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.
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:
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.
Common sites include:
The degree of pigment loss can vary within each patch. A border of darker skin may circle an area of light skin.
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).
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:
There is a particularly high incidence of vitiligo among individuals with pernicious anemia, and vice versa. The reason for this is unknown.
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.
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]
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 repigmentation 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.
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.
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.
PABA can help in vitiligo repigmentation. Depending on the severity of the problem, recommended dosage varies between 500 and 2000mg, three times daily.
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