2015 will herald the final episodes of the acclaimed cable drama, “Mad Men,” the story of secretive 1960’s era advertising executive, Don Draper.  Gradually, audiences have learned that much of what Draper appears to be is a lie, from his initial “happy” marriage to his very identity.  As portrayed by Cary Grant look-alike actor Jon Hamm, the character’s style, good looks and charisma conceal his private life. Hamm may not have a hidden side but he does have an affliction, hidden in plain sight. While he has a dab of white powder on his upper nose, note lighter than normal skin on the cheek to the right of his right eye.

 

Channel surf to current day reality programming: “The Next Top Model.”  As glamorous women vie to achieve maximum mannequin status, one of this year’s contestants, Winnie Harlow (Chantelle Brown-Young), reveals the same disease as Hamm, usually concealed with the latest in high tech makeup techniques.  These two TV personalities share a covert condition:  The cosmetically challenging, immune system over-reaction known as vitiligo.

 

Wait!  The astute Skinnies Awards spectator may blurt out:  Isn’t that Michael Jackson’s disease?  Short answer:  Yes, with caveats, but we’ll get back to that.

 

Just as Don Draper’s layers of lies have been peeled away over 7 seasons, let’s clear up what we can about this conundrum.  Vitiligo is an auto-immune disease, mysterious maladies where the mechanisms designed to fight off infections go awry.  In this case, white blood cells designed to battle invading bacteria instead direct their misguided energies attacking pigment cells in the skin.  


In turn, the color-generating melanocytes opt to stop producing pigment, creating localized, often symmetric regions of epidermis that resemble the bleached look of acid-washed jeans. Note the white patches on Hamm's hands. Usually, this means splotches of white on the face, hands and groin, but this can occasionally mean extensive bleached-appearing areas, mimicking albinism.


Why would such a thing occur? Hamm has brought up stress as a trigger, noting that his condition began at the same time as he felt mounting pressures from performing in a successful cable show. While it is clear that stress can spur “skin-flammation”, much like eczema and psoriasis, the research regarding vitiligo is not as...black and white.


There also are no clear links to diet, environmental exposures or the glare of TMZ’s flash bulbs. For some, such as reality show personality Tamar Braxton, vitiligo can be a life long issue. It is unlikely that Braxton brought this upon herself. Some things in medicine have to be attributed to bad luck or freak occurrences.

 

Which brings us back to Michael Jackson.  MJ famously came forward with vitiligo as the cause for the gradual extensive lightening of his skin tone.  There is enough current evidence to confirm that Jackson had the condition.  For most with vitiligo, the pattern is of small symmetric snow-colored islands, rather than an entire milky ocean. Note in this image, Jackson still has streaks of normal brown skin. Our take is that MJ had the condition and pursued medical treatments  to permanently bleach out the remainder of his skin.  We will not speculate whether that was to create a consistently light tone or an effort combined with plastic surgery to alter his physical appearance for other reasons. “Dermatologist” means “skin doctor” not “psychiatrist.”


Most with vitiligo don’t opt to zap their normal skin color, but rather turn to treatments that lessen the inflammation.  Topical ointments such as Protopic (tacrolimus) can safely revive melanocytes.  Phototherapy treatments can been used.  Unfortunately, not everyone responds to treatment and flareups can occur. Restoring pigment takes a long time, like the months spent waiting for new “Mad Men” episodes. Many women use the option afforded to models: Makeups that match the normal hue.


Kudos to Winnie Harlow.  Models are pressured to follow beauty trends, which usually mean an even epidermal tone. Yet she has elected to not always conceal her condition. Throughout the show and in photo shoots, she has elected to embrace her differences. Free of camouflage makeup, her videos and layouts work as both glamour shots and out-takes from a derm textbook.


While a simple permanent cure for vitiligo continues to elude us, the finale of “Mad Men” is coming soon.



Runner up:  The Skin-flammation Will Be Televised:

Kevin Bull, “American Ninja Warrior” with Alopecia Universalis


Alopecia areata lives in the medical neighborhood as vitiligo, though in this case the immune cells batter hair follicles rather than pigment cells.  Most sufferers have small bald patches, as Keanu Reeves can attest.
Kevin Bull, the bulked-up “American Ninja Warrior” contestant, has a rare total body variant, looking like he trained in a vat of Nair.  Hair-free is not the same as talent-free, as a trapeze-style flip moved him into the finals. 

Soon, there may be and option to rejuvenate his follicles.  2014 heralded a report of a novel anti-inflammatory treatment that re-grew a similar patient’s hair.  As they say on TV: Stay tuned!



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