Vitiligo

Also indexed as: Depigmentation

Vitiligo is a type of skin discoloration characterized by progressively widening areas of depigmented (very white) skin. The depigmentation that occurs with this condition is associated with the local destruction of melanocytes, the cells that produce the pigment that darkens the skin, called melanin. Vitiligo affects 1–4% of the world’s population.1

Checklist for Vitiligo

Rating Nutritional Supplements Herbs
2Stars L-phenylalanine Khella
Picrorhiza
1Star Betaine HCl
Folic acid
PABA
Vitamin B12
Vitamin B-complex
Vitamin C
Vitamin D (topical calcipotriol only)		  
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of vitiligo? Symptoms of vitiligo include decreased or absent pigmentation in localized or diffuse areas of the skin. Hair in these areas is typically white, and the skin tends to sunburn more easily.

How is it treated? Conventional treatment includes cosmetic creams and tanning solutions, topical cortisone or related drugs, oral and topical psoralens (drugs that increase the skin’s sensitivity to light) with ultraviolet A irradiation (PUVA), and, rarely, skin transplants. Treatment may also involve the management of any underlying medical condition, such as Vogt-Koyanagi-Harada syndrome, scleroderma, melanoma-associated leukoderma, chronic mucocutaneous candidiasis, and autoimmune disorders (including Grave’s disease, diabetes mellitus, pernicious anemia, and Addison’s disease).

Nutritional supplements that may be helpful: Supplementation with the amino acid L-phenylalanine (LPA) may have value when combined with ultraviolet (UVA) light therapy. Several clinical trials, including one double-blind trial, indicated that LPA (50 mg per 2.2 pounds of body weight per day—3,500 mg per day for a 154-pound person—or less) increased the extent of repigmentation induced by UVA therapy. LPA alone also produced a more modest repigmentation in some people.2 A study of vitiligo in children reported that LPA plus UVA was an effective treatment in a majority of the children.3

A group of Spanish doctors reported on their experience using LPA over a six-year period. Some of the 171 people with vitiligo received LPA (50 or 100 mg per 2.2 pounds body weight per day) for up to three years. Between April and October of each year, participants also applied a 10% LPA gel, prior to exposing their skin to the sun for 30 minutes. Some improvement was seen in 83% of participants, and the results were rated as good in 57% (75% improvement or better).4

A clinical report describes the use of vitamin supplements in the treatment of vitiligo.5 Folic acid and/or vitamin B12 and vitamin C levels were abnormally low in most of the 15 people studied. Supplementation with large amounts of folic acid (1–10 mg per day), along with vitamin C (1 gram per day) and intramuscular vitamin B12 injections (1,000 mcg every two weeks), produced marked repigmentation in eight people. These improvements became apparent after three months, but complete repigmentation required one to two years of continuous supplementation. In another study of people with vitiligo, oral supplementation with folic acid (10 mg per day) and vitamin B12 (2,000 mcg per day), combined with sun exposure, resulted in some repigmentation after three to six months in about half of the participants.6 This combined regimen was more effective than either vitamin supplementation or sun exposure alone.

When used topically in combination with sun exposure, a pharmaceutical form of vitamin D, called calcipotriol, may be effective in stimulating repigmentation in children with vitiligo. In a preliminary study, children applied a cream containing calcipotriol daily and exposed themselves to sunlight for 10–15 minutes the following morning.7 After 11 months, marked to complete repigmentation occurred in 55% of the children, moderate repigmentation occurred in 22%, and little or no improvement was seen in 22%. None of the children developed new areas of vitiligo. The first evidence of repigmentation occurred within 6 to 12 weeks in the majority of the children. All participants tolerated the cream well, with approximately 17% complaining of mild, transient skin irritation. Calcipotriol is a prescription medication to be used only under the supervision of a doctor. It is not known whether vitamin D as a dietary supplement has any effect on vitiligo.

In one early report, lack of stomach acid (achlorhydria) was associated with vitiligo. Supplementation with dilute hydrochloric acid after meals resulted in gradual repigmentation of the skin (after one year or more).8 Hydrochloric acid, or its more modern counterpart betaine HCl, should be taken only under the supervision of a doctor.

Another early report described the use of PABA (para-aminobenzoic acid)—a compound commonly found in B-complex vitamins—for vitiligo. Consistent use of 100 mg of PABA three or four times per day, along with an injectable form of PABA and a variety of hormones tailored to individual needs, resulted, in many cases, in repigmentation of areas affected by vitiligo.9

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: An extract from khella (Ammi visnaga) may be useful in repigmenting the skin of people with vitiligo. Khellin, the active constituent, appears to work like psoralen drugs—it stimulates repigmentation of the skin by increasing sensitivity of remaining melanocytes to sunlight. Studies have used 120–160 mg of khellin per day.10

In preliminary trial, Picrorhiza, in combination with the drug methoxsalen and sun exposure, was reported to hasten recovery in people with vitiligo compared with use of methoxsalen and sun exposure alone.11 Between 400 and 1,500 mg of powdered, encapsulated picrorhiza per day has been used in a variety of studies.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: People with vitiligo have occasionally improved using hypnosis along with other treatments.12

References:

1. Ortonne JP, Bose SK. Vitiligo: where do we stand? Pigment Cell Res 1993;6:61–72.

2. Siddiqui AH, Stolk LM, Bhaggoe R, et al. L-phenylalanine and UVA irradiation in the treatment of vitiligo. Dermatology 1994;188:215–8.

3. Schulpis CH, Antoniou C, Michas T, Strarigos J. Phenylalanine plus ultraviolet light: preliminary report of a promising treatment for childhood vitiligo. Pediatr Dermatol 1989;6:332–5.

4. Camacho F, Mazuecos J. Treatment of vitiligo with oral and topical phenylalanine: 6 years of experience. Arch Dermatol 1999;135:216–7.

5. Montes LF, Diaz ML, Lajous J, Garcia NJ. Folic acid and vitamin B12 in vitiligo: a nutritional approach. Cutis 1992;50:39–42.

6. Juhlin L, Olsson MJ. Improvement of vitiligo after oral treatment with vitamin B12 and folic acid and the importance of sun exposure. Acta Derm Venereol 1997;77:460–2.

7. Parsad D, Saini R, Nagpal R. Calcipotriol in vitiligo: A preliminary study. Pediatr Dermatol 1999;16:317–20.

8. Francis HW. Achlorhydria as an etiological factor in vitiligo, with report of four cases. Nebraska State Med J 1931;16(1):25–6.

9. Sieve BF. Further investigations in the treatment of vitiligo. Virginia Med Monthly 1945;Jan:6–17.

10. Abdel-Fattah, Aboul-Enein MN, Wassel GM, El-Menshawi BS. An approach to the treatment of vitiligo by khellin. Dermatologica 1982;165:136–40.

11. Bedi KL, Zutshi U, Chopra CL, Amla V. Picrorhiza kurroa, an Ayurvedic herb, may potentiate photochemotherapy in vitiligo. J Ethnopharmacol 1989;27:347–52.

12. Shenefelt PD. Hypnosis in dermatology. Arch Dermatol 2000;136:393–9.