Vitiligo Products


Vitiligo
 

Vitiligo Introduction

Vitiligo is a hypopigmentation disorder of the skin characterized by complete loss of melanocytes, the cells responsible for skin color. It results in white patches of skin with sharp borders, defined by normally pigmented skin. The most common areas affected by vitiligo are the face, elbows, knees, and hands, though it can appear anywhere on the body. Some individuals may only exhibit one or two patches, while others may have small patches over the majority of their body’s. Vitiligo can even affect the scalp and result in white hair growth. It is considered to be both progressive and stable. [1]

It is not completely understood what causes a loss of melanocytes in the individuals with vitiligo. Several theories do exist, including, an autoimmune destruction of melanocytes, a neurotoxic destruction of melanocytes, and chemical toxicity resulting in melanocyte death. There are several precipitating factors associated with the onset of vitiligo. These include; physical trauma (especially to the head), family history of vitiligo, and autoimmune diseases such as Addison’s, diabetes, pernicious anemia, and thyroid disease. [2]

Vitiligo may begin at any age, though it most commonly occurs between the ages of 10 - 30. It affects men and women equally, as well as all races. Vitiligo is extremely rare in newborns. Additionally, it is equally uncommon for elderly individuals to suddenly develop the condition. [3]

Vitiligo Statistics

  • It is estimated that 1 - 2% of individuals worldwide are affected by vitiligo. That accounts for approximately 50 - 60 million people. In the US alone, 2 - 5 million people are affected by this condition. It affects each race equally across the globe. [4]
  • While Vitiligo may begin at any age, some 50% of reported cases will be diagnosed by the age of 20. 95% are diagnosed by the age of 40. [5]
  • 20-30% of individuals with vitiligo will also have a family member with vitiligo. A child born to a parent with vitiligo has a 10% chance of also developing the condition. [6]
  • Up to 30% of individuals with vitiligo will also have thyroid disease, mostly affecting women. Less than 5% of cases will have diabetes mellitus along with vitiligo. [7]

Vitiligo Symptoms

Patients will present with a gradual onset of pigment loss in otherwise normal skin. It may be associated with an ongoing autoimmune condition. The borders of the white patches will be sharply defined and irregular. The first lesions may appear on the fingers, elbows, or knees and slowly spread to other parts of the body.

Vitiligo presents with very few symptoms. Individuals may complain that the white patches are more sensitive to sun and burn easily. Some individuals may also be experiencing premature graying of hair and even early balding. Otherwise, the major complaint is cosmetic in nature.

Vitiligo Treatment

Conventional vitiligo treatment is focused on these five major areas:

  • The first vitilitgo treatment is sunscreen. It serves to protect the depigmented skin from burning and also helps to decrease the pigmentation (tanning) in normal skin.
  • The second vitilitgo treatment option is make-up (e.g. conceal, cover-up). This is especially useful when vitiligo affects the face. It helps to blend the depigmented areas with that of normal skin and reduces the high contrast.
  • The third vitilitgo treatment option is repigmentation. This process involves the use of natural or artificial UVA and UVB light, combined with either topical corticosteroids, topical psoralen (PUVA), or oral psoralen drugs.
  • The fourth vitilitgo treatment option is minigrafting, which takes pieces of normal skin and grafts them into areas affected by the vitiligo.
  • The fifth vitilitgo treatment option is depigmentation, where the pigment is removed from the normal skin to match the areas affected by vitiligo. This is mostly reserved for either cases that did not respond well to repigmentation with psoralens, or when the vitiligo affects a large surface area of the body. [8]

Supplements helpful for Vitiligo

Vitamin B12 and Folic Acid Both vitamin B12 and folic acid have been found to be deficient in individuals with vitiligo. The relationship between these nutrients and the development and treatment of vitiligo are unclear, though many hypotheses exist. Vitiligo is associated with autoimmune diseases and pernicious anemia. However, in pernicious anemia there is a decreased absorption of Vitamin B12. This may be a causal relationship.

In a study of 100 patients with vitiligo, supplementation with B12 and folic acid, concurrent with sun exposure, caused a repigmentation in 52% of the cases. Six patients had complete repigmentation. The spreading of lesions was ceased entirely in 64% of the patients. Results were more significant when there was an inclusion of UVA exposure. [9] In another study, folic acid and B12 status was measured in individuals with vitiligo and was found to be lower than normal subjects. Supplementation with both B12 and folic acid in this group also resulted in repigmentation. [10]

Vitamin E and CoQ10 It has been observed that individuals with vitiligo have an imbalance in the anti-oxidant systems of skin. This supports the theory that oxidative damage (via the sun) may play a role in the pathogenesis of melanocyte destruction and the subsequent development of vitiligo. Free radicals are elevated in the melanocytes of individuals with vitiligo. Anti-oxidants that are specific to cell membranes are also found to be extremely low. [11]

One study measured the oxidative stress in the epidermis of individuals with vitiligo and found it to be increased. Also measured and found to be deficient were the anti-oxidants that are usually present to protect the cell membrane from damage, namely, Vitamin E and CoQ10. [12] This supports the theory that the supplementation of anti-oxidants aids in protecting skin cells from the damage caused by free radicals.

