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Vitiligo is a condition in which the pigment cells in the skin are destroyed, resulting in irregularly shaped white patches. Any part of the body where pigment cells are present may be involved.
The depigmentation commonly causes much concern and distress to the sufferer.
Incidence; Causes & Development
Vitiligo affects some 1% of the population and does not discriminate between sex, age or background. At least half the people who develop this skin disorder experience some pigment loss before they are 20 years old. About 20% of all vitiligo sufferers have other family members with it.
The cause of vitiligo is not known. Some people have reported pigment loss soon after suffering emotional stress, or physical injury such as severe sunburn. There are three main theories about the cause of this disorder:- Abnormally functioning nerve cells may injure nearby pigment cells.
- The body may destroy its own tissue (an autoimmune reaction). Researchers speculate that the pigment in the cells may be destroyed in response to a substance the body perceives as foreign.
- Some researchers believe that pigment-producing cells are self-destructive (auto toxic). While new cells form, the body produces highly toxic by-products which may destroy pigment cells.
The age of onset and the severity of pigment loss differs from person to person. Light-skinned people notice the pigment loss more during the summer as the contrast between the vitiligous skin and the suntanned skin becomes more distinct. Darker-skinned people notice the contrast any time.
Signs & Symptoms
Common sites include:- Exposed areas - face, neck, eyes, nostrils, nipples, navel, genitals
- Body folds - armpits, groin
- Sites of injury - cuts, scrapes, burns
- Surrounding pigmented moles
- Hair - early graying of the hair on the scalp
- Retina of the eyes
The degree of pigment loss can vary within each patch. A border of darker skin may circle an area of light skin.
Treatment & Prevention
Even under the most favorable circumstances, using all of the treatment recommendations, usually very little progress is seen in the first few months, and it takes two to three years to achieve as much as possible. However, the majority of the time partial or complete repigmentation can be achieved. No results are seen in only a minority of individuals.
Camouflage makeup will help to hide the areas of depigmentation. If the skin is almost completely depigmented, removal of the remaining pigment may be preferred (by using bleaching agents.)
Local steroid creams are sometimes used in the early stages of a rapidly progressive depigmentation. Affected skin should be protected against direct sunlight to prevent sunburn. Trauma or injury to the skin should be avoided as much as possible (e.g. playing with animals which scratch).
Prognosis; Complications
There is a 30% chance of spontaneous recovery. Those who have very severe pigment loss may lose color over their entire bodies (except for their eyes, which do not change color). There is no way to predict how much pigment an individual will lose. Illness and stress can result in more pigment loss. Cycles of pigment loss, followed by periods of stability, may continue indefinitely.
Even though most people with vitiligo are in good general health, they are at greater risk of:
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Signs, symptoms & indicators of Vitiligo:
Conditions that suggest Vitiligo:
Risk factors for Vitiligo:
Vitiligo suggests the following may be present:
Recommendations and treatments for Vitiligo: | | | | | Amino Acid / Protein |  L-Phenylalanine | A recommended dosage is usually 2 to 3gm daily, depending on the severity of the vitiligo. For best absorption, L-phenylalanine should be taken in between meals. |
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Botanical |
 Picrorhiza| | Picrorhiza, in preliminary research and in combination with the drug methoxsalen and sun exposure, was reported to hasten recovery in people with vitiligo, compared to using methoxsalen and sun exposure alone. [Bedi KL, Zutshi U, Chopra CL, Amla V. Picrorhiza kurroa, an Ayurvedic herb, may potentiate photochemotherapy in vitiligo. J Ethnopharmacol 1989;27: pp.347-52] |
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Digestion |
Hydrochloric Acid (Trial)| | In the 1940s it was discovered that the large majority of people with vitiligo also have stomach malfunction, with partial or complete lack of hydrochloric acid and pepsin production. At that time, hydrochloric acid and pepsin supplementation was recommended in some cases and repigmentataon was achieved in 2 to 3 years with this alone. In the 1990s, hydrochloric acid and pepsin supplements are still recommended for those who need them, and still are part of overall vitiligo treatment. |
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Environmental |
Sunlight Exposure |
Lab Tests/Rule-Outs |
Test Copper Levels| | Melanin, the normal body pigment, is synthesized from the essential amino acid L-phenylalanine by an enzyme system dependent on copper, vitamin B6, vitamin C. That's why these nutrients are all part of vitiligo repigmentation programs, also.
