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DESCRIPTION
Vitiligo, also called leukoderma, is a chronic skin condition (dermatological disorder) that causes loss of melanin, the pigment that determines the color of your skin, hair and eyes. Vitiligo is characterized by the appearance of slowly enlarging, chalky or milky-white, irregular patches of skin possibly surrounded by a dark border. Vitiligo is the destruction of the cells that make pigment (melanocytes). These spots occur because, for some reason, the cells that normally produce skin pigment melanin are absent, die or are unable to function.
The spots can be few or many and they may be tiny or cover the body, varying from one to two white spots on the skin to large areas of depigmentation. They usually appear on both sides of the body in approximately the same place (for example, you may have exactly the same white patches on the top of your left and right foot), and they do not hurt or itch. If the affected area is on the scalp, the hair that grows from it is likely to be white as well. Common areas of involvement are the face, lips, hands, arms, legs, and genital areas.
Vitiligo is not contagious and should not be confused with alphos, a form of leprosy once called vitiligo. It seems to occur more often among people who have certain autoimmune diseases. For some people, although not for everyone, the depigmentation is progressive.
About 0.5 to 2 percent of the world's population, or as many as 65 million people, have vitiligo. Vitiligo affects 1-2 percent (1 or 2 of every 100 people) of the American population, and it is estimated that 2 to 4 million Americans have the condition. In most cases, vitiligo develops early in life, between the ages of 10 and 30 years and 95 percent of those affected will develop the disorder before age 40. About half the people who develop it do so before the age of 20 and about 1/5 have a family member with this condition. Both men and women are equally likely to develop vitiligo and all races, but is often more noticeable and more disfiguring in people with darker skin. Vitiligo may run in families; those with a family history of vitiligo or premature graying of the hair are at increased risk for the development of vitiligo. Other risk factors that increase one's chances of developing vitiligo include having autoimmune diseases, such as autoimmune thyroid disease (Hashimoto's thyroiditis).
MoonDragon's Health & Wellness: Autoimmune Disorders
Vitiligo usually starts as small areas of pigment loss that spread and become larger with time. These changes in your skin can result in stress and worries about your appearance.
There is no cure for vitiligo. The goal of treatment is to stop or slow the progression of pigment loss and, if you desire, attempt to return some color to your skin.
SIGNS & SYMPTOMS
Melanin is the pigment that gives the skin its characteristic color. Vitiligo is caused by a loss of pigment in the skin, due to destruction of pigment-forming cells known as melanocytes. Although vitiligo affects all races equally, it is more noticeable in dark-skinned people. Vitiligo can cause cosmetic problems.
The course and severity of pigment loss differ with each person. Light-skinned people usually notice the contrast between areas of vitiligo and suntanned skin in the summer. Year round, vitiligo is more obvious on people with darker skin. Individuals with severe cases can lose pigment all over the body. There is no way to predict how much pigment an individual will lose.
It is rare for skin pigment in vitiligo patients to return on its own. Some people who believe they no longer have vitiligo actually have lost all their pigment and no longer have patches of contrasting skin color. Although their skin is all one color, they still have vitiligo.
SYMPTOMS MAY INCLUDE
People who develop vitiligo usually first notice white patches (depigmentation) on their skin. These patches are more commonly found on sun-exposed areas of the body, including the hands, feet, arms, face, and lips. Other common areas for white patches to appear are the armpits and groin, and around the mouth, eyes, nostrils, navel, genitals, and rectal areas. Vitiligo can affect any part of the body. Although typical vitiligo shows areas of milky-white skin (depigmentation), the degree of pigment loss can vary within each vitiligo patch. There may be different shades of pigment in a patch, or a border of darker skin may circle an area of light skin.
Vitiligo often begins with a rapid loss of pigment in several areas of the skin. This may continue until, for unknown reasons, the process stops. The initial appearance of the white patches can be followed by a stable period without any progression of the condition. Cycles of pigment loss, followed by times where the pigment does not change, may continue indefinitely.
Purple or golden brown patches on mucous membranes and around the eyes, nostrils, and mouth.
Loss of color on the tissues that line the inside of your mouth (mucous membranes).
Loss or change in color of the inner layer of your eye (retina).
Uveitis. Uveitis is an inflammation (swelling and irritation) of the uvea. The uvea is the layer of the eye between the sclera and the retina. This layer includes the iris, ciliary body, and the choroid.
Premature whitening or graying of hair on your scalp, eyelashes, eyebrows or beard. Vitiligo on the scalp may affect the color of the hair (though not always), leaving white patches or streaks. It will similarly affect facial and body hair.
Sun sensitivity. Depigmentation usually develops first on the sun-exposed areas of your skin, such as your hands, feet, arms, face and lips.
Although it can start at any age, vitiligo often first appears between the ages of 20 and 30. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent (dormant or inactive) state is reached. Half of people with vitiligo develop patches of depigmented skin appearing on extremities before their 20s. The patches may grow, shrink, or remain constant in size. Patches often occur symmetrically across both sides on the body. Occasionally small areas may repigment as they are recolonized by melanocytes. The location of vitiligo affected skin changes over time, with some patches re-pigmenting and others becoming affected.
The natural course of vitiligo is difficult to predict. Sometimes the patches stop forming without treatment. In other cases, pigment loss can involve most of the surface of your skin.
Vitiligo generally appears in one of three patterns:
- Focal Pattern: Depigmentation is limited to one or a few areas of your body. Focal pattern vitiligo remains localized to one part of the body and does not spread.
- Segmental Pattern: Loss of skin color (depigmentation) occurs on only one side of your body. Segmental vitiligo remains localized to one part of the body and does not spread.
- Generalized Pattern: Pigment loss (depigmentation) is widespread across many parts your body and is the most common pattern. Depigmentation occurs symmetrically on both sides of the body. There is no way to predict if generalized vitiligo will spread. For some people, the depigmented patches do not spread. The disorder is usually progressive, however, and over time the white patches will spread to other areas of the body. For some people, vitiligo spreads slowly, over many years. For other people, spreading occurs rapidly. Some people have reported additional depigmentation following periods of physical or emotional stress.
PSYCHOLOGICAL EFFECTS
Vitiligo can have a significant effect on the psychological well being of the patient. This is especially true for darker skinned patients as the contrast between pigmented and depigmented skin can be quite drastic.
In some cultures there is a stigma attached to having vitiligo. Those affected with the condition are sometimes thought to be evil or diseased and are sometimes shunned by others in the community. People with vitiligo may feel depressed because of this stigma or because their appearance has changed dramatically. Other people with vitiligo experience no negative psychological effects at all - this depends heavily on the location of the patches, as those affected only in the hair area may find it an interesting natural color.
CAUSE
The precise cause of vitiligo is complex pigment disorder and is not fully understood. Vitiligo occurs when melanocytes (the cells that make the pigment melanin - the dark pigment in the epidermis that gives your skin its normal color) are damaged or destroyed so melanin is not produced. The involved patch of skin then becomes white. Why this occurs is not known. As a result, white patches appear on the skin in different parts of the body. Similar patches also appear on both the mucous membranes (tissues that line the inside of the mouth and nose), and the retina (inner layer of the eyeball). The hair that grows on areas affected by vitiligo sometimes turns white.
