"Speaking of Vitiligo..."

Believe it or not, among the most commonly searched terms with vitiligo on Google Search is Michael Jackson. That’s probably because he is the most famous person to have claimed to suffer from vitiligo, and the disease is rumored to be responsible for a number of his well-known quirks, like wearing a single white glove. But possibly the most controversial discussion about Michael Jackson is the fact that his skin seemed to get lighter over time, and he was accused of using a bleaching treatment on his skin. That, combined with multiple plastic surgeries that changed a number of his features (nose, chin, etc), suggested that he wanted to look less like himself, and more like someone else – some have said he “wanted to look white”. The discussion is complicated, as was his life, but I think there are a few things that I can clear up in this post.

Michael Jackson was undoubtedly an incredibly talented performer, maybe one of the best in history. I remember seeing his music video Thriller, and being utterly amazed at just how innovative he was, not to mention a great singer, songwriter, and dancer. His fame began as a young child (6 years old) when he sang with his brothers in the Jackson Five, and so he spent almost his entire life in the public eye. That is not easy for anyone, but imagine him as a young person, maybe the most famous person on earth, when white spots started to appear on his skin, including his hands and face. He was likely embarrassed and ashamed (like many people with vitiligo who AREN’T constantly on camera for the world to see), and probably did not know exactly what was happening. And if he did get diagnosed early, his doctor wouldn’t be able to tell him how extensive it would become, or whether he would be able to successfully hide it with clothing and makeup.

First, we know that Michael Jackson stated that he had vitiligo, although this was not until many years after rumors were flying about his “turning white” and his many surgeries. The best-known occasion on which he addressed his vitiligo was during an interview with Oprah on her show in 1993. He said that his skin started to change sometime after Thriller, which was released in 1982, so he was about 24 years old when it started, and he had progressed for about 10 years at the point of the interview. He was a 24-year old, one of the most famous people on earth for his music, dancing, and music videos, and he acquired a disease that started to change his appearance and was very difficult to hide. I have met and treated many patients with vitiligo, and I can tell you that for many, even those who are not public icons, it is devastating. They often become the focus of attention in any public place, getting stared at, stopped and asked questions (“did you get burned?” is a common one), and cashiers even refuse to take money from their hands. Michael Jackson, the self-proclaimed perfectionist who was never happy with his music or his appearance (he said he hated to look in the mirror and tried not to), must have been very self-conscious about the white spots appearing on his skin.

The single white glove made its appearance in 1983 (along with his signature “moonwalk” dance move), which was right after Thriller was released and when he said his vitiligo started. His new onset vitiligo may have been the reason for starting to wear the glove – while the disease typically affects both sides of the body, it can begin in a small area on one side, like the hand. But the single glove was switched between hands over time, and his costumer said that it was used so the audience could track his quick hand moves. He wore makeup to help cover up the spots, a point that he made in the Oprah interview. But over time and certainly by the time of the interview, he did not have the telltale white spots of vitiligo, he just appeared completely white, which was a big difference from earlier photos in which he had black skin. Could vitiligo do THAT? What about the bleaching cream that many accused him of using in order to “look more white”?

Yes, vitiligo can remove most, if not all, of the pigment in someone’s skin, such that they have no skin color. However that is very rare, and it usually takes many years to do this, with spots appearing during the process. So it’s not likely that vitiligo alone was responsible for his significant transformation in skin color. There is a treatment, though, that can remove the remaining pigment in someone’s skin if they have vitiligo. The treatment is a skin cream called monobenzyl ether of hydroquinone (monobenzone, or Benoquin), and it is, in fact, the only FDA-approved treatment for vitiligo. But in most cases, using this cream doesn’t work unless you have vitiligo, so it is not as simple as someone “wanting to look white” and using the cream. It is a bona-fide vitiligo treatment, approved by the FDA, for people who would rather remove their remaining pigment than continue to look spotted. I have prescribed this for vitiligo patients, and they have always been happy with the results. So it is not too surprising that Michael Jackson would use Benoquin to treat his vitiligo, and this is why he went from having clearly black skin to very white skin. In fact, Oprah commented in an interview after Michael Jackson’s death that he had no pigment in the skin of his hands, that they were essentially translucent. Benoquin would do that, and could do it relatively quickly, after about 12 months of use. From available pictures of Michael Jackson, his skin color seemed to change significantly sometime in the late 1980’s, which would make sense if he was diagnosed in the early 80’s, tried to treat it for a while, and then decided to go the other way and use Benoquin.

Did Michael Jackson have vitiligo? After his death, his autopsy report stated that there were “patches of light and dark pigmented areas” on examination of his skin, and vitiligo was listed as a diagnosis in his medical history. In addition, a tube of Benoquin 20% cream was noted among his medications, revealing that he did use this FDA-approved treatment for vitiligo. He also had a tube of BQ/KA/RA (Benoquin 8%, Kojic acid 1%, and retinoic acid 0.025%), another effective formulation for Benoquin, as well as hydroquinone 8% lotion (which would help to lighten any remaining pigment), and UVA Anthelios XL sunscreen, a good idea for anyone with vitiligo, especially if they had depigmented their skin. Microscopic examination of his skin revealed a lack of pigment and reduced number of melanocytes, which is most consistent with vitiligo, with or without the use of Benoquin, and vitiligo was the official diagnosis on the report. Rare photos of him when his skin was exposed appear to show his depigmented skin, and one (above) shows his largely depigmented arms with some remaining spots of pigment.

So there is no question that Michael Jackson had vitiligo, by his own admission and according to his autopsy after his death. He did appear to use Benoquin to help depigment his skin, but not because he “wanted to be white”, but as an FDA-approved treatment for his vitiligo. He was a remarkable person who was a self-proclaimed perfectionist who was undoubtedly stressed by his vitiligo and visibility, and this may have been an important factor in his avoidance of the public later in life, his use of drugs (which was ultimately the cause of his death), and his frustration about the press’s invasion into his private life. Did he have vitiligo? Yes, but he’s probably not a great example of what it looks like to have the disease, since he was very good at covering it up and, eventually, treated his condition with the skin depigmenting cream Benoquin. As with many of my patients with vitiligo, I hurt for him, and hope that someday people will recognize the disease, its effect on those who suffer from it, and have sympathy for them. I also hope that someday we will have better treatments and, eventually a cure, for patients who seek my help.