Vitamin D3 Vitamin D is nutritive to the skin. It helps to maintain the integrity of cellular membranes. It is also involved in the production of melanin and directly affects cell growth and differentiation. Topical treatments of vitamin D3 have been proven to be an effective treatment for vitiligo. The mechanism of action may be associated with the immunomodulatory effect of vitamin D3.

In a small study, 6 of 15 patients had greater than 30% clearance of vitiligo after a short treatment period. The application was combined with sun exposure for 30 minutes. Results were more positive in individuals who had been diagnosed within the previous five years before study. [13] In considerably larger clinical study, 77% of patients had a 30-100% improvement in repigmentation after treatment for 3-9 months with both topical Vitamin D3 and UVA light. These results were consistent with conventional therapies that employ PUVA treatments. [14]

Phenylalanine Phenylalanine is an amino acid that has been effective in the treatment of vitiligo. Although the mechanism is not fully understood, it is postulated that phenylalanine stimulates the production of melanin by the melanocytes. Oral and topical phenylalanine has been used with positive results.

In one study, the oral supplementation or L-phenylalanine for six months resulted in an improvement (repigmentation) in 90% of the cases. 68% of these individuals had greater than 75% improvement. The areas on the face and trunk were affected most. [15] In an uncontrolled trial, the combination of oral and topical phenylalanine in conjunction with sun exposure, resulted in complete repigmentation in 57% of total cases (n=171). [16] Results are best when oral and topical phenylalanine is combined with regulated amounts of UV exposure. [17]

Ginkgo Biloba Ginkgo biloba is a potent anti-oxidant due to its high flavonoid content. Because of its free radical quenching abilities, it has been looked at as a possible therapy for vitiligo. In one recent study, supplementation with ginkgo biloba extract resulted in significant results. All of the participants had a cessation of disease progression, while 10 patients had complete repigmentation. [18]

References

[1] Beers M and Berkow R. The Merck Manual 17th Ed. Pp: 835-836.

[2] Beers M and Berkow R. The Merck Manual 17th Ed. Pp: 835-836.

[3] Fitzpatrick T et al. Color atlas and synopsis of clinical dermatology. 3rd Ed. McGraw-Hill New York. Pp: 287-295.

[4] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml National Institute of Arthritic Musculoskeletal and Skin Diseases. Oct 2004.

[5] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml National Institute of Arthritic Musculoskeletal and Skin Diseases. Oct 2004.

[6] Fitzpatrick T et al. Color atlas and synopsis of clinical dermatology. 3rd Ed. McGraw-Hill New York. Pp: 287-295.

[7] Fitzpatrick T et al. Color atlas and synopsis of clinical dermatology. 3rd Ed. McGraw-Hill New York. Pp: 287-295.

[8] Fitzpatrick T et al. Color atlas and synopsis of clinical dermatology. 3rd Ed. McGraw-Hill New York. Pp: 287-295.

[9] Juhlin L and Olsson MJ. Improvement of vitiligo after oral treatment with Vitamin B12 and folic acid and the importance of sun exposure. Acta Derm Venereol. 1997 Nov; 77(6): 460-462.

[10] Montes LF et al. Folic acid and vitamin B12 in vitiligo: a nutritional approach. Cutis. 1992 Jul; 50(1): 39-42.

[11] Maresca V et al. Increased sensitivity to peroxidative agents as a possible pathogenic factor of melanocyte damage in vitiligo. J Invest Dermatol. 1997 Sep; 109(3): 310-313.

[12] Passi S et al. Epidermal oxidative stress in vitiligo. Pigment Cell Res. 1998 Apr; 11(2): 81-85.

[13] Katayama I et al. Open trial of topical tacalcitol [1 alpha 24(OH)2D3] and solar irradiation for vitiligo vulgaris: upregulation of c-Kit mRNA by cultured melanocytes. Eur J Dermatol. 2003 Jul-Aug; 13(4): 372-376.

[14] Ameen M, Exarchou V, and Chu AC. Topical calcipotriol as monotherapy and in combination with psoralen plus ultraviolet A in treatment of vitiligo. Br J Dermatol. 2001 Sep; 145(3): 476-479.

[15] Camacho F and Mazuecos J. Oral and topical L-phenylalanine, clobetasol propionate and UVA/sunlight- a new study for the treatment of vitiligo. J Drugs Dermatol. 2002 Sep; 1(2): 127-131.

[16] Arch Dermatol. 1999; 135: 216-217.

[17] Antoniou C et al. Vitiligo therapy with oral and topical phenylalanine with UVA exposure. Int J Dermatol. 1989 Oct; 28(8): 545-547.

[18] Parsad D, Pandhi R, and Juneja A. Effectiveness of oral ginkgo biloba in treating mild slowly spreading vitiligo. Clin Exp Dermatol. 2003 May; 28(3): 285-287.