OVERVIEW OF MELANOGENESIS & MELANOCYTES
The color in human hair, skin and irises is produced by the pigment melanin, which is produced by the dermal melanoycte cells. The melanocyte cells transform the peptide tyrosinase into two different forms of melanin, which then is spread throughout the dermal cells and the keratinocytes via melanosomes to darken tissue. The end product of melanogenesis are two different types of melanin, eumelanin and pheomelanin. Eumelanin is metabollized from DHICA and produces a brown color in hair in its intact form; pheomelanin is metabolized from 5,6-indolequione, which produces a red color in hair in its intact form. From these two slightly different forms of pigment in various degrees of structural integrity come all the differing shades of Caucasian hair. In addition to coloration, melanin pigmentation in the skin also provides photoprotection from UV radiation to the skin. However, the melanocytes themselves are not immune from radiation damage: melanomas are tumors of the melanocytes, which often present themselves as discolorations owing to the pigment-producing nature of the cells.
VITILIGO CAUSE THEORIES
Health care providers and scientists have several theories as to what causes vitiligo.
AUTOIMMUNE - IMMUNE SYSTEM DISORDERS
Vitiligo may be due to an immune system disorder. The most widely accepted view is that the depigmentation occurs because vitiligo is an autoimmune disease-a disease in which a person's immune system reacts against the body's own organs or tissues. As such, people's bodies produce proteins called cytokines that alter their pigment-producing cells and cause these cells to die. Vitiligo seems to be somewhat more common in people with certain autoimmune diseases. These autoimmune diseases include hyperthyroidism (an overactive thyroid gland), adrenocortical insufficiency (the adrenal gland does not produce enough of the hormone called corticosteroid), alopecia areata (patches of baldness), and pernicious anemia (a low level of red blood cells caused by the failure of the body to absorb vitamin B-12). Scientists do not know the reason for the association between vitiligo and these autoimmune diseases. However, most people with vitiligo have no other autoimmune disease.
AUTOIMMUNE THEORY
There is great anecdotal evidence that an autoimmune disorder causes the destruction of melanocytes, and this theory is now generally accepted as the common cause of vitiligo. It is known vitiligo appears in conjunction with several other autoimmune disorders, such as juvenile diabetes mellitus, Addison's disease, and pernicious anemia, and additionally organ-specific antibodies can often be seen in patients with vitiligo. If the immune system raises antibodies or cytotoxic T cells to damage melanocytes, the mode of action the cells take against the melanocytes could be apoptosis induction directly against melanocytes or Ig induced complement-both are demonstrated in figure below. Proving this theory, there is histological evidence in vitiligo patients that apoptosis is occurring in the unpigmented skin lesions: there is damage to the melanocytes and keratinocytes in these areas, and the melanocytes exhibit nuclear shrinking, vacuolization, loss of dendrites, and detachment. If antibodies do cause vitiligo, some research suggests the Ig's may bind to tyrosinase related proteins 1 and 2, which are important for melanogenesis, instead of Ig's targeting the melanocytes directly.
Autoimmune theory of vitiligo showing both
cell-mediated and humoral autoimmune responses.
DISEASE MECHANISM - AUTOIMMUNE & INFLAMMATORY
Vitiligo is associated with autoimmune and inflammatory diseases, commonly thyroid overexpression and underexpression. Jin in the New England Journal of Medicine reported a study comparing 656 people with and without vitiligo in 114 families, which found several mutations (single-nucleotide polymorphisms) in the NALP1 gene. The NALP1 gene, which is on chromosome 17 located at 17p13, is on a cascade that regulates inflammation and cell death, including myeloid and lymphoid cells, which are white cells that are part of the immune response. NALP1 is expressed at high levels in T cells and Langerhan's cells, white cells that are involved in skin autoimmunity.
Among the inflammatory products of NALP1 are caspase 1 and caspase 5, which activate the inflammatory cytokine interleukin-1Β. Interleukin-1Β is expressed at high levels in patients with vitiligo. There are compounds which inhibit caspase and interleukin-1Β, and so might be useful drugs for vitiligo and associated autoimmune diseases.
Of the 656 people, 219 had vitiligo only, 70 had vitiligo with autoimmune thyroid disease, and 60 had vitiligo and other autoimmune diseases. Addison's disease (typically an autoimmune destruction of the adrenal glands) may cause vitiligo.
In one of the mutations, the amino acid leucine in the NALP1 protein was replaced by histidine (Leu155→His). The original protein and sequence is highly conserved in evolution, and found in humans, chimpanzee, rhesus monkey, and bush baby, which means that it's an important protein and an alteration is likely to be harmful.
The following is the normal DNA and protein sequence in the NALP1 gene:
TCA CTC CTC TAC CAA Ser Leu Leu Tyr Gln S L L Y Q
In some cases of vitiligo the first leucine is altered to histidine, by a Leu155→His mutation:
TCA CAC CTC TAC CAA Ser His Leu Tyr Gln S H L Y Q
(Leucine is nonpolar and hydrophobic; histidine is positively charged and hydrophilic, so it is unlikely both serve the same function.)
The normal sequence of the DNA code for NALP1 of TCACTCCTCTACCAA is replaced in some of these vitiligo families by the sequence TCACACCTCTACCAA, which respectively code for the amino acid sequence of the normal NALP1 protein SLLYQ being replaced by SHLYQ.
HEREDITY & GENETICS
Heredity may be a factor because there's an increased incidence of vitiligo in some families. Children whose parents have the disorder are more likely to develop vitiligo. In fact, 30 percent of people with vitiligo have a family member with the disease. However, only 5 to 7 percent of children will get vitiligo even if a parent has it, and most people with vitiligo do not have a family history of the disorder. There is strong evidence that people with vitiligo inherit a group of three genes that make them susceptible to depigmentation.
GENETIC INFLUENCES
There does appear to be a strong genetic influence in vitiligo: a positive family history has been reported in about 20 percent of patients and it has been found in monozygotic twins. Studies have shown that vitiligo does not progress via a simple Mendelian pattern, but more likely is coded polygenically and can be expressed across a spectrum. There has been some evidence both proving and disproving the involvement of the HLA system in the occurrence of vitiligo. So, it is believed that genetic factors probably play a key role in the pathogenesis of vitiligo, but the exact cause is unknown.
A team of researchers used the family histories kept by the American Vitiligo Foundation to examine the Mendelian inheritance of vitiligo, and found that most instances of the disease were clustered in families. They found that for patients of vitiligo, offspring have the highest chance of developing the disease, followed by siblings, parents and grandparents. Before this work Majumder's team published a report in 1988 suggesting a multiple recessive homozygous model for the disease. In 1994 a separate team of researchers validated Majumder's proposition of multiple homozygous recessive alleles, causing non-Mendelian inheritance of the disease; this team found that 3 "epistatically interacting autosomal diallelic loci" are involved in the pathogenesis of the disease and affected individuals exhibit homozygous recessive genotypes for all 3 loci.
