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Psychosocial harm caused by vitiligo: The importance of looking at the body

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ORIGINAL ARTICLE 

ROCHA, Marizete Oliveira [1], MARTINS, Luciana Melo [2]

ROCHA, Marizete Oliveira. MARTINS, Luciana Melo. Psychosocial harm caused by vitiligo: The importance of looking at the body. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 05, Ed. 12, Vol. 02, p. 163-178. December 2020. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/psychology/caused-by-vitiligo

ABSTRACT

Vitiligo is a dermatosis that causes white spots on the skin, has different shapes and sizes, appears in any part of the body and can lead to aesthetic disfigurement, in addition to causing psychosocial damage in the life of the affected patient. Without a form of prevention and undefined etiology, vitiligo does not distinguish between gender, age and ethnicity, it can affect all skin types. It is not contagious and does not compromise the functionality of the individual, it presents itself as one of the most disturbing dermatoses in the description of the literature and causes self-deprecating feelings. It is important that the treatment is integrated, involving health professionals committed to the psychosocial well-being of the dermatological patient. The objective was the knowledge of the psychosocial damages caused by vitiligo in those affected. Methodology: Bibliographic review, inclusion-Works published from 2002 to 2016. Those that did not contemplate the objective of the study were excluded, following the analysis of the selected contents and analysis of the results. In the selection, studies were chosen whose objectives showed considerable and numerous psychosocial damages to these patients in various contexts, marking their behaviors such as: shame, depression, anxieties, helplessness, sadness, social isolation, difficulties in relationships and at work, suicidal idealization, between others. Hence the need for a new look at the understanding and empathy of health professionals involved in the treatment of patients with skin conditions.

Keywords: vitiligo and treatment, psychosocial effects, body in psychoanalysis.

1. INTRODUCTION

According to the literature, vitiligo is a skin condition that presents with white macules in some skin locations (ROSA; NATALI, 2009; SILVA et al., 2007). The shape and location of the spots give rise to their classification (VIZANI et al., 2014). As for the treatment, several forms are offered, although it can be slow and not always successful, among them are oral medication, therapy with physical agents such as, for example, the Excimer laser, skin pigment restoration and also surgeries with melanocyte transplantation. It is common for people who have this condition to complain about the prejudice and stigma they often experience, which are one of the greatest difficulties faced by these patients (SILVA et al., 2007).

Although it is not contagious and does not compromise the functionality of the individual, vitiligo is one of the skin diseases that presents itself as one of the most disturbing in the description of the literature, as the lesion usually causes feelings such as shame, anxiety, sadness in the affected ones. , insecurity, helplessness, in addition to conditions such as social isolation and depression, which can lead to suicidal idealization (NETO et al., 2015). However according to Nogueira; Zancanaro; Azambuja (2009) the macules are considered by some professionals in the medical field, as just an aesthetic issue because they do not compromise the physical health of the individual and end up neglecting a factor of great relevance such as the psychosocial damages of this patient, who experiences the challenge of accepting himself. and be socially accepted.

In the psychoanalytic view, chronic dermatoses can be suggested as somatic diseases, in which the body is a means or vehicle for instinctual satisfaction. This same body also becomes a vehicle or means of expressing pain and suffering, thus, the biological body is not the object of study of psychoanalysis, but what is in the unconscious of this body (FERNANDES, 2003). According to Piera (1991) the body manifests itself through various signs, making itself visible. The manifest body, pronounced a latent body that remained hidden, then takes emotion and somatic suffering as the special messengers of the psyche in its manifestations on the somatic plane. According to Weinman; Petrie; Morris (1996) each patient has a representation of their condition that is unique, these authors state that the individual with dermatosis has their individual beliefs about the identity, cause, duration and cure of their condition, hence the importance of a comprehensive treatment, because clinical and psychotherapeutic treatment will contribute more effectively to the psychosocial well-being of this patient. Therefore, it is important that the professional knows how the life of this individual can be affected by the dermatosis, the real context in which he is inserted and the strategies that can help him to face everyday situations (PEREIRA; OLIVEIRA, 2012).

The academic justification of this research was to generate knowledge about vitiligo, in addition to providing a reflection on the importance of psychotherapeutic follow-up in patients with this skin condition. The justification for society was the possibility of bringing information about aspects of this dermatosis that is little known socially, which for this reason can cause inappropriate and inappropriate contempt for the affected individual. This is a bibliographic research with a qualitative approach, in which the general objective consisted in the search for knowledge of the psychosocial damages caused by vitiligo in the lives of those affected.

