually.

Such areas obtain a darker border and irregular borders.” Vitligo most often affects the face, elbows and knees, hands and feet, as well as genes. It is also more noticeable in dark-skinned people.

Family links
It is also believed that vitligo is inherited. “There is a familial connection to this condition which means that if one’s forefathers experienced it, there is about a 10% that their descendants will have it,” says Musinguzi.

“Indeed, studies have shown that about 30% of people with vitiligo have a family member with the condition.” These theories rule out any cases of cultural causes to this complex and disturbing condition.

While this condition can have debilitating effects, it is not widely prevalent. According to online sources, only about 0.5 to 1% of the world’s population, or as many as 65 million people, experience this condition.

According to Dr. Patrick Musinguzi, a medical officer at the Mulago Hospital dermatology unit, no studies have been undertaken to establish the prevalence of this condition in Uganda. “But we often see a number of people with this condition on a daily basis.”

While this condition is usually painless, it can have psychological effects on individuals that experience it.

Janice Katimba always wears long sleeved blouses and only a few close friends and family know her condition. “My arms are not pretty,” she told me. “I have to hide them away from the public.” Vitligo can bring such feelings of unworthiness for people that experience it. 

If not well handled, says Musinguzi, it can lead to depression. While there is no permanent cure for this condition Musinguzi says steroids are administered to stimulate cells in the hair roots to aid pigmentation.

“In other cases, it is possible to pick a normal skin from one part of the body and put it in the affected place (skin grafting).
It helps to understand that culture for all its importance, plays no significant role in this condition. This is the beginning to managing it.