SELF-DESTRUCTION
Another theory is that melanocytes destroy themselves. Intracellular transformation of tyrosinase into pre-melanin metabolites, and finally into melanin; several of the metabolites between tyrosinase and melanin are toxic to melanocytes according to the self-destruct theory.
SELF-DESTRUCT THEORY
It is known that some of the intracellular pre-melanogenesis metabolites are toxic to melanocytes, such as dopa and dopachrome. Normally melanocytes possess cellular measures to counteract these toxic substances, but it is believed that cells may lose the ability to counteract these toxic metabolites and are destroyed by leakage of metabolites into the cytoplasm and eventually cell lysis. There is evidence that points to this in that certain hydroquinone derivatives that are similar to these intra-cellular metabolites cause leukoderma experimentally.
STRESS & TRAUMA
Vitiligo may also be caused by stress that affects the immune system, leading the body to react and start eliminating skin pigment. Some people have reported a single event, such as sunburn or emotional distress, that triggered the condition.
NEURAL THEORY
There is also evidence that peripheral nerve endings may secrete a substance that is cytotoxic to melanocytes and causes their destruction. This is supported by the segmental variety of vitiligo, which occurs in specific dermatomes, indicating the skin is possibly only being affected by the nerves of that specific dermatome. Additionally, vitiligo appears with certain neurological disorders such as encephalitis, and trauma that causes peripheral nerve damage. Nerve endings in depigmented areas were seen to produce abnormal neuropeptides and nerve growth factors, and displayed axonal degeneration-these abnormal chemicals may be toxic to melanocytes. Additionally, depigmented areas showed some abnormal autonomic function, such as increased adrenergic tone, increased norepinephrine, and an increased concentration of catecholamines. These data then suggest that neurotransmitter release could, directly or indirectly, have an affect on melanocyte destruction and depigmentation.
GROWTH FACTOR DEFECT HYPOTHESIS
A study in the 1980's found that melanocytes in lesions from vitiligo patients contained melanocytes, but that these cells exhibited "defective growth and passage capacities." The researchers then noted that the growth defects of the melanocytes were partially corrected by adding a growth factor to their culture, additionally suggesting that growth defects may be part of the pathology of vitiligo. In depigmented areas, cellular analysis showed that there were melanocytes but that they grew poorly. These data suggest that, whether a primary or secondary cause, growth defects appear to play a role in leukoderma and vitiligo.
COMBINATION OF FACTORS
There is some evidence suggesting it is caused by a combination of autoimmune, genetic, and environmental factors. It may be an autoimmune process in which the body makes antibodies to its own pigment cells. Most people with vitiligo are in good general health, although vitiligo may occur with other autoimmune diseases such as thyroid disease or lupus.
CONVERGENCE THEORY
Following genetic studies, researchers have begun to lean towards a multi-faceted etiology for vitiligo, that combines components of the aforementioned theories and genetics. This theory states that genetic influences have a role in causing vitiligo in addition to other elements, such as stress, accumulation of toxic compounds, infection, autoimmunity, mutations, and impaired melanocyte proliferation.
However, none of these theories has been scientifically proved as a definite cause of vitiligo.
THEORY REFERENCES
Janeway, C. A. Jr., Travers, P., Walport, M., and Shlomchik, M. J. Immunobiology 5. New York: Garland Publishing, 2001. Huang, C.L., Nordlund, J.J., & Boissy, R. 2002. "Vitiligo: A manifestation of apoptosis?" American Journal of Clinical Dermatology 3(5): 301-308. Majumder, P.P., Das, S.K., Li, C.C. 1988. "A genetical model for vitiligo." American Journal Human Genetics 43: 119-125. Majumder, P.P., Nordlund, J.J., Nath, S.K. 1993. "Pattern of familial aggregation of vitiligo." Archives of Dermatology 129: 994-998. Nath, S.K., Majumder, P.P., Nordlund, J.J. 1994. "Genetic epidemiology of vitiligo: multilocus recessivity cross-validated." American Journal of Human Genetics 55: 981-990. Njoo, M.D., & Westerhof, W. 2001. "Vitiligo: Pathogenesis and Treatment." American Journal of Clnical Dermatology 2(3): 167-181. Prota, G. 2000. "Melanins, Melanogenesis and Melanocytes: Looking at Their functional significance from the chemist's viewpoint." Pigment Cell Research 13: 283-293. Taneja, A. 2002. "Treatment of Vitiligo." Journal of Dermatological Treatment 13: 19-258.
DIAGNOSIS
The diagnosis of vitiligo is made based on a physical examination, medical history, and laboratory tests.
PHYSICAL EXAMINATION
A health care provider will likely suspect vitiligo if you report (or the physical examination reveals) white patches of skin on the body-particularly on sun-exposed areas, including the hands, feet, arms, face, and lips.
MEDICAL HISTORY
If your health care provider suspects you have vitiligo, he or she will ask about your medical history. Important factors in your medical history include:
- A family history of vitiligo.
- A rash, sunburn or other skin trauma at the site of vitiligo within two to three months of the start of pigment loss.
- Premature graying of the hair (before age 35).
- Stress or physical illness.
In addition, your health care provider needs to know whether you or anyone in your family has had an autoimmune disease and will ask if your skin is sensitive to the sun. He or she will examine you to rule out other medical problems or skin conditions, such as dermatitis or psoriasis.
SKIN BIOPSY
Your health care provider may take a small sample (biopsy) of your affected skin to examine under a microscope to confirm diagnosis. In vitiligo, the skin sample will usually show a complete absence of pigment-producing melanocytes. On the other hand, the presence of inflamed cells in the sample may suggest that another condition is responsible for the loss of pigmentation.
BLOOD TESTS
Your health care provider may take a blood sample to check your blood cell count and thyroid function. Vitiligo may be associated with pernicious anemia (a condition in which an insufficient amount of vitamin B-12 is absorbed from the gastrointestinal tract) or hyperthyroidism (an overactive thyroid gland).
A blood test to look for the presence of anti-nuclear antibodies (a type of autoantibody) also may be done to determine if you have an autoimmune disease.
EYE EXAMINATION
In some cases, your health care provider may recommend an eye examination to check for inflammation in your eye (uveitis).
CONVENTIONAL MEDICAL TREATMENT
There are a number of ways to alter the appearance of vitiligo without addressing its underlying cause. In some cases, medical treatment for vitiligo may not be necessary.
The main goal of treating vitiligo is to improve appearance. Therapy for vitiligo takes a long time and it usually must be continued for 6 to 18 months. The choice of therapy depends on the number of white patches; their location, sizes, and how widespread they are; and what you prefer in terms of treatment. Each patient responds differently to therapy, and a particular treatment may not work for everyone. Current treatment options for vitiligo include medical, surgical, and adjunctive therapies (therapies that can be used along with surgical or medical treatments).
In addition to medical and surgical therapies, there are many things you can do on your own to protect your skin, minimize the appearance of white patches, and cope with the emotional aspects of vitiligo.
