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Vitiligo is not a life–threatening nor a contagious disease. But the disfigurement of vitiligo can be devastating to its sufferers, especially dark-skinned individuals. Available treatment options are disappointing and sufferers often use various forms of camouflage. Remedial cosmetic cover creams help conceal the blemish of vitiligo at least temporarily. A high concentration of pigment is incorporated into water–free or anhydrous foundations to give a color that matches the patient’s skin, thereby concealing vitiligo patches. The article highlights the content and technique of application of these creams.
Camouflage is derived from the French word, ‘Camoufler’ which means ‘to blind’ or ‘veil’. Also known as protective concealment, it means to disguise an object in plain view, for the purpose of concealing it from something or someone. In mammals, the color of skin/fur plays an important role in camouflage and prey-predator relationship. That is why early Homosapiens living naked in the depth of the yesteryear African forest was black-skinned.
A great example of this is the ‘stick insect’, which becomes almost invisible due to the shape of its body, coloration and slow movement. It looks and acts like a twig on a bush or tree.
The art of camouflage has been well exploited by the army to hide from the enemy. To make their face match a jungle backdrop, soldiers have used camouflage cosmetics that come in rich greens and browns. The soldiers paint their faces in blotchy patterns to match their surroundings.
Another camouflage cosmetic was pioneered during the Second World War to help pilots who were badly burnt by making use of plastic surgery and camouflage cream. These creams did not camouflage the person but were used to conceal blemishes on the skin so that they were not obvious.
During the 1950s, Joyce Allsworth researched and implemented the concept of remedial skin camouflage within the UK. She went on to form the British Association of Skin Camouflage (BASC) in 1985.
The BASC defined remedial cosmetic skin camouflage as being the ‘the art of concealing a discoloration, blemish or scar with the application of specialist camouflage creams that are matched to the surrounding skin tone.’
Nowadays, it is used to conceal abnormalities from various dermatological disorders, especially vitiligo.
Vitiligo is not a life–threatening or a contagious disease, but, its disfiguring signature often devastates the sufferers, specifically the dark-skinned type. For many, it is not just a cosmetic problem but a major social dysfunction that seriously curtail their ability to lead normal, professional, social or married lives.
The results of standard and experimental treatment options for vitiligo are disappointing with only partial results. In addition, most require treatment periods, lasting months or years, before re-pigmentation occur. Sufferers use practices of concealment such as the use of camouflage make-up, clothing, hair dye and specific bodily movements (like putting hands in their pockets).
On asking vitiligo patients whether they made a conscious effort to hide or camouflage their discoloration, 47% said that they did attempt to cover while 29% said they did so sometimes. Most (87%) female patients, especially the dark-skinned type, attempted to camouflage vitiligo all the time or sometimes.
In a cohort study of vitiligo patients, Ongenae et al. showed that the Dermatology Life Quality Index (DLQI) improved after the use of camouflage and hence, recommended the use of camouflage in patients with higher DLQI scores.
Camouflage improves the appearance of the individual, as the focus is no longer on the discoloration that the person wishes to hide, thereby improving their confidence and self-esteem.
Camouflage may be permanent or temporary.
Permanent camouflage is obtained with a cosmetic tattoo. Unlike pigments used for ritual or symbolic tattoos, cosmetic tattoos are inert iron oxides that are available in more than 15 shades.
Various tattoo pigments include:
The color is implanted into the dermal layer with specialized techniques and cannot be washed off [Figure 1] Very satisfactory results are obtained when only small areas of the face, [Figure 2] particularly in the perioral area, and the dorsal hands are involved. Dark photo types are more easily treated than people with fair skin.
Cosmetic results are strongly dependent on the doctor’s or the technician’s skill in perfectly matching the color of the tattoo with the color of the surrounding skin area. The colors of the tattoo fade naturally over time, requiring periodic maintenance, usually 2–5 years.