2. METHODOLOGY

A bibliographic review with a qualitative approach was chosen because it is considered a scientific research instrument that is based on evidence from studies already prepared and published. According to Gil (2008), bibliographic research is a study that is developed based on scientific materials already prepared, mainly in books and articles. According to this author, the research can opt for an approach that will follow, in the case of the qualitative approach, its focus is not to analyze metric data, but the knowledge and understanding of a social group, organization, among others.

The following methodological steps were followed: initially, articles were selected for the review that addressed issues such as: What do national and international publications reveal about the psychosocial damage caused by vitiligo in the lives of those affected? 202 articles were found, after establishing the criteria for sample selection. Inclusion criteria for the material were articles published in the period from 2002 to 2016, except for classics, which used the theme of vitiligo and the psychosocial damage caused by vitiligo with abstracts and texts available in full via the internet. Exclusion criteria were articles published outside the period established here, also those that did not contemplate the objective of this study and unavailable online access or non-free reading. After analyzing the content of 37 selected works, the results were analyzed. Data collection was carried out through an online search on the website of the Virtual Health Library – VHL, selecting the following databases: Scientific Electronic Library Online – SciELO, Latin American and Caribbean Literature on Health Sciences – LILACS ), United States National Library of Medicine -PubMed and Google Scholar. The full articles were obtained from the databases mentioned above and the following descriptors were used: Psychosocial damages of vitiligo, skin disorders with psychosocial effects, treatment of vitiligo, the body in psychoanalysis.

The methodology followed was “bola de neve” (DEWES, 2010), in which, through the bibliographic references of the articles that were analyzed, others with similar themes were accessed.

3. BIBLIOGRAPHIC REVIEW

3.1 VITILIGO

Vitiligo is a skin condition that is characterized by the loss of natural skin tone and causes achromic macules (SILVA et al., 2007), with unequal sizes and shapes. It can appear anywhere on the body, especially the face, hands, elbows, feet and knees. With the possibility of leukotrichia, which is discoloration in hair, regardless of gender, age and ethnicity. There are two groups of vitiligo classification: localized and generalized (VIZANI et al., 2014). In the localized, spots appear in at least three parts of the body. This group of vitiligo is divided into three types: segmental, where the spots appear in the form of bands on one side of the body; focal, where macules appear in at least three locations on the body, this is the most common type; and the mucous type, which occurs only on the genitals and lips (STEINER et al., 2004).

When the focal takes a proportion in almost every body, it characterizes the second group, this being the generalized one that is subdivided into four types: the vulgar, which has symmetrical shapes and in various parts of the body; the mixed that is characterized by the mixture of vulgar and segmental; universal, which is rare and affects more than 70% of the skin and, finally, the acrofacial type, which appears spots only on the hands, feet and face. Some authors (ROSA; NATALI, 2009) point out that the estimated worldwide prevalence of this dermatosis is approximately 1%, but the literature shows a variation from 0.5% to 4% in the most varied countries of the world. Its etiology is still not definitively proven, although several theories try to explain the true origin of vitiligo, none of them managed to completely elucidate its real cause.

Many patients attribute the onset of vitiligo to intense emotional stress previously experienced, such as loss of close people, separation or death. Even so, most of the literature on this condition prioritizes only medical issues exclusively, thus requiring further studies on this theory (MÜLLER; RAMOS, 2005).

According to Geremias; Viana (2009) in addition to the white macules, there is also normal skin simultaneously in the same person, initially with hypochromic spots[3] that then become achromic[4] where the edges are well defined and hyperpigmented, making it clinically impossible to predict the extent and the shape of the lesions.

A very useful exam that allows to verify the extension of the lesion and makes the affection clearly evident is the exam elaborated by Wood ‘s light (SAMPAIO; RIVITTI, 2007). This exam reflects a bluish-white light on the affected skin, which is very effective in diagnosing the condition that is less apparent to the naked eye and favors early diagnosis and, consequently, the therapeutic follow-up of the patient. Also becoming necessary are laboratory tests, such as blood glucose and antibody, for a more accurate diagnosis (AZULAY et al., 2007). As for microscopic observations, the patient can undergo a skin biopsy if necessary, in order to eliminate the probability of diseases that can also lead to hypopigmentation, as in the case of leprosy (BORTOLOSO; SANTOS, 2009). This additional diagnostic criterion is left to the dermatologist. After the diagnosis, the ideal is to start the treatment and for that it is necessary to take into account the most appropriate techniques, the advantages and disadvantages to the patient, because the treatment is individual (PEREIRA; OLIVEIRA 2012). In addition to drug treatments, there are other alternatives such as: therapy with physical agents such as the Excimer laser, restoration of skin pigment and also surgeries with melanocyte transplantation (VISANI et al., 2014).