Self-care steps, such as using sunscreen and applying cosmetic camouflage cream, may improve the appearance of your skin. For fair-skinned individuals, avoiding tanning can make the areas almost unnoticeable.COSMETIC CAMOUFLAGE
In mild cases, vitiligo patches can be hidden with makeup or other cosmetic camouflage solutions. Some patients with vitiligo cover depigmented patches with stains, makeup, or self-tanning lotions. These cosmetic products can be particularly effective for people whose vitiligo is limited to exposed areas of the body. Dermablend, Lydia O'Leary, Clinique, Fashion Flair, Vitadye, and Chromelin offer makeup or dyes that you may find helpful for covering up depigmented patches. Self-tanning lotions have an advantage over makeup in that the color will last for several days and will not come off with washing.
SUNSCREENS & AVOIDING SUNLIGHT
People who have vitiligo, particularly those with fair skin, should minimize sun exposure and use a sunscreen that provides protection from both the UVA and UVB forms of ultraviolet light. Sunscreen helps protect the skin from sunburn and long-term damage. Sunscreen also minimizes tanning, which makes the contrast between normal and depigmented skin less noticeable.
If the affected person is pale-skinned, the patches can be made less visible by avoiding sunlight and the sun tanning of unaffected skin. However, exposure to sunlight may also cause the melanocytes to regenerate to allow the pigmentation to come back to its original color.
COUNSELING & SUPPORT GROUPS
Many people with vitiligo find it helpful to get counseling from a mental health professional. People often find they can talk to their counselor about issues that are difficult to discuss with anyone else. A mental health counselor can also offer support and help in coping with vitiligo. In addition, it may be helpful to attend a vitiligo support group.
Depending on the number, size and location of the white patches, you may decide to seek medical treatment. Medical treatments for vitiligo aim to even out skin tone, either by restoring color (pigment) or destroying the remaining color.
Depending on the type of therapy, treatment for vitiligo may take from six to 18 months. Medical treatment choices are based on the number of white patches you have and how widespread they are. Each person responds differently to treatment, and a particular therapy may not work for you.IMMUNOSUPPRESSIVE TREATMENTS
The traditional treatment given by most dermatologists is corticosteroid cream applied topically. As vitiligo is believed to be an autoimmune disorder, suppressing the immune system would then be an effective treatment at halting the spread of vitiligo and even inducing re-pigmentation.
Corticosteroids are the main choice for this treatment and they effectively halt the progressive spread of vitiligo and also lead to re-pigmentation (returning of color to your skin) of lesioned areas, particularly if the medication is started early in the disease. These drugs, which include cortisone, are similar to the hormones produced by your adrenal glands.
Your health care provider may prescribe a mild topical corticosteroid cream or ointment for children younger than 10 years old or a stronger form for adults. For small, localized lesions, topical and intralesional corticosteroids are used once a day. You may need to apply the cream or ointment to the white patches on your skin for at least three months before you see any results.
For rapidly spreading vitiligo or vitiligo universalis, systemic corticosteroids are employed; however, the role of systemic corticosteroids is controversial due to the serious adverse side effects.
This treatment is considered simple and safe, but your health care provider will monitor you closely for side effects, such as thinning of the skin (atrophy) and streaks or lines on your skin (skin striae). These side effects are more likely to occur in areas where the skin is thin, such as on the face and armpits, or in the genital region. They can be minimized by using weaker formulations of steroid creams in these areas.
Calcipotriene (Dovonex), a vitamin D derivative, also may be used topically and is sometimes used with corticosteroids or ultraviolet light.
PHOTOTHERAPY & PHOTOCHEMOTHERAPY
Currently, the most popular treatments for vitiligo are forms of phototherapy; it is known that various sources of UV light can be successfully used to stimulate re-pigmentation. Phototherapy can either be used by itself or in conjunction with light-sensitizing drugs.
PUVA treatment is the most popular treatment for vitiligo currently; the concept for the treatment dates back thousands of years, when the plants Psoralea coryifolia Linnaues and Ammi majus Linnaeus where eaten or used topically in Egypt and India to treat vitiligo. Today, isolates of the plants are used topically or orally in conjunction with a synthetic compound to chemically increase sensitivity to light. The patient is then exposed to a measured amount of natural sunlight (PUVASOL) or artificial UV radiation (PUVA) to induce re-pigmentation.
Topical psoralen plus ultraviolet A (PUVA). Topical PUVA may be a treatment option if you have a small number of depigmented patches (affecting less than 20 percent of your body). PUVA, also called photochemotherapy, is performed under artificial UVA light once or twice a week in your health care provider's office. Your health care provider or another medical practitioner will apply a thin coating of psoralen to the depigmented patches of your skin about 30 minutes before UVA light exposure. You are then exposed to an amount of UVA light that turns the affected area of your skin pink. Your health care provider may slowly increase the dose of UVA light over many weeks. Eventually, the pink areas of your skin fade and a more normal skin color appears.
Potential short-term side effects of topical PUVA therapy include severe sunburn and blistering and too much re-pigmentation or darkening of the treated patches or the normal surrounding skin (hyperpigmentation). You can minimize your chances of sunburn by avoiding exposure to direct sunlight after each treatment. Hyperpigmentation is usually a temporary problem and eventually disappears when treatment stops.
Oral psoralen photochemotherapy, or oral PUVA. Oral PUVA therapy may be used if you have extensive vitiligo (affecting more than 20 percent of your body) or if you have not responded to topical PUVA therapy. Oral PUVA is not recommended for children younger than 10 years of age because of an increased risk of damage to the eyes, such as cataracts. For oral PUVA therapy, you take a prescribed dose of psoralen by mouth about two hours before exposure to artificial UVA light or sunlight. Your health care provider adjusts the dose of light until the skin areas being treated become pink. Treatments are usually given two or three times a week, with at least one day in between.
If you do not have access to a PUVA facility, your health care provider may prescribe psoralen to be used with natural sunlight exposure. Your health care provider will give you careful instructions on carrying out treatment at home and monitor your progress with frequent office visits.
Short-term side effects of oral PUVA may include sunburn, nausea and vomiting, itching, abnormal hair growth, and too much re-pigmentation or darkening of the treated patches or the normal surrounding skin (hyperpigmentation). If received for longer periods of time, this type of treatment may increase your risk of skin cancer. To avoid sunburn and reduce your risk of skin cancer, apply sunscreen and avoid direct sunlight for 24 to 48 hours after each treatment. Wear protective UVA sunglasses for 18 to 24 hours after each treatment to avoid eye damage, particularly cataracts.
Amino phenylalanine. The amino phenylalanine is also used to treat vitiligo, although it is not a photo-sensitizing chemical. It is known that phenylalanine is a precursor for melanin via L-tyrosine, and it appears that there is a problem with L-phenylalanine metabolism in vitiligo. A combination of topical application and oral ingestion of phenylalanine with natural sunlight exposure resulted in re-pigmentation for 83 percent of patients.
In addition to photochemotherapy, there are several forms of phototherapy, without the light-sensitizing chemicals. In recent years, narrow-band UVB, a special form of UVB light, has been used as an alternative to PUVA. This type of therapy can be administered like PUVA and given up to three times a week. However, no pre-application of psoralen is required, thus simplifying the treatment process. Narrow-band UVB may be a safer long-term alternative to PUVA. Because it is simpler to administer, this type of phototherapy is gaining wide acceptance. However, more research is needed to determine if it is superior to PUVA.