Although 4mg of copper sebacate daily is usually a safe minimum amount, it is best to have red cell copper levels tested before settling on an amount of copper for long term treatment. |
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Vitamins |
Vitamin B12 (Cobalamine)| | Because many people with vitiligo also have stomach malfunction, they do not absorb vitamin B12 and folic acid very well. This may be part of the reason why these nutrients, along with vitamin C, are often successfully used as part of a vitiligo repigmentation program. Suggested doses are 5mg folic acid and 1000mg vitamin C, twice daily. For the best chance of success, the vitamin B12 should be given by injection, 1000mcg weekly. Several months are usually required before early repigmentation is seen. |
Vitamin C (Ascorbic Acid)
Vitamin Paba| | PABA can help in vitiligo repigmentation. Depending on the severity of the problem, recommended dosage varies between 500 and 2000mg, three times daily. |
Vitamin B6 (Pyridoxine)| | See the link between Vitiligo and Copper. Typical recommended dosage is 1000mg twice daily. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link | | | May do some good | | | Likely to help |
GLOSSARY
Addison's Disease
A condition characterized by the chronic destruction of the adrenal cortex, which leads to an increased loss of sodium and water in the urine, muscle weakness and low blood pressure. The bronze color of the skin is due to the increased production of the skin pigment, melanin.
Adrenal (Adrenal Gland, Adrenal Glands, Adrenals)
The adrenal glands sit on top of each kidney and consist of an outer cortex and an inner medulla. Of the 50 or so hormones the adrenals make, only cortisone and adrenaline are recognized by most people. Some of these hormones must be produced to preserve life, while others help resist stress. Other hormones from the adrenals control normal energy output (along with the thyroid) and govern the breakdown of stored energy into quick energy sources. The medulla produces epinephrine and norepinephrine, which are specifically designed to help the body deal with stressful situations. The adrenals control the body's potassium/sodium balance, which is vital for energy production. They also produce sex hormones in minute amounts, which is important for later years when the gonads drop or cease their production.
Alopecia
Loss of hair.
Amino Acid (Amino Acids)
An organic acid containing nitrogen chemical building blocks that aid in the production of protein in the body. Eight of the twenty-two known amino acids are considered "essential," and must be obtained from dietary sources because the body can not synthesize them.
Autoimmune Disease (Autoimmune, Autoimmunity)
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Ayurvedic (Ayurveda)
Type of alternative medicine in which diet and therapies, such as herbal inhalation and massage, are dictated by individual's body type; 4,000 year-old traditional Indian system believed to be helpful to those suffering insomnia, hypertension and digestive problems.
Cobalamin (B12, B-12, Cobalamine, Vitamin B12)
Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Copper
An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Folic Acid
A B-complex vitamin that functions along with vitamin B-12 and vitamin C in the utilization of proteins. It has an essential role in the formation of heme (the iron containing protein in hemoglobin necessary for the formation of red blood cells) and DNA. Folic acid is essential during pregnancy to prevent neural tubular defects in the developing fetus.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Herbs (Herb, Herbal)
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Hydrochloric Acid (HCl)
An inorganic acidic compound, excreted by the stomach, that aids in digestion.
Hyperthyroidism (Hyperthyroid)
An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.
Hypothyroidism (Hypothyroid)
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Melanin
A dark pigment produced in the skin. Dark-skinned individuals produce more melanin, and melanin production increases in response to sunlight, causing the skin to become darker.
Microgram (mcg, Micrograms, ug)
0.000001 or a millionth of a gram.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Mole (Moles, Nevi, Nevus)
Known more accurately as a "nevus", a mole is a lesion of the skin that may be present from birth, but which most often appears later in life. By three years of age, 40% of children will have at least one nevus. Some varieties are hereditary and most have color. A common nevus in light-skinned people is typically small, round, tan or brown, with a smooth border, and exactly the same throughout. Other types may be very large, or have irregular borders. There are dozens of different types, with many shapes, colors and sizes. While most are benign, malignant changes can occur to turn the benign nevus into a melanoma.
Nipple (Areola, Nipples, Subareolar)
The small projection near the center of the breast containing the outlets of the milk ducts, OR the corresponding projection of the male breast. The areola is the darker tissue that encircles the nipple. Subareolar describes the location beneath the surface of the areola.
Para Aminobenzoic Acid (PABA)
May be considered part of the B-complex vitamins. As a coenzyme, PABA functions in the breakdown and utilization of proteins and in the formation of red blood cells.
Pernicious Anemia
Anemia caused by a vitamin B12 deficiency.
Retina (Retinal)
A 10-layered, frail nervous tissue membrane of the eye, parallel with the optic nerve. It receives images of outer objects and carries sight signals through the optic nerve to the brain.
Steroid (Steroids)
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Vitamin B6 (B6, B-6)
Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.
Vitamin C (Ascorbic Acid)
A water-soluble antioxidant vitamin essential to the body's health. When bound to other nutrients, for example calcium, it would be referred to as "calcium ascorbate". As an antioxidant, it inhibits the formation of nitrosamines (a suspected carcinogen). Vitamin C is important for maintenance of bones, teeth, collagen and blood vessels (capillaries), enhances iron absorption and red blood cell formation, helps in the utilization of carbohydrates and synthesis of fats and proteins, aids in fighting bacterial infections, and interacts with other nutrients. It is present in citrus fruits, tomatoes, berries, potatoes and fresh, green leafy vegetables.
Last updated: Apr 13, 2008
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