Sampaio; Rivitti; Evandro (2007) states that when the patient has more than 70% of the skin affected, the depigmentation is indicated, which becomes definitive, as it destroys the melanocytes. This second line of treatment is indicated only for adults, due to its better assimilation capacity, as the procedure will change the patient’s physiognomy in a precise and definitive way, being care with sun exposure for life, always using protection (ZANINI; MACHADO FILHO, 2004). The reality of the person affected by vitiligo is usually full of challenges, in addition to facing the dermatosis, they still face relevant prejudice and social stigma.

It is common for people who have this condition to report being victims of prejudice and stigma they often experience (SILVA et al., 2007). Throughout history, its term of origin, whose Latin word Vitium, which means “mark”, “defect”, “stain”, made it possible for the person affected by vitiligo to be seen as stained, marked, defective or lacking in purity, in this context it was confused. sometimes vitiligo with other disfiguring diseases (SANT’ANNA et al., 2003). The Old Testament mentions various skin diseases with white spots, together with the Hebrew word Zoraat, which in Greek means “leprosy”. This disorder between both skin diseases contributed significantly to the prejudice in relation to the spots, which made possible even more discrimination with those affected by vitiligo, starting to identify these people with the figurative sense of their dermatoses (ISSA, 2003).

According to Sant’Anna et al. (2003) in skin conditions such as vitiligo, stigma is registered in the patient as if their marks needed to reveal or recognize something of their nature, thus demonstrating a considerable lack of social information that is usually caused by the deficiency in transmitted communication. Although our society is well developed in relation to new technologies and also in information, this situation occurs due to the lack of social interest in seeking the correct information and also the public policies that do not offer conditions to meet this need, as a consequence, a contradictory view of what dermatosis really is (NETO et al., 2015). Ailments like vitiligo are often associated with the popular idea of ​​dirt and what is dirty is soon contagious and therefore not beautiful and so should be kept away. Prejudice is one of the main problems faced by people affected by the condition in question, it can worsen their condition and reduce the effectiveness of treatment (SILVA et al., 2007).

According to (NETO et al., 2015), although the dermatosis is not contagious, many affected by this condition suffer from discrimination from a lay society, which insists on judging them by their appearance. The coexistence between patients with vitiligo and society can influence negatively or positively on the psychological life of the afflicted, depending on the attitudes of the people around him.

For Goffman quoted by Szabo; Brandão (2016) an individual could be naturally inserted in the social relationship, but because he has a trait that stands out and draws attention, he ends up moving away from the other who does not consider his various attributes. It also reports that physical imperfections are among the stigmas in which those affected by vitiligo are inserted, which in addition to being discriminated against and considered inferior, the patient may end up agreeing that he is inferior after realizing that social standards do not fit him and that others do not. see as equal. (TELLES; BLOC; EVANGELISTA, 2008) There is also self-stigma, which occurs when stigmatized patients identify these conceptions against themselves, starting to feel guilty about this situation. The feeling of shame causes the individual to incorporate this social judgment for himself, justifying it. The suffering experienced by prejudice can make the person with dermatosis afraid to follow the treatment and end up trying to hide the condition they have. Thus, the common sense perception regarding dermatoses is closely related to socially reproduced moral values. Also according to this author, the stigma and prejudice experienced by some people with skin disorders involve social, work and family relationships.

In this sense, those affected by vitiligo, experience experiences that can cause numerous psychosocial harm, live with the disease as: “a punishment”, “ugly”, “suffering”, “bad”, they feel discriminated against, victims of prejudice and curiosity. Skin diseases that cause lesions usually cause innumerable embarrassments to those affected, such as feelings of inferiority, anxiety, sadness, among others, thus the challenge of accepting and being accepted arises. Currently the skin is considered socially as a relevant beauty requirement and has considerable social value attribution, imperfections such as wrinkles, blemishes, acne, scars and cellulite are considered undesirable marks.