Broad-band ultraviolet therapy. UV light in the wavelengths from 290-320 nm are often used to treat vitiligo. There are few studies reporting the efficacy of this treatment, but anecdotally the treatment appears effective, though not as good as other forms of phototherapy.
Narrow-band ultraviolet B (NBUVB) therapy. In addition to broad band UV (BUVB), there is also narrow band UV treatment (NBUVB). This is a more recent form of UV phototherapy and was initially used to treat psoriasis. This UV treatment operates between 305 and 311 nm, and is highly effective for treating psoriasis and moderately effective at treating vitiligo. When used as monotherapy, NBUVB is slightly but not significantly more effective at stimulating re-pigmentation than PUVA treatment.
In addition to UV treatment, the excimer laser has now been implemented as phototherapy for vitiligo. The 308 nm laser produces light similar to the narrow band UVB treatment, and has shown good results in stimulating re-pigmentation of about 90 percent of patients. The excimer laser also allows more focused treatment on specific lesions, or hard to reach areas of the body.
There is little scientific evidence examining why phototherapies are effective at stimulating re-pigmentation; however, it is very strongly believed that if there are stores of unaffected but immature melanocytes in the lesioned area, these melanocytes can be induced to produce melanin in the lesioned areas. Likewise, there are often functional, but not melanin producing melanocytes at lesion boundaries that can produce melanin that spreads into the lesions causing re-pigmentation.
IMMUNOMODULATOR CREAMS
Studies have also shown that immunomodulator creams such as Protopic and Elidel also cause re-pigmentation in some cases, when used with UVB Narrowband treatments.
CHEMICAL DEPIGMENTATION
Alternatively, some people with vitiligo opt for chemical depigmentation, which uses 20 percent monobenzone (monobenzylether of hydroquinone). This process is irreversible and generally ends up with complete or mostly complete depigmentation.
PIPERINE THERAPY
In early 2008 scientists at King's College London discovered that piperine, a chemical derived from black pepper can aid re-pigmentation in skin, especially when combined with UV therapy produces a longer lasting and more even pigmentation than previous treatments.
GINKGO BILOBA THERAPY
A study has shown that orally-taken Ginkgo biloba can be effective in arresting the progression of slowly-spreading vitiligo.
DEPIGMENTATION TREATMENTS (BLEACHING)
In addition to treatments to repigment skin, in extremely progressive, full-body vitiligo called vitiligo universalis, the patient can opt to bleach (depigment) the remaining pigment off healthy skin. Depigmentation involves fading the rest of the skin on your body to match the already-white areas. If you have vitiligo on more than 50 percent of your body, depigmentation may be the best treatment option.
This treatment does have profound psychosocial implications, especially for naturally dark-skinned individuals who become light or white-skinned.
In this procedure, the drug monobenzylether of hydroquinone (monobenzone or Benoquin) is applied twice a day to the pigmented areas of your skin until they match the already-depigmented areas. Avoid direct skin-to-skin contact with others for at least two hours after applying the drug, as the transfer of the drug may cause depigmentation of the other person's skin.
The major side effect of depigmentation therapy is redness and swelling (inflammation) of the skin. You may experience itching, dry skin or abnormal darkening of the membrane that covers the white of your eyes. Depigmentation is considered permanent and cannot easily be reversed. In addition, if you undergo depigmentation you will always be extremely sensitive to sunlight.
This is the proposed medical scenario with performer Michael Jackson, who was born black but claims to have been afflicted with vitiligo universalis causing his skin to become extremely pale. No person has brought more attention to vitiligo and its treatment possibilities than Jackson. Despite many re-pigmenting therapies, Jackson was allegedly opposed to seeking re-pigmentation and instead Jackson opted for depigmentation of remaining, naturally dark areas by assumedly choosing a bleaching treatment to rid his skin of remaining pigment. This is a feasible scenario, although there is great debate as to the authenticity of Jackson's claim.
SURGICAL THERAPIES
All surgical therapies must be considered only after proper medical therapy is provided. Surgical techniques are time-consuming and expensive and usually not paid for by insurance carriers. They are appropriate only for carefully selected patients who have vitiligo that has been stable for at least 3 years.
In addition to phototherapy, there is also surgical treatment for vitiligo that mainly consists of grafting patches of skin with healthy melanocytes to lesioned sites.
In late October 2004, health care providers successfully transplanted melanocytes to vitiligo affected areas, effectively re-pigmenting the region. The procedure involved taking a thin layer of pigmented skin from the patient's gluteal region. Melanocytes were then separated out and used to make a cellular suspension. The area to be treated was then ablated with a medical laser, and the melanocyte graft applied. Three weeks later, the area was exposed to UV light repeatedly for two months. Between 73 and 84 percent of patients experienced nearly complete re-pigmentation of their skin. The longevity of the re-pigmentation differed from person to person.
In both minigrafting and suction blister grafting, superficial layers of skin are removed from normally-pigmented skin and these patches then grafted onto the lesioned areas. These techniques are believed to work by healthy melanocytes from the grafts proliferating into the lesioned areas and repopulating them. Success rates for these techniques are between 80 and 90 percent. Full thickness grafts of skin are implanted in minigrafting, using 1-2 mm healthy skin punches from areas such as the buttocks and followed by exposure to sunlight or PUVA treatment. Success of minigrafting is around 67 percent in patients.
Autologous skin grafts or "minipunch" skin transfer. This type of skin grafting uses your own tissues (autologous). Your health care provider removes tiny pieces of skin from one area of your body and attaches them to another. This procedure is sometimes used if you have small patches of vitiligo. Your health care provider removes very small sections of your normal, pigmented skin (donor sites), often containing a small hair and places them on the depigmented areas (recipient sites). Possible complications of this procedure include infection at the donor or recipient site, but this is rare. The recipient and donor sites may develop scarring, a cobblestone appearance, spotty pigmentation, or may fail to repigment at all. Treatment with grafting takes time and is costly, and many people find it neither acceptable nor affordable.
Blister grafting. In this procedure, your health care provider creates blisters on your pigmented skin primarily by using heat, suction or freezing cold. The tops of the blisters are then cut out and transplanted to a depigmented skin area where a blister of equal size has been created and removed. The risks of blister grafting include the development of a cobblestone appearance, scarring and lack of re-pigmentation. However, there is less risk of scarring with this procedure than with other types of skin grafting.
Tattooing (micropigmentation). Tattooing implants pigment into your skin with a special surgical instrument. For treatment of vitiligo, tattooing works best for the lip area, particularly if you have dark skin. However, it may be difficult for your health care provider to match your natural skin color (the skin of the surrounding area). The tattooed area will not change in color when exposed to sun, while the surrounding normal skin will. So even if the tattooed area matches the surrounding skin perfectly at first, it may not later on. Tattooing tends to fade over time, and when used on the lips it may lead to episodes of blister outbreaks caused by the herpes simplex virus.