However, unless performed under universal precautions with scrupulous sterile technique including sonic cleaning and autoclaving of the instruments, tattooing carries a risk of transmitting infectious diseases, including viral hepatitis and human immunodeficiency virus (HIV) infection.
Granulomatous foreign bodies, allergic, and photo allergic reactions have been reported from tattooing. Mercury accounted for most of the allergic reactions to red tattoos, but its restriction in the USA has ameliorated this allergy.
Temporary camouflages include:
Potassium permanganate, indigo carmine, bismarck brown, and henna paste are commonly used to camouflage vitiligo. These are used to provide an immediate, natural, amber-like shade that can be adjusted to the desired shade by applying a single layer for a lighter shade or an additional layer to get a darker color. These are washed away easily.
Loha Bhasma: Exposing iron filings to sunlight with a liberal lacing of vegetable extracts yields a powder that was commonly used for anemia. This provided a good coverage for vitiligo but the disadvantage was that it rubbed off easily.
Swarna Karani: Sugathan et al. reported that a swarna karani, a type of clay mixed with oils and henna was an effective camouflage in vitiligo.
None of these give acceptable match for pigmented skin.
The uniform application of thin films of selected opaque cosmetics with light-reflecting ingredients is very effective for covering or at least reducing the visual impact of white patches. Products for covering vitiligo are specific and quite different from other common cosmetic make-ups.
There are four basic facial foundations:
There are three basic approaches to basic camouflage cosmetics, i.e. contour correction, color correction, or a combination of both.
Color abnormality camouflaging: Pigmentation defects can be camouflaged by applying an opaque cosmetic that allows none of the abnormal underlying skin tones to be appreciated. The most effective way to hide irregular coloring would be to apply a camouflage cosmetic of the complementary color; this will neutralize the underlying unwanted color. For instance, if we want to hide a purple tattoo, an orange camouflage must be applied first, followed by the application of a cream camouflage cosmetic that matches the skin. Skin areas that are lighter or darker than desired can be camouflaged by applying facial foundations with the appropriate amount of brown pigment to hide the defect. Table 1 summarizes these color-blending techniques.
Finally, facial powders that match the skin tone may be applied to set the camouflage makeup and prevent it from smudging off. They are valuable cosmetics that provide coverage of complexion imperfections, oil control, a matte finish, and increased tactile smoothness to the skin. They predominantly contain talc known as hydrated magnesium silicate and high amounts of covering pigments. Iron oxide is the main pigment but other inorganic pigments such as ultramarine; chrome oxide, and chrome hydrate may also be used. These powders are designed to augment the underlying skin and foundation tones.
Self-tanning products contain dihydroxyacetone 3–5% (DHA) which is a sugar that binds with the amino acids of the corneum layer, inducing the production of colored components that change yellow to brown, giving the skin a tanned effect. DHA dyes are easy to apply—they are neither dirty nor greasy. The pigmentation appears a few hours later and the application has to be repeated until the desired result is obtained, and more times in a week, because DHA- induced pigment reduces with normal exfoliation of the epidermis. These dyes do not provide protection against sunburn and psoralen phototherapy can be used.
Rajatanavin et al. found that color matching was achieved by using a higher concentration of DHA in darker-skinned subjects. Most of the vitiligo patients (88.9%) reported moderate to marked satisfaction with the cosmetic results of 6% DHA cream.
The skin, like a cloak that covers us all over, is the oldest and the most sensitive of our organs, our first medium of communication, and our most efficient of protectors. Despite all these unique factors, it cannot offer protection from the social ostracism and psychological crippling that a disease like vitiligo can cause.
Vitiligo often affects the minds of patients, lowering their confidence and self-esteem and affects their relationship with family and friends.
Skin camouflage represents a quick, noninvasive treatment, which by disguising vitiligo patches, helps to significantly reduce the patient’s distress. Whether the patient uses it everyday allowing them to work and enjoy normal social activities without being self-conscious, or just uses it for special occasions; camouflage can make all the difference to the patient’s quality of life.
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