Vitiligo is a skin disease in which pigment-making cells, called melanocytes, are destroyed, leaving white irregular patches of skin where pigment used to be. The patches usually appear on the hands, feet, arms, face, and lips, but can also occur on the skin around the mouth, nose, eyes, and genitals. Hair growing from areas affected by vitiligo may also turn white. Although vitiligo in itself is not painful, it can cause emotional distress.
Science has not identified the cause of vitiligo, but some researchers theorize that an autoimmune process plays a role. In an autoimmune disease, the body's immune system starts attacking innocent tissues. In vitiligo, antibodies may develop against melanocytes, ultimately destroying some of them. Vitiligo seems to be more common in people who have other autoimmune diseases; however, most people with vitiligo have no other autoimmune disease.
Most conventional vitiligo treatments combine ultraviolet light (UVA) exposure with oral or topical drugs that selectively sensitize the skin to UVA—such drugs are called "psoralens" because they are most commonly used to treat psoriasis. The results of this treatment are generally reasonably good. Another option is topical corticosteroids, which may be best for localized vitiligo.1 In severe cases, surgical procedures including skin grafting and melanocyte transplantation may be considered, although these approaches are still experimental.
Most natural therapies for vitiligo also employ exposure to UVA or natural sunlight in conjunction with an oral or topical treatment.
Khellin, an extract of the fruit of the Mediterranean plant khella ( Ammi visnaga), is closely related to the standard psoralen drug methoxsalen. Both are used in conjunction with UVA to repigment vitiligo patches.
A double-blind, placebo-controlled study of 60 people indicated that the combination of oral khellin and natural sun exposure caused repigmentation in 76.6% of the treatment group; in comparison, no improvement was seen in the control group receiving sunlight plus placebo.2 A subsequent placebo-controlled study of 36 people found that a topical khellin gel plus UVA caused repigmentation in 86.1% of the treated cases, as opposed to 66.6% in the placebo group.3
A typical oral dosage of khellin is 100 mg daily.
Khellin has no reported side effects when used topically. Oral doses, however, have caused various side effects ranging from nausea and vomiting to liver inflammation.
A handful of preliminary studies suggest that oral L-phenylalanine, a natural amino acid, might also be helpful for vitiligo. It too is combined with either sunlight or controlled ultraviolet light.
Of four studies on the subject, only one was double-blind.4 It found positive results; however, because only 24 people were enrolled, further research will be necessary to confirm its conclusions. The other studies were open, uncontrolled trials, and as such prove little.5,6,7
For more information, including dosage and safety issues, see the full Phenylalanine article.
There is some evidence that people with vitiligo have lower than average levels of both vitamin B12 and folate.12 In addition, there is a particularly high incidence of vitiligo among individuals with pernicious anemia, a condition in which vitamin B 12 is poorly absorbed. However, this information does not prove that taking extra vitamin B 12 and folate will help. Furthermore, a much larger study of 100 people found no significant association between vitiligo and low levels of either vitamin.13 One uncontrolled study does suggest that vitamin B 12 and folate supplements might improve pigmentation in vitiligo, but because of its poor design the results prove little.14
Para-aminobenzoic acid ( PABA) is best known as an active ingredient in sunblock. Based on a 1942 study, oral PABA has been suggested as a vitiligo treatment. The study, however, lacked a control group, so the results are not meaningful.16 Ironically, another study suggests that high oral doses of PABA can actually cause vitiligo.17
As noted above, vitiligo is sometimes associated with pernicious anemia. Pernicious anemia in turn is often linked to low levels of stomach gastric acid, a condition called achlorhydria.18 For this reason, some physicians specializing in natural medicine recommend supplemental hydrochloric acid (HCl, often in the form of betaine hydrochloride) to augment low gastric acid, but there is no evidence as yet that it helps.
Njoo MD, Spuls PI, Bos JD, et al. Nonsurgical repigmentation therapies in vitiligo. Meta-analysis of the literature. Arch Dermatol. 1998;134:1532-1540.
Abdel-Fattah A, Aboul-Enein MN, Wassel GM, et al. An approach to the treatment of vitiligo by khellin. Dermatologicia. 1982;165:136-140.
Orecchia G, Sangalli ME, Gazzaniga A, et al. Topical photochemotherapy of vitiligo with a new khellin formulation: preliminary clinical results. J Dermatol Treat. 1998;9:65-69.
Siddiqui AH, L-Phenylalanine and UVA irradiation in the treatment of vitiligo. Phamacol Treat. 1994;188:215-18.
Siddiqui AH, Stolk LML, Bhaggoe R, et al. L-phenylalanine and UVA irradiation in the treatment of vitiligo. Dermatology. 1994;188:215-218.
Camacho F, Mazuecos J. Treatment of vitiligo with oral and topical phenylalanine: 6 years of experience. Arch Dermatol. 1999;135:216-217.
Schulpis CH, Antoniou C, Michas T, et al. Phenylalanine plus ultraviolet light: preliminary report of a promising treatment for childhood vitiligo. Pediatr Dermatol. 1989;6:332-335.
Montes LF, Diaz ML, Lajous J, et al. Folic acid and vitamin B 12 in vitiligo: a nutritional approach. Cutis. 1992;50:39-42.
Kim SM, Kim YK, Hann S-K. Serum levels of folic acid and vitamin B 12 in Korean patients with vitiligo. Yonsei Med J. 1999;40:195-198.
Juhlin L, Olsson MJ. Improvement of vitiligo after oral treatment with vitamin B 12 and folic acid and the importance of sun exposure. Acta Derm Venereol (Stockh). 1997;77:460-462.
Bedi KL, Zutshi U, Chopra CL, et al. Picrorhiza kurroa, an ayervedic herb, may potentiate photochemotherapy in vitiligo. J Ethnopharmacol. 1989;27:347-352.
Sieve BJ. The clinical effects of a new B complex factor, para-aminobenzoic acid, on pigmentation and fertility. South Med Surg. 1942;104:135-139.
Hughes CG. Oral PABA and vitiligo [letter]. J Am Acad Dermatol. 1983;9:770.
Howitz J, Schwartz M. Vitiligo, achlorhydria, and pernicious anmia. Lancet. 1971;1:1331-1334.
Parsad D, Pandhi R, Juneja A. Effectiveness of oral ginkgo biloba in treating limited, slowly spreading vitiligo. Clin Exp Dermatol. 2003;28:285-287.
Last reviewed December 2015 by EBSCO CAM Review Board
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