Autologous melanocyte transplant. The future of surgical treatment for vitiligo is actually extracting melanocytes from a donor area of the patient's healthy skin, culturing these melanocytes into a large population, then grafting them as sheets onto the lesioned areas. This procedure is called an autologous melanocyte transplant. Your health care provider takes a sample of your normal pigmented skin and places it in a laboratory dish containing a special cell culture solution to grow melanocytes. When the melanocytes in the culture solution have multiplied, they are transplanted to your depigmented skin patches. This procedure is experimental and performed only in a few institutions where vitiligo research is conducted. It is impractical for the routine care of people with vitiligo. It is also very expensive, and its side effects are not known. Preliminary trials with this technique have been highly successful; however there is some concern about controlling malignancy in the cultured melanocytes.
CONSIDERING SURGICAL TREATMENT FOR VITILIGO
You should consider the surgical treatment of vitiligo only if:
- Your vitiligo has not changed in the last year.
- You are not responding to PUVA or PUVB treatment.
- Your skin has never permanently lost its color (pigment) when you have suffered a small cut or scrape.
- You do not have Hepatitis C or AIDS.
Surgical treatment is ideal for those that have Segmental Vitiligo (this form involves an area only on one side of the body and tends not to repigment with other forms of treatment).
VITILIGO RESEARCH
In the past two decades, research on the role that melanocytes play in vitiligo has greatly increased. A variety of technical advances, such as gene mapping and cloning, have permitted relatively rapid advances in knowledge of melanocytes at the cellular and molecular levels.
Much of the research that holds promise for understanding, treating, and possibly preventing vitiligo is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Current NIAMS-supported research includes the following:
- Examination of the mechanism by which trauma or stress to the skin can trigger vitiligo or the development of new lesions.
- Development of a mouse model of vitiligo that not only would help scientists better understand the disease but also would allow them to test treatments for it.
- Identification of genes that play a role in and predispose people to vitiligo. At the University of Colorado, NIAMS supports a large collaborative project involving families with vitiligo in the United States and the United Kingdom. Researchers have found evidence of a link between vitiligo and variants of a gene called FOXD3. It is hoped that further genetic analyses of these and other families will enable them to identify one or more additional vitiligo susceptibility genes. This work may lead to development of specific approaches to disease therapy and prevention for patients at high genetic risk.
PROGNOSIS
You should see your health care provider if areas of your skin, hair or eyes lose coloring. Although there is no cure for vitiligo, treatments exist that may help to stop or slow the process of depigmentation and attempt to return some color to your skin.
COPING WITH VITILIGO
While vitiligo is usually not harmful medically, its emotional and psychological effects can be devastating. In fact, in India, women with the disease are sometimes discriminated against in marriage. Developing vitiligo after marriage can be grounds for divorce.
Regardless of a person's race and culture, white patches of vitiligo can affect emotional and psychological well-being and self-esteem. People with vitiligo can experience emotional stress, particularly if the condition develops on visible areas of the body, such as the face, hands, arms, and feet; or on the genitals. Adolescents, who are often particularly concerned about their appearance, can be devastated by widespread vitiligo. Some people who have vitiligo feel embarrassed, ashamed, depressed, or worried about how others will react.
Fortunately, there are several strategies to help people cope with vitiligo. Also, various treatments discussed above under "Treatments" can help to minimize, camouflage, or, in some cases, even eliminate white patches. First, it is important to find a qualified health care provider who is knowledgeable about the disorder and takes it seriously. The practitioner should also be a good listener and be able to provide emotional support. You must let your health care provider know if you are feeling depressed, because health care providers and other mental health professionals can help people deal with depression. You should also learn as much as possible about the disorder and treatment choices so that you can participate in making important decisions about medical care.
Talking with other people who have vitiligo may also help. The National Vitiligo Foundation can provide information about vitiligo and refer you to local chapters that have support groups of patients, families, and health practitioners. Contact information for helpful organizations and support groups are listed below. Family and friends are another source of support.
Some people with vitiligo have found that cosmetics that cover the white patches improve their appearance and help them feel better about themselves. You may need to experiment with several brands of concealing cosmetics before finding the product that works best.
HOLISTIC, DIETARY, AND HERBAL RECOMMENDATIONS
HERBS
The use of Picrorrhiza (an Indian herb used in Ayurvedic medicine) has been shown to reduce the number and size of unpigmented skin patches.
St. John's Wort can help reduce stress and anxiety.
Herbal Remedies: St. John's Wort Tea, Caffeine Free, Yogi Tea, 16 Bags
Herbal Remedies: St. John's Wort Herbal Tea, 20 Tea Bags
Herbal Remedies: Kira St. John's Wort, Kwai, 45 Tabs
Herbal Remedies: St. John's Wort Tincture, Alcohol Free, 1 fl. oz.
Herbal Remedies: St. John's Wort, Perika, 300 mg, 60 Tabs
Herbal Remedies: St. John's Wort Supplement Tincture, 2 fl. oz.
Herbal Remedies: St. John's Wort Powder (Hypericum Perforatum), 4 oz. Bulk
Horsetail (Silica) helps rebuild connective tissue, stimulates collagen formation, and is important for developing skin's strength and elasticity.
Mountain Rose Herbs: Horsetail, Certified Organic, 4 oz, 8 oz, or 16 oz. Bulk
Herbal Remedies: Horsetail Supplement Tincture, 2 fl. oz.
Herbal Remedies: Horsetail Herb Grass, Nature's Way, 440 mg, 100 Caps
Herbal Remedies: Silica Complex Supplement, 8% Extract, NOW Foods, 500 mg, 90 Tabs
RECOMMENDATIONS
Consult a nutritionally oriented health care provider for vitamin B complex plus PABA injections (see under "Nutrients" below). This treatment is often effective.
Treat the affected area gently. Cleanse gently, apply moisturizers liberally, and protect exposed areas from cleansing agents or other chemicals by wearing protective gloves or clothing.
Expose patches of affected skin to the sun - this may promote re-pigmentation - but do not overdo it. Use adequate sun protection on the affected area, and always apply a sunscreen with a sun protection factor (SPF) of 15 or higher to any unpigmented areas. They have no natural protection against the sun's ultraviolet rays.
CONSIDERATIONS
Vitiligo sometimes responds to the use of PABA and magnesium. Small spots of pigment appear gradually, like freckles. The spots gradually merge until normal color is restored. Some people with vitiligo have prematurely gray or white hair. A small percentage of such people treated with PABA and magnesium have experienced a return of both skin and hair to the original color. (See "Nutrients" below for links to these products.)
Vitiligo lesions may be de-emphasized by the use of commercial cosmetics that cover the affected area with an opaque, waterproof layer. Dermablend is one widely available product. A few available products are listed below. To see the full range of products and colors available from Amazon.com, use the search box further down on this page.
Creams and lotions that contain antioxidants such as Ginkgo Biloba, Green Tea, Vitamin C, and Carotenes may be helpful.
Herbal Remedies: Jason Lotion, Aloe Vera Hand & Body, 84% Organic, 8 oz.
Jason Aloe Vera Lotion is 84% Organic and is formulated with aloe vera gel, herbal tea extracts, vitamins A, C, and E, and botanical extracts that soothe, and relieve rough, chapped and dry skin with an fast absorbing and non-greasy formula.
Herbal Remedies: Avalon Organics Lotion, Vitamin C Moisture Plus Lotion, SPF 15, 4 fl oz.