In the liberal society of the 21st century, body care in search of health and perfect beauty are routines and become increasingly compulsive behaviors, this demonstrates how individuals more often think and act in order to seek perfection at any given cost (ROSA et al., 2009). It is in the body that the strategies of power are reached, making it the object of social investment that becomes a passage to the production of differences that are spread today through the great appreciation of symbols of health, beauty, quality of life and also happiness. , in the quest to match the physical models and thus it is increasingly frequent to have silicone, projected, healed, well-defined, thin and slender bodies that, strictly speaking, submit to a socially imposed standard of beauty and determine physical appearance as a symbol of body care (BASTOS et al., 2013).

Vitiligo sufferers do not meet the requirements of perfect skin and this is one of the requirements imposed to be beautiful and successful. Your body carries the lesions of an affection that has no commitment to aesthetic standards culturally and that, even apparently harmless, when in conflict with these standards generates psychosocial complications (GOLDENBERG, 2005). It is evident in the current situation in which we live, where the search for the “perfection” of external beauty is highly valued, so that skin diseases have a potential stigma in their character. The standards of aesthetics and beauty imposed by today’s society are well defined, and most people strive to achieve them. In patients with skin conditions, the feeling of inadequacy and the stigma experienced are clearly evident in the face of these demands for “normality”. The feeling of feeling discriminated against by their physical appearance accompanies the patient constantly, causing great dissatisfaction with himself due to the way the other sees him, therefore, the adaptation to the condition becomes a source of stress (SILVA; MÜLLER, 2007) .

The person affected with the condition in question did not want to be different, but to standardize himself, matching the prevailing aesthetics and mix equally with others, in order not to be exposed to the eyes of others, being able to exercise his “invisibility” with the crowd, as emphasize Szabo; Brandão (2016). The discrimination experienced often brings consequences such as psychosocial harm, an additional difficulty for these patients.

3.2 PSYCHOSOCIAL LOSSES

The psychosocial damages in these patients are explained by the fact that the skin is the most extensive organ of the human body, more exposed to people’s eyes and consequently to judgments (LUDWIG et al., 2009). It is common for the patient to express feelings such as insecurity, helplessness and anxiety, in addition to situations such as social isolation and depression because they do not understand how the disease developed in their body (CORREIA; BORLOTI, 2013).

For Vizani, et al. (2014), those affected by vitiligo can develop as a result of this condition: personality changes, low self-esteem, stress and also interference in sexual relationships due to the embarrassment of their injuries. Due to the fact that it is usually confused with other hypopigmentation diseases, some people associate the contagion with the lack of hygiene, which may cause the patient to withdraw from social life, as the way of seeing vitiligo has serious consequences, which causes self-deprecating feelings. that can lead the victim of vitiligo to feel social fear and shame (DIAS, 2005). Also according to this author, skin diseases significantly affect the relationships and communication of this individual, in addition to psychosocial stressors, such as losses, anxiety, unemployment and low self-esteem.

Injuries impact the patient’s quality of life and emotional in such a way that in some cases it can reach suicidal ideation (LAYEGH et al., 2010). For Ludwig et al. (2008), no matter where the lesions are located, both visible and on the hands, arms and face, or on the rest of the body, if the patient feels exposed to the other’s gaze, the damage will be the same. According to Nogueira; Zancanaro; Azambuja (2009) vitiligo is considered by some medical professionals as just an aesthetic issue, because it is not transmissible and does not compromise the functional capacity of the individual, where there are no muscle or bone lesions and only the aesthetic compromise of the skin. Thus, they end up neglecting a factor of great relevance such as the psychosocial damages of this patient, dermatosis has a considerably devastating effect on the affected person’s self-esteem, since his body has had aesthetic changes that are not pleasing to him or to social standards.

3.3 THE BODY IN PSYCHOANALYSIS

The skin is the mirror of the functioning of the organism: its texture, color, temperature, humidity, dryness and all its other aspects reflect the psychological and physiological state of each individual, as Montagu (1988) assures. The skin not only receives signals from the environment such as cold, heat, among others, it also captures signals from the internal world, as in the case of emotions. In addition to demonstrating the external and internal state of the organs, the skin also shows psychic processes and reactions in general, it is the envelope of the body, as well as the psychic envelope (ANZIEU, 1989). It is like an inside-outside barrier, I and the other, I and the world, thus, it acts as a shelter for individuality and “at the same time it protects, it is also the limit that exposes itself” (STRAUSS, 1989) .

