Also indexed as: Depigmentation
White spots on the skin may be the visible signs of vitiligo, a
disorder that causes skin depigmentation. According to research or other evidence, the
following self-care steps may help restore color:
- Go for the ginkgo
- Improve repigmentation by taking 40 mg of a standardized extract
of the herb Ginkgo biloba three times a day
- Discover L-phenylalanine
- Improve repigmentation of skin by taking 50 mg of this nutritional
supplement for every 2.2 pounds of body weight on a daily basis, in conjunction with
ultraviolet light exposure
- Check out khella
- Increase the sun sensitivity of the pigmenting skin cells with
this herb; take an extract delivering a daily amount of 120 to 160 mg of khellin
- Get a checkup
- Visit your healthcare provider to find out whether your vitiligo
is the result of a treatable medical condition
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full vitiligo article for more
in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
About vitiligo
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
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vitiligo
What are the symptoms?
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.
Medical options
Over-the-counter dihydroxyacetone (Chromelin Complexion Blender) might help darken light
areas of skin.
Prescription topical corticosteroids, such
as amcinonide (Cyclocort) and betamethasone dipropionate (Diprosone) might help in
some situations. The psoralens methoxsalen (Oxsoralen, Uvadex) and trioxsalen (Trisoralen) are
occasionally used together with ultraviolet A irradiation (PUVA). Topical monobenzone
(Benoquin) is also available to treat extensive vitiligo.
Other treatment includes cosmetic creams and tanning solutions. 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). Rarely, skin transplants may be necessary.
Vitamins 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
In a double-blind study of 52 people with slowly spreading vitiligo, supplementation with
Ginkgo biloba extract (standardized to contain 24% ginkgoflavonglycosides), in the
amount of 40 mg three times per day for up to six months, resulted in marked to complete
repigmentation in 40% of cases, compared with only 9% among those receiving a
placebo.10
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.11
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.12
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.
Holistic approaches that may be helpful
People with vitiligo have occasionally improved using hypnosis along with other treatments.13
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. Parsad D, Pandhi R, Juneja A. Effectiveness of oral Ginkgo biloba in
treating limited, slowly spreading vitiligo. Clin Exp Dermatol
2003;28:285–7.
11. Abdel-Fattah, Aboul-Enein MN, Wassel GM, El-Menshawi BS. An approach
to the treatment of vitiligo by khellin. Dermatologica 1982;165:136–40.
12. Bedi KL, Zutshi U, Chopra CL, Amla V. Picrorhiza kurroa, an
Ayurvedic herb, may potentiate photochemotherapy in vitiligo. J Ethnopharmacol
1989;27:347–52.
13. Shenefelt PD. Hypnosis in dermatology. Arch Dermatol
2000;136:393–9.