Avalon Organics Lotion, Vitamin C Moisture Plus Lotion SPF 15 is formulated with a powerful antioxidant team, Vitamins C & E, Lemon Bioflavonoids and Melatonin plus White and Green Teas, because antioxidants perform longer and more effectively when used in combination. Magnesium Ascorbal Phosphate is a form of vitamin C that is readily utilized by the skin cells to protect against damaging free radicals, and stimulate collagen and elastin production. One of the most stable forms of vitamin C, it will remain active over the shelf life of the product. Daily UVA/UVB protection plus Vitamin C to guard against sun-aging. This daily moisture lotion is formulated with organic Coconut, Borage and Flax oils to repair and nourish for therapeutic hydration. Fortified with the antioxidant action of Vitamin E and organic White Tea to provide added defense against skin damaging free radicals. Made with soothing organic Aloe, hyaluronic acid and Rosehip oil to hydrate and moisturize plus the refreshing aroma of organic Sweet Orange essential oil. This light-weight lotion with SPF 15 provides broad-spectrum protection with FDA-approved sunscreen ingredients. Directions: Perfect for daily use, apply to clean face and body, reapply as needed.
Herbal Remedies: Nutrasilk Natural Body Creme, Life-Flo, 5 oz.
Nutrasilk natural body creme soothes and nourishes the skin with enzogenol, the newest and most powerful broad-spectrum, anti-oxidant known to man. It helps slow down the signs of premature aging. Sepilift DPHP is a French botanical that helps rebuild collagen in skin. Nutrasilk natural body lotion reduces the look of fine lines and wrinkles for smoother younger looking skin. Shea Butter is a deep moisturizer, rich in Vitamins A,B,H & F (Omega 3 fatty acids), and is essential to healthy skin. Nutrasilk has high moisturizing properties for softer, smoother skin and gives a healthier tan during UV exposure. MSM is naturally occurring sulfur in our bodies. It is a key element in healthy skin and cellular activity. It helps repair skin damaged by oxidation and UV exposure. Nutrasilk natural body lotion contains essential oils. Key essential oils combine to offer a neutral fragrance that is light and fresh. Nutrasilk natural body lotion is a maximum hydration nourishing lotion is non greasy, does not plug the pores and leaves the skin silky soft.
Creams containing fluorinated steroids may be prescribed to stimulate re-pigmentation of the skin.
For persons with widespread vitiligo, bleaching of the unaffected skin with hydroquinone (a weak but safe de-pigmenting agent) may be recommended. This is done to minimize the difference between pigmented and depigmented areas. The process is irreversible, and it can take from several months to years to complete.
Psoralen plus ultraviolet light A (PUVA) therapy is often used to treat vitiligo. This therapy combines ultraviolet light with an oral drug and has proven to be effective, even for those with advanced symptoms. However, this treatment has many potential side effects for some individuals, including eye problems, liver damage, nausea, and skin blistering.
For mild forms of vitiligo, topical corticosteroids may be used to restore small patches of non-pigmented skin.
An article in Let's Live magazine reported on a new treatment in which healthy pigment cells were transplanted into the affected area. These transplants were successful in all but one case and none of the recipients rejected the transplantation of healthy pigment cells.
GH3 cream from Gero Vita International has given good results for many skin problems. This face cream is for adult use only.
Gerovital GH3 Cream
NUTRITIONAL SUPPLEMENT RECOMMENDATIONS FOR VITILIGO
Unless otherwise specified, the following recommended doses are for those over the age of 18. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.
VITILIGO SUPPLEMENTS & PRODUCTS
Information, supplements and products for vitiligo, a skin condition that appears as chalky white patches of skin surrounded by a dark border.
Alive! Whole Food Energizer, Multi-Vitamin & Mineral With Naturally Occurring Iron (No Iron Added), Nature's Way, 90 Tabs
No other supplement contains more life-giving nutrients than Nature's Way Alive Multi-Vitamin. Alive Multi-Vitamin is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands.Beta Carotene, 100% Natural, Nature's Way, 25,000 IU, 100 Softgels
Nature's Way beta carotene is 100% all natural from Dunaliella Salina.B-Stress Vitamin Complex With Siberian Eleuthero, Nature's Way, 100 Caps
If you are looking for herbal stress relief, you will find B-Stress Vitamin Complex with Siberian Eleuthero, formerly Siberian Ginseng Root to be just what you are looking for.Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.
WaterOz Ionic Calcium is a pure liquid Calcium supplement. Calcium is one of the most essential of the major biochemical elements needed in human nutrition. It is needed in every organ of the body, including the brain. Calcium is called the "knitter" because it promotes healing or knitting everywhere in the body. It is valuable for tone, power, strength, longevity, vitality, and endurance, healing of wounds, counter-acting acids, and helping regulate metabolism.Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
WaterOz Ionic Copper is a pure liquid Copper supplement. Copper influences protein metabolism and general healing, improves vitamin c oxidation and is integral in the formation of RNA.Coral Calcium (Okinawa) Plus w/ Magnesium & Vitamin D, 100% Natural, 500 mg, 100 Vcaps
Okinawa Coral Calcium Plus with Magnesium, Vitamin D and 70 other trace minerals provides essential minerals, restores body alkalinity, supports the immune system, and is bio available for better absorption.Coral Calcium with ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz.
Coral Calcium with ConcenTrace® contains a highly absorbable form of every mineral needed by the body.Evening Primrose Oil, Cold Pressed, Nature's Way, 1300 mg, 120 Softgels
Nature's Way EFA Gold is the highest quality Evening Primrose Oil, guaranteed to contain 10% gamma-linolenic acid (GLA).Ginkgo Biloba Extract, Standardized, Nature's Way, 60 mg, 120 VCaps
Nature's Way Ginkgo biloba extract is a technically and scientifically advanced herbal extract standardized to 24% Ginkgo flavone glycosides and 6% terpene lactones, supported by whole Gotu Kola herb.Ginkgold, Ginkgo Biloba Extract, Standardized, Vegetarian, Nature's Way, 60 mg, 150 Tabs
Nature's Way Ginkgold ginkgo biloba extract has been proven to support healthy circulation to the brain as well as the extremities.Hair & Skin With MSM & Glucosamine, Nature's Way, 100 Caps
Nature's Way Hair and Skin with MSM & Glucosamine combines MSM, glucosamine and more to bring you the best combination for Hair and Skin health.Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.
Just An Ounce, Calcium and Magnesium Liquid can help with the development of strong bones and teeth, also prevents muscle cramping, risk of colon cancer, maintain regular heart beat, protects against osteoporosis and helps relax the central nervous system.L-Tyrosine, Pharmaceutical Grade, Free Form, NOW Foods, 500 mg, 120 Caps
L-Tyrosine is used to treat insomnia, improve muscle tone, improve skin and hair pigment and depression and anxiety. L-Tyrosine should not to be used while taking prescription antidepressants or MAO inhibitors.MSM (Methylsulfonylmethane) Liquid, Pure Lignisul, 16 fl. oz.