It is observed that in current times there are numerous ways for people to seek a skin for their homeless self, such as: the epidemic use of anabolic steroids, botox, silicone prostheses, the intense organization of the appearance of the self through aesthetic treatments. , in the expectation of finding in the eyes of the other the accommodation and the address of the “I”. Also as a symbol of an ideal perfection, which tirelessly seeks to achieve nowadays, the body is hyperinvested, but it is often a source of frustration and also of suffering, “constituting itself as a means of expression of contemporary malaise” (FERNANDES , 2003). Also according to the author, the body is a means or vehicle for instinctual satisfaction, this same body also becomes a vehicle or means of expressing pain and suffering, thus, the biological body is not the object of study of psychoanalysis, but rather what is in the unconscious of this body, this path can be easily observed when one thinks about the impasses of the psychoanalytic clinic, especially in so-called somatic patients, as they need a deepening of the psychoanalytic reference (FERNANDES, 2003).

The drive is not physical energy, but an instinctual energy, an emotion that has not been experienced correctly and that is why it has been repressed in the unconscious, where it is in a raw state and flows through the representation in the form of an organic symptom, without being necessary to do so. appear directly. Because it is known that something is represented in one place, its original must be in another (FERNANDES, 2003). According to Piera (1991) the body manifests itself through several signs, which become visible. The manifest body, pronounced a latent body that remained hidden, then takes emotion and somatic suffering as the special messengers of the psyche in its manifestations on the somatic plane. Emotion is an experience that the “I” is aware of, that is, it knows what caused it, it is something heard, visible that modifies the somatic state of the one who experiences it and shares an identification with the one who shares it. For example: a disease that was hidden and manifests itself causing suffering, this situation can provoke a reaction in the witness, so we say that pain and emotion are “relational”, they make a connection between the sensory body and a relational body. They are messengers then because they speak of their own somatic manifestations and even allow different forms of reactions from others.

A fact linked to pain or emotion can break a singular story and the construction that the person will make of this occurrence will depend not only on his particular connection between his body and his psyche, but also on the response that his pain or emotion will cause in the other. Successive representations are being formed in the body by emotion and pain and articulating with unconscious motivations, thus, together they will decide how the subject will attribute the historical meaning of the events of his life. The history of the individual is the script of the marks related to pain and also of the emotion in his own body, this is his identity and the story he wrote in which he attributes meanings to his marks becomes a context that is never complete. This body identity, which always seems to be defined, must always remain open, always unfinished, so that the individual accepts the changes imposed by time without losing the sense of permanence. Also according to Piera (1991), this possibility of the other being always changing, being present or absent, inflicting pleasure or pain, submits the “I” to the situation of also being self-modifiable, but to sustain the difference it is necessary that the “I” eu” represents itself as a stable pole of this investment relationship and to continue this connection will depend on the possibility of negotiation of the “I” between the demands of the id and the other, thus the body is a mediator between the psyche and the world.

Pines (1980) reports that, at birth, the skin is already the most complete organ of perception, it feels the changes from the warm and cozy mother’s body to a cold external world. In this way, the skin becomes the means of physical contact and also of response to the emotions that the baby experiences, both of well-being and anguish. For the author mentioned above, the skin becomes a source of pre-verbal communication, as unexpressed feelings can be not only experienced but also observed. Any difficulties in this communication, irrespective of the reason, could result in the frustration of children’s needs and could result, for example, in childhood dermatitis, or even create a fixation on this ongoing emotional development. The symptoms would then be messages brought from the psyche. Galiás (2002) says that these signs or symptoms must be understood first before anything else, and only after that they are eliminated. Dermatosis can represent unresolved emotions that present themselves as organic manifestations. So the symptom comes as language, symbolic manifestation, of what remained hidden (AZULAY; AZULAY, 1997).

3.4 INTEGRATED TREATMENT

Despite several studies highlighting the manifestation of unconscious conflicts in the skin, it was not until the year 1980 that dermatologists became interested in the delicate relationship between body and psyche. For Folks and Knney (1992) this is mainly due to the clear relationship of psychosocial impairments, low self-esteem and social stigma in patients with dermatological disorders. This is where the body/psyche bidirectionality gives rise to a segment of dermatology, psychodermatology, which proposes to understand and treat the patient in an integral way. In the understanding of this area, in addition to medical follow-up, it is necessary to ally with psychotherapeutic follow-up, in the most different ways: supportive, group, individual, behavioral psychotherapy, relaxation techniques, self-help groups, use of psychotropic drugs such as antidepressants and anxiolytics. and the joint work of the doctor with the psychotherapist.

