It’s just not fair, being peely-wally in Scotland’s less sunny climate

There’s not a great deal of love these days for looking a bit peely-wally. It’s the natural skin tone for someone who whose origins are the northern reaches of the British Isles. But you don’t see glossy magazines giving people tips on how to achieve that perfect “skimmed milk complexion”. I was explaining to a patient how having lighter skin would help with her vitiligo. This is a condition which affects the skin – or just below the surface of skin in the epidermis, to be more accurate. We’re not sure what causes it but there are cells called melanocytes and these produce a substance called melanin. This is what causes a tan in fair-skinned people, which helps to protect the skin from the sun’s rays. People whose origins are this part of the globe don’t tend to produce a lot of melanin. In darker-skinned people, the melanocytes are more active and produce more melanin. With vitiligo though, the melanocytes in certain areas of the skin are damaged and stop producing melanin. It affects around one in 100 people and can occur anywhere on the body, although the face, neck, hands, wrists and scalp are the most common areas. In white British people it tends not to be very noticeable and my patient’s patch was actually quite hard to see. Being peely-wally can sometimes be a boon, then, but not all people are so lucky. I have another Asian British patient and the vitiligo on her hand is much more noticeable as she has darker skin. While it’s not a painful condition, some people find it understandably upsetting, particularly if the face is affected. Camouflage creams can alter the colour of a patch of skin, and these can be available on the NHS. Fake tans might help, too. Steroid creams, applied when the vitiligo patch first appears, can be tried, but these can’t be used on the face. Various treatments exist, but there’s no easy cure unfortunately. One important piece of advice is to use high-factor sunblock. This will make vitiligo less obvious by keeping the surrounding skin paler. But, more importantly, skin lacking melanin has no protection from the sun, so sunscreen is recommended all year. That also means sunbeds are out, but in my opinion they should avoided by everyone anyway.