The unexpected ringing of my mobile phone snapped me out of my sleep at 3am. I half-wished for the ringing to stop, but it persisted.
No choice, I thought. I have to answer the call - one of the downsides of being accessible to my patients, even in the middle of the night.
"So sorry, Dr Steven, but I am the father of Mr X, your patient with vitiligo. He is now sitting on the parapet, threatening to jump out of the window. Can you help?"
Rubbing my bleary eyes and trying to kickstart my still-sleeping brain, I struggled to remember the patient and formulate a plan to defuse the situation quickly.
Needless to say, I never did get back to bed that night.
Luckily, the story had a good ending for Mr X, who eventually stepped back from the edge.
The episode, which took place many years ago, kickstarted my journey into pigment research.
Mr X suffered from vitiligo, a chronic condition where one's skin loses its pigment, resulting in white patches across the body.
It is thought to be an autoimmune disease, where the body's immune system attacks and destroys skin pigment cells, known as melanocytes. Those affected often start to show symptoms in their 20s.
Pop star Michael Jackson, who died in 2009, was thought to be suffering from this condition, which resulted in his skin turning white. It was suggested that he wore his iconic white gloves to cover up patches of vitiligo.
Up until recently, vitiligo was viewed as a purely "cosmetic" disease. Some doctors have told their patients the condition is harmless and to "live with it".
Sometimes, we doctors forget how much physical appearance can impact the mental and emotional well-being of patients.
Vitiligo sufferers may endure relentless bullying. Some of my patients have been called "dalmatian", "zebra" or worse.
They encounter people who do not understand that the condition can be cruel, while their doctors, by sticking to cold hard facts, can be unknowingly insensitive.
There is no cure for vitiligo. Sufferers often turn to alternative medicine, folk remedies or miracle cures through word of mouth or the Internet. Most of them do not work.
As patients see white patches conquering vast swathes of normal skin, they turn to alcohol, drugs or, in Mr X's case, suicide.
SLOWING THE SPREAD
Fast-forward to today. Things have since improved.
While we still cannot cure vitiligo, we can slow or stop the spread of discolouration and restore pigment in more than 80 per cent of the cases.
What we cannot do is to prevent a relapse, though research is under way to address this.
Still, obstacles prevent some patients from accessing such care. One obstacle comes in the form of the deep-rooted myths associated with the condition. These include avoiding certain foods or activities like swimming, or that "vitiligo is a curse from my previous life".
Patients are also not seeking treatment early enough.
Our research has shown that patients have the highest chance of achieving re-pigmentation if they receive appropriate treatment within six months of the onset of the disease.
Unfortunately, most patients tend to ignore small patches and choose to self-medicate. In some cases, white patches could be misdiagnosed as fungal infections.
For those who seek help early, treatment can be done more quickly, leading to better results.
Seven-year-old Darren, who had vitiligo on his face, received treatment within two months of the onset of the disease.
He regained skin colouration completely within a few months.
There is hope, too, for patients like Mr X, who have had vitiligo for years.
Medical advances now allow doctors to harvest and transplant the patient's healthy pigment cells to the affected areas.
In cases of focal or segmental vitiligo - a sub-category of vitiligo which affects only a segment or a small part of the body - the success rates are more than 90 per cent, with relapse rates of less than 1 per cent.
The procedure is simple, taking less than four hours, but the effects can be life-changing.
Looking back on that fateful night, I am happy to note that we have made much headway at the National Skin Centre for patients suffering from vitiligo.
Over the last 10 years, we have witnessed thousands of patients regaining their skin colour and confidence, and living fulfilling lives.
It has been a long journey but there is still much work to do.
- Associate Professor Steven Thng heads the pigment clinic at the National Skin Centre, a member of the National Healthcare Group. He is in charge of managing all complex pigmentary disorders. He is also executive director of the Skin Research Institute of Singapore.