Interventions with dermatological patients require an individual and unique treatment for each patient. Walnut; Zancanaro; Azambuja (2009) emphasize that for better patient care, the dermatologist needs to consider an important aspect of the condition: the psychosocial damages and offer an approach in the most humanized way possible. Because a wrong word, an unfortunate intonation, an inappropriate phrase, can have disastrous results for a given individual, which ends up seriously compromising the treatment of dermatosis.

In a study developed by Müller; Ramos (2005), with 13 female patients, all affected by vitiligo, aimed to verify the effectiveness of the integrated treatment in the repigmentation of the injured skin, in this study 10 patients were followed up with a doctor and a psychologist for six months, of these, five received group psychological care, the other five received individual psychological care, the remaining three received only medical care for the same period of time. Finally, patients who received integrated follow-up had a percentage of up to 80% of skin repigmentation, while patients who received only medical follow-up had up to 20% of the percentage of repigmentation. Therefore, this result highlights the importance of an integrated treatment in patients affected by vitiligo. It is important for the professional to know how the life of this individual can be affected by the dermatosis, the real context in which he is inserted and the strategies that can help him to face everyday situations, so that he can act in the best way with the patient. , thus contributing to a more effective treatment.

Weinman; Petrie; Morris (1996) emphasize that each patient has a representation of their condition that is unique, these authors state that the individual with dermatosis has their individual beliefs about the identity, cause, duration and cure of their condition. Such representations reflect the cognitive response of each patient to the symptoms and dermatosis, emotional responses are processed in parallel with the representation of the condition. Although vitiligo is still a disease with few studies in the field of psychology, it is evident the importance of a psychotherapeutic follow-up that promotes the well-being of this patient for better results in the treatment, making it necessary, then, an integrated care (PEREIRA; OLIVEIRA, 2012).

4. FINAL CONSIDERATIONS

Since the gestation of a baby, the skin is his first means of contact, it is through this that he feels the sensations of warmth and coziness in the mother’s womb. At birth, the first external connections of this baby also occur through this organ, it is through it that the child will feel the touch, caresses and body temperature of its mother, so the skin from its origin is a source of protection. , relationship, communication, perception and contact. It works as a barrier that, in addition to shelter and support, also presents him to his peers and to the world, it is through the eyes of the other that he recognizes himself, thus, seeking his ideal self through the image reflected through the other, like a mirror.

Psychoanalysis uses internal elements of this individual to help him face what causes him suffering, as in the case of prejudice. Listening and welcoming the individual in a unique way, knowing his entire life history, what is behind this suffering, how it is for this patient to deal with his affection and its consequences, which causes him pain in this real context. It is important to know all the uniqueness of the patient, because each one has a way of feeling and facing their difficulties in a unique and exclusive way.

Therefore, the reality of the individual affected by vitiligo is full of challenges, in addition to coping with the condition, the difficulties in exposing their emotions, they still face relevant psychosocial stressors frequently. Although the dermatosis is not transmissible, nor does it cause damage to the individual’s physical functioning, it still must be considered an important factor of great relevance: vitiligo is highly harmful to the psychosocial life of this patient and can be devastating to their self-esteem, in addition to their evolution being clinically unpredictable, can cause cosmetic disfigurement. As evidenced, the psychotherapist contributes considerably together with the dermatologist in the treatment of vitiligo, it is necessary to take into account the better quality of life of the individual in relation to their self-acceptance and facing prejudice, among other barriers that may arise as a result. of the psychosocial damage caused by the condition in question.

Hence the need for a new context in the understanding and empathy of health professionals in favor of a more humanized and integrated treatment possible for dermatological patients. More studies on vitiligo in the field of psychology are needed due to the precariousness in relation to the amount of work published in this context nationally. It is also important to take into account the number of reports from patients who indicate that their injuries arose after intense situations of emotional stress, in addition to the fact that this factor can worsen the situation or even impair the treatment. It is also suggested that more research is needed to investigate vitiligo as a possible symptom manifested through the psyche. In addition to being a dermatosis that has been described since antiquity and after several theories elaborated in an attempt to explain its real origin, vitiligo is still a condition with no defined etiology.

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APPENDIX – FOOTNOTE REFERENCES

3. The term hypochromic is used to designate spots on the skin that are lighter than the skin itself.

4. Achromic: colorless, colorless spot.

[1] Psychology student at Faculty Morgana Potrich (FAMP), Mineiros- GO, Brazil.

[2] Master in Psychology from Catholic university of Brasilia, professor at Faculty Morgana Potrich (FAMP), Mineiros- GO, Brazil.

Submitted: January, 2020.

Approved: December, 2020.

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