Vitiligo treatment, supplements, herbs, vitamins - Cause and treatment with alternative and natural therapy and remedy - Ray Sahelian, M.D.
Feb 15 2014

Vitiligo is one of the most common pigment cell disorders, distinguished by depigmented patches of skin. Approximately one percent of the world's population has vitiligo, whose psychosocial impact is often underestimated. The standard treatment for vitiligo is ultraviolet (UV) light therapy, which may last several months and can cause physical discomfort. Transplantation of pigment cells (called melanocytes) is another treatment option in patients with vitiligo. Non-blistering skin diseases, such as alopecia areata, vitiligo and psoriasis are increasingly believed to be directly mediated by the activities of autoreactive T cells.

Vitiligo natural treatment
Oxidative stress is involved in the pathophysiology of vitiligo and perhaps certain antioxidants, such as acetyl-cystiene and alpha lipoic acid may be helpful. As you can see from the studies listed below, ginkgo biloba, polypodium leucotomas, a Chinese herb Xiaobai,and a couple of B vitamins have been studied. I will continue to review research regarding the natural treatment of vitiligo. I am not aware of a natural vitiligo cure. I also searched the internet for Xiaobai and could not come up with any useful information. As soon as I come across some natural options for vitiligo, I will mention them on this web page. Ginkgo biloba is worth a try for those who want to try a natural remedy for vitiligo.

Gingko as a natural treatment for vitiligo skin condition
Drs. Orest Szczurko and Heather S. Boon of the University of Toronto reviewed published research regarding natural vitiligo treatment and found 15 controlled studies. Three of the studies looked at L-phenylalanine with UVA or UVB therapy, and one looked at L-phenylalanine in combination with other drugs. While all these studies showed benefits, there were a high number of dropouts and the lack of a control group. Drs. Orest Szczurko and Heather S. Boon report that there is mild to moderate evidence for the benefit of Gingko biloba as a natural vitiligo treatment. BMC Dermatology, 2008.
   Comments: Patients with vitiligo who want to try ginkgo biloba could take a 40 mg capsule twice daily for a few weeks or months to see whether there is any improvement. One positive effect of ginkgo biloba is that it can enhance mental focus and concentration. If two capsules a day is too potent, you could drop to one ginkgo capsule daily.

I have seen an article on your website that ginkgo biloba can treat vitiligo and I want to know if this information is correct? What kind of ginkoba biloba is best to purchase to treat the matter of vitiligo? We have purchased ginkoba biloba extract and it says it's good for memory it doesn't say if it's good for anything else. I haven't used this product ever since I bought it and when I saw your article I'm wondering what kind of herb or extract is best to use for this skin condition? How long will it take to see results?
   Studies using this herb as a treatment for this skin condition are limited and there is no convincing evidence yet that it would be effective. Even if it works, the benefits are probably mild to moderate. However, it is worth a try.

Role of oxidative stress as a cause
It appears that one cause of vitiligo may be due to the death of melanocytes from oxidative stress.

Study on the antioxidant status of vitiligo patients of different age groups in Baroda.
Pigment Cell Res. 2004. Agrawal D, Shajil EM, Marfatia YS, Begum R. Department of Biochemistry, Faculty of Science, M.S. University of Baroda, Vadodara, Gujarat, India.
One of the major hypotheses in the pathogenesis of vitiligo is the oxidative stress hypothesis. Pollution plays a major role in the production of free radicals. Gujarat, a highly industrialized state in India has a high prevalence of vitiligo patients. No previous studies were done on the age-dependent antioxidant status of vitiligo patients in Baroda city, Gujarat. Results: Whole blood glutathione levels, erythrocyte glutathione peroxidase and glucose-6-phosphate dehydrogenase activity were decreased significantly, whereas erythrocyte catalase activity and plasma vitamin E levels were not different in vitiligo patients as compared with age-matched healthy controls. No specific age group showed a significant difference. Conclusion: This is the first report on the age-dependent antioxidant status of vitiligo patients in Baroda. The disease affects individuals of any age group as shown in this study and systemic oxidative stress might precipitate the pathogenesis of vitiligo in susceptible patients.

Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial.
Clin Exp Dermatol. 2007. Spedali Civili, Brescia, Italy.
To evaluate the clinical effectiveness of narrow band UVB and the repairing of oxidative stress-induced damage, using oral supplementation with an antioxidant pool. Patients with nonsegmental vitiligo were enrolled in a randomized, double-blind, placebo-controlled multicentre trial. The treatment group received, for 2 months before and for 6 months during the NB-UVB treatment, a balanced antioxidant supplement containing alpha-lipoic acid, vitamins C and E, and polyunsaturated fatty acids. Oral supplementation with antioxidants containing alpha-lipoic acid before and during NB-UVB significantly improves the clinical effectiveness of NB-UVB, reducing vitiligo associated oxidative stress.

Role of food or diet? Benefit of gluten free diet?
I read with interest your vitiligo page as I am affected and have been seeing reversals and repigmentation on my legs, feet and now it is starting to happen on my hands which were the first site of depigmentation 24 years ago. One of the things that I have used and believe is definitely a part of this recovery is methyl B12, along with serrapeptase, other enzymes, and an organic, gluten free diet.

Thank you for posting helpful information on the net. I wanted to chime in with the other person who has seen repigmentation with a gluten free diet. Since I was diagnosed with Celiac Disease about 6 years ago, and been on a gluten free diet I have seen significant repigmentation over the entire 5 years, starting about 6 months into the gluten free diet. I had vitiligo for 25 years before this occurred. Repigmentation has occurred, so far, over about 2/3 of the white spots.

Topical piperine
Investigators at King's College London have found that piperine -- the compound that gives black pepper its spicy, pungent flavor -- and its synthetic derivatives help stimulate pigmentation in the skin of people with vitiligo. Piperine was particularly effective when combined with phototherapy treatment using ultraviolet radiation. Topical treatment with piperine stimulated even pigmentation in the skin.

Traditional vitiligo treatment
Conventional treatments for vitiligo include topical steroids. Treatment with ultraviolet A or ultraviolet B (UVA or UVB) light alone or along with medications known as psoralens or calcipotriol may also be effective.

Pak J Biol Sci. 2013. Frequency of autoimmune diseases in those suffering from vitiligo in comparison with normal population. The most common autoimmune disorder in patient with vitiligo was hypothyroidism. Family history had a poor prognostic effect on response to therapy.

Vitiligo Research
Clinical observation on treatment of vitiligo with xiaobai mixture
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2003.
To observe the therapeutic effect of Xiaobai Mixture (XBM) in treating vitiligo. Seventy-four patients with vitiligo were randomly divided into the XBM group treated with XBM and the control group treated with 8-MOP. The therapeutic effect, nail-fold microcirculation, plasma endothelin-1, serum immunoglobulin were observed and compared. The therapeutic effect of XBM was better than that of 8-MOP. XBM could also obviously improve the nail-fold microcirculation, elevate the plasma endothelin-1 level and lower the serum IgG. XBM has superiority in treating vitiligo.

Alterations of mitochondria in peripheral blood mononuclear cells of vitiligo patients.
Pigment Cell Res. 2003.
The possible role for a defective mitochondrial functionality in the pathogenesis of vitiligo was investigated by measuring intracellular levels of reactive oxygen species and of antioxidants, the activity of Krebs cycle enzymes, as well as the effects of inhibitors of the electron transport chain, in peripheral blood mononuclear cells from patients with active or stable disease vs. normal subjects. Plasma glyoxal levels were also determined in the same groups of subjects as an index of systemic oxidative stress. In patients with vitiligo in active phase, we observed an increased intracellular production of reactive oxygen species with a consequent imbalance of the prooxidant/antioxidant equilibrium, whereas plasma did not show apparent alterations in glyoxal levels, ruling out a systemic oxidative stress. In patients with stable disease, the balance between pro-oxidants and anti-oxidants seems to be maintained. Moreover, a marked increase in the expression of mitochondrial malate dehydrogenase activity and a specific sensitivity to electron transport chain complex I inhibitor were observed. Overall, these data provide further evidence for an altered mitochondrial functionality in vitiligo patients.

Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo.
Clin Exp Dermatol. 2003.
For effective treatment of vitiligo, it is as important to arrest the progression of the disease as it is to induce repigmentation. Recently, oxidative stress has been shown to play an important role in the pathogenesis of vitiligo. Ginkgo biloba extract has been shown to have antioxidant and immunomodulatory properties. In a double-blind placebo-controlled trial, we evaluated the efficacy of G. biloba extract in controlling the activity of the disease process in patients with limited and slow-spreading vitiligo and in inducing repigmentation of vitiliginous areas. Fifty-two patients were assigned to two treatment groups (A and B) in a double-blind fashion, but only 47 patients could be evaluated, because one patient in group A and four patients in group B withdrew for reasons unrelated to the study. Patients in group A were given G. biloba extract 40 mg three times daily whereas patients in group B received placebo in similar doses. A statistically significant cessation of active progression of depigmentation was noted in patients treated with G. biloba (P = 0.006). Marked to complete repigmentation was seen in 10 patients in group A, whereas only two patients in group B showed similar repigmentation. The G. biloba extract was well tolerated. G. biloba extract seems to be a simple, safe and fairly effective therapy for arresting the progression of the disease.

Vitiligo: a manifestation of apoptosis?
Am J Clin Dermatol. 2002. Huang CL, Nordlund JJ, Boissy R. Department of Dermatology, University of Cincinnati, Pavilion A, Ohio
Vitiligo is a common cutaneous disorder that has significant biological and social consequences for those affected. It is characterized by a loss of melanocytes from the epidermis, which results in the absence of melanin, i.e. depigmentation. There are numerous hypotheses about the etiology of vitiligo, but no data to definitively prove one theory over another. It is likely that there are numerous causes for the loss of these melanocytes. One way to approach the identification of the etiology is to determine the mechanism by which the melanocytes are destroyed. The two known mechanisms for the destruction of cells are necrosis and apoptosis. One purpose of this paper is to review the extant data that might suggest which of the two mechanisms is operative against melanocytes in patients with vitiligo. The histological data, and some laboratory data, support apoptosis, rather than necrosis, as the mechanism for removal of melanocytes. Apoptosis can be induced by a variety of factors, including immune cytokines, some environmental chemicals (for example substituted hydroquinones such as monobenzone) or other molecular mechanisms. Current therapies, such as corticosteroids and ultraviolet light, do affect apoptosis in a variety of ways. Confirmation of apoptosis as a mechanism, and identification of how apoptosis is initiated to produce vitiligo, can serve as a basis for devising medications that might stop the progression of the disorder. The problem of vitiligo would be essentially solved if there was a medication that is well tolerated in children, adults and pregnant women, and that would halt the progression of the depigmentation. The study of apoptosis, mechanisms of its induction, and the ways to block apoptosis, is one possible way to find both the causes of depigmentation and medications to prevent its progression.

Improvement of vitiligo after oral treatment with vitamin B12 and folic acid and the importance of sun exposure.
Acta Derm Venereol. 1997.
The aim of this 2-year study was to test the hypothesis that folic acid, vitamin B12 and sun exposure could be helpful in treating vitiligo. One hundred patients with vitiligo were treated with oral folic acid and vitamin B12 after being informed that sun exposure might enhance repigmentation. They were requested to keep a record of sun exposure in summer and UVB irradiation in winter. The minimal treatment time suggested was 3-6 months but should be longer if improvement was achieved. Clear repigmentation occurred in 52 patients, including 37 who exposed their skin to summer sun and 6 who used UVB lamps in winter. Repigmentation was most evident on sun-exposed areas, where 38% of the patients had previously noted repigmentation during summer months. Total repigmentation was seen in 6 patients. The spread of vitiligo stopped in 64% of the patients after treatment. Folic acid and vitamin B12 supplementation combined with sun exposure can induce repigmentation better than either the vitamins or sun exposure alone. Treatment should continue as long as the white areas continue to repigment. Further studies are needed to determine ideal minimal dosages of vitamins and UV exposure, as well as treatment time.

Vitiligo repigmentation with Anapsos (Polypodium leucotomos)
Int J Dermatol. 1989 ; Mohammad A.

Vitiligo natural treatment questions
Q. Do you have any supplement product that are effective for treating or concealing vitiligo spots on the hands, fingers and underneath the neck.
   A. At this time we are not aware of a natural vitiligo treatment or cure that works consistently.

Q. I noticed that many "tanning pills" contain L-Tyrosine. Does L-Tyrosine help produce melanin? Can a person with vitiligo take a supplement to help simulate melanin production?
   A. We don't think taking tyrosine orally will help form melanin. Currently we are not aware of a natural and effective vitiligo treatment.

Q. Can you please advise on here I can find and purchase Xiaobai Mixture for treating Vitiligo.
   A. We have not looked into this herbal combination, but a website that sells Chinese herbs may be a good place to inquire.

Q. I went to a dermatologist to have my white spots on my lower lips checked. My dermatologist found out that its actually vitiligo. The growth is somewhat very fast because it already scattered in many areas of my face since 7 months ago. I have my medication using meladenine as prescribed by my Dermatologist. I came across reading about glutathione as a supplement that may result to whiter skin. I just want to check from you if ever Im going to take glutathione, would there be some effect on my skin considering that I have vitiligo? Or what would be the effect if I'm going to take this in order to whiten my skin to conceal my vitiligo? Please advise as I am already socially affected. Im on my early 40ís now and have brown skin.
   A. Vitiligo is an acquired disorder of the skin involving melanocyte dysfunction.Melanocyte impairment could be related to increased oxidative stress. The glutathione S-transferases are group of polymorphic enzymes that are important in protection against oxidative stress. I have not come across any research regarding the influence of glutathione supplements on vitiligo. An in vitro study I found is interesting:

Glutathione prevented dopamine-induced apoptosis of melanocytes and its signaling.
J Dermatol Sci. 2007. Department of Dermatology, Seoul National University College of Medicine, Chongno-Gu, Seoul, Republic of Korea.
Dopamine, a monoamine neurotransmitter, is a well-known neurotoxin and plays an etiologic role in neurodegenerative disorders such as Parkinson's disease. Dopamine exerts its toxic effect by generation of reactive oxygen species and quinone product. Vitiligo, a depigmentary disorder of the skin and hair characterized by selective destruction of melanocytes, has been reported to show increased levels of Dopamine with onset and progression of the disease. The aim of this study is to investigate the cytotoxic effect of Dopamine on melanocytes and to search for protective antioxidants against Dopamine-induced toxicity. To investigate the cytoprotective activity of various antioxidants, vitamin C, vitamin E, Trolox, quercetin, N-acetylcysteine (NAC) and l-glutathione (GSH) were used. Results: Among various antioxidants used in this study, only thiol-containing antioxidants such as NAC or GSH inhibited both JNK and p38 MAPK activation and apoptosis, indicating the unique protective capacity of thiol compounds. Dopamine-induced apoptosis and cytoprotective effect of thiol compounds shown in this study could be a clue to understand pathogenesis of viltigo and provide a new therapeutic strategy.

Q. I'm suffering from vitiligo. I have blotches in all the common places on my body. I've tried different products and nothing seems to be working and it seems to be spreading more this passed year. is there a miracle product that you can tell me about that would cure vitiligo?
   A. I am not aware of a miracle vitiligo cure.

Q. I have suffered from vitiligo since 1984. It started on one of my fingers and has progressed to about 20% of my body. I believe it is an auto-immune disease and all the oral supplementations that I have tried were just expensive lessons on what does not work. Do you have, or know of any treatment that could combat this disease? About the same time in 1984, I was diagnosed to have type II diabetes.

Greetings, I am 32 years old and I had a problem in my melanin pigmentation called vitiligo for almost 10 years now and I am considering to take a tyrosine supplement. Does tyrosine help cure vitiligo?
    Tyrosine amino acid is not an effective treatment.

i have been doing excimer laser and protopic ointment (tacrolimus) for months for vitiligo treatment with no results.

I am a pharmacist )and my brother 32years old has vitiligo 4 monthes ago and we went to doctors and begin treatment with uv rays but no slight improvment and he give up hope and im trying to find any thing to him i prefer medicinal herb or any thing as it grow so rapidly we dont know what to do im from Egypt.

I read your site and informations that you have about herbs suppliment i want to ask about herbal medicins for cure of vitiligo desases I am living in Afganistan i need to your help I found out herbal medicine like Psoralea corylifolia seed and oil and also other like anti vitiligo oil or ginkgo biloba tablet but my problem is this that i can not find these drugs in my country and i want you to introduce me a good support center for treatment of vitiligo if you have information in india or pakistan or china or if you have information about other herbs medicins except that please dont hesitat to inform me. i will become very happy if you pay attention to my request.
    We apologize but we are not familiar with the availability of dietary supplements available in your country or nearby countries.