MSM is a non toxic physiologically active sulfur compound that may be helpful for connective tissue, cartilage, tendons, mucous membranes, nails, hair, and skin damage and repair.MSM (Methylsulfonylmethane) Lotion, 15%, 8 fl. oz.
MSM Lotion contains methylsulfonylmethane, a form of sulfur, which may be helpful in treating skin disorders including acne, psoriasis, eczema, dermatitis, dandruff, scabies, diaper rash, and certain fungal infections.MSM (Methylsulfonylmethane) Lotion With Aloe, 4 fl. oz.
MSM lotion with aloe vera supports healthy skin, helping to keep it moisturized and smooth throughout the day.MSM (Methylsulfonylmethane), Pure Lignisol, 4 oz.
MSM plays a beneficial role in allergies, connective tissue and joint flexibility.MSM (Methylsulfonylmethane), Pure Lignisul, 1000 mg, 240 Caps
With many benefits, MSM plays a beneficial role in connective tissue and joint flexibility, immune health, arthritis, osteoporosis, nails, fibromyalgia, muscle soreness, athletic injuries and allergies.MSM (Methylsulfonylmethane), Pure Lignisul, 500 mg, 250 Caps
MSM is a non toxic physiologically active sulfur compound that may be helpful for connective tissue, cartilage, tendons, mucous membranes, nails, hair, and skin damage and repair.MSM (Methylsulfonylmethane), Pure Lignisul, With Glucosamine, 500 mg, 120 Caps
MSM with Glucosamine provides nutritional support for healthy joints by lubricating, nourishing, and easing, inflammation in damaged tissue and cartilage.MSM (Methylsulfonylmethane) Supplement, Pure Lignisul With Free 4 oz. Lotion, 1000 mg, 120 Caps
Buy MSM Supplement caps and get a free 4 oz. lotion. MSM supplement plays a beneficial role in connective tissue and joint flexibility, immune health, arthritis, osteoporosis, rheumatoid arthritis, inflammation, pain, hair, skin, nails, athletic injuries, acne, wrinkles and allergies.MSM (Methylsulfonylmethane), With Vitamin C, 875 mg/ 100 mg, 120 Caps
MSM with Vitamin C offers support for allergies, connective tissue, joint flexibility, immune function, arthritis, osteoporosis, digestive disorders, circulation,bruising, carpal tunnel syndrome, and antioxidant protection.MSM (Methylsulfonylmethane), Ultra Fine Powder, 1 lb.
Helps rejuvenate joints and all body cells, lessens the pain and stiffness of arthritis, boosts energy level.Multi-Mineral Optimum Complex, Nature's Way, 100 Caps
Nature's Way Multi Mineral Optimum Complex offers a complete carefully dosed blend of minerals vital to the body. This multi Mineral Optimum Complex provides nutritional support for normal bone development, muscle function, reproduction and metabolism.Nerves Formula Tincture, 100% Organic, 2 fl. oz.
The Nerves Formula was created to help calm and soothe the nerves. Can also help arteriosclerosis/atherosclerosis, arthritis, auto-immune diseases.PABA / Para-aminobenzoic Acid, NOW Foods, 500 mg, 100 Caps
PABA is a non-essential member of the B-vitamin family. PABA has been reported to enhance the effects of cortisone.Pycnogenol W/ Vitamin E, 100% Natural, Nature's Way, 50 mg, 30 Tabs
The proanthocyanidins in Pycnogenol are potent antioxidants and provide protection for collagen and connective tissues. Pycnogenol is a concentrated source of proanthocyanidins, organic acids and other biologically active components.SAM-e with B Vitamin Cofactors, Vegetarian, Enteric Coated, 200 mg each Tablet, 60 Tabs
Important for the production of glutathione, this powerful free radical scavenger defends the body from toxic agents and is necessary for liver detoxification.Silica Complex, 8% Extract, Silica Supplement, NOW Foods, 500 mg, 90 Tabs.
NOW Foods Silica Supplement is a vegetarian supplement that will help build strong and healthy hair, skin and nails.St. John's Wort Extract, Standardized, 300 mg, 90 Caps
St. John's Wort Extract has been proven in many European clinical studies to be a natural antidepressant and is widely used for this reason.Vitamin B-100 Complex W/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
A complete Vitamin B complex of 8 essential vitamins. B Vitamins are precursors of coenzymes involved in the conversion of cellular energy, manufacture of hormones and proteins, and repair and maintenance of nerve structures.Vitamin B-50 Complex With B-2 Coenzyme, 100% Natural, 330 mg, 100 Caps
B Vitamins, as found in a Vitamin B Complex, are precursors of coenzymes involved in the conversion of cellular energy, manufacture of hormones and proteins, and repair and maintenance of nerve structures.Vitamin B-5 (Pantothenic Acid), 100% Natural, Nature's Way, 250 mg, 100 Caps
Pantothenic acid (vitamin B-5) is converted to coenzyme A, which is involved in the biochemical cycles responsible for conversion of fats, proteins and carbohydrates into energy.Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 Vcaps
Nature's Way Vitamin C with bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Vitamin E, D-Alpha Tocopherol, 400 IU, 100 Softgels
Vitamin E has potent antioxidant activity, supplies oxygen to the blood, aids in strengthening capillary walls, and plays a beneficial role in cancer and cardiovascular disease prevention, anti-aging benefits, circulation, wound-healing, immune function, nervous system function, PMS, hot flushes, diabetes, vascular disease, eye health, tissue repair, athletic performance, leg cramps, skin and hair health, and alleviating fatigue.Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps
Zinc is present in all tissues, organs and secretions of the body. Nature's Way chelated zinc is 100% natural chelated with an advanced amino acid complex for superior absorption.
Herbal Remedies: Vitiligo Information
Herbal Remedies: Vitiligo Supplements & Products
FURTHER INFORMATION
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or 877-22-NIAMS (226-4267) (free of charge)
TTY/TDD: 301-565-2966
Fax: 301-718-6366
E-mail: NIAMSinfo@mail.nih.gov
Website: www.niams.nih.gov
NIAMS provides information about various forms of arthritis and other rheumatic diseases; as well as other bone, muscle, joint, and skin diseases. It distributes patient and professional education materials and refers people to other sources of information. Additional information and updates can also be found on the NIAMS Web site.
American Academy of Dermatology
P.O. Box 4014
Schaumburg, IL 60168-4014
Phone: 847-330-0230 or 888-462-DERM (3376) (free of charge)
Fax: 847-330-0050
Website: www.aad.org
The academy is the national organization for dermatology. It is dedicated to achieving the highest quality of dermatologic care for everyone. The academy produces patient information on vitiligo. It can also provide referrals to dermatologists.
National Vitiligo Foundation
76 Garden Rd.
Columbus, OH 43214
Phone: 614-261-8145
Fax: 614-261-1254
National Vitiligo Foundation
700 Olympic Plaza Circle
Suite 404
Tyler, TX 75701
Phone: 903-595-3713
Fax: 903-593-1545
E-mail: info@nvfi.org
Website: www.nvfi.org
The foundation strives to locate, inform, and counsel vitiligo patients and their families; to increase public awareness and concern for the vitiligo patient; to broaden the concern for the patient within the medical community; and to encourage, promote, and fund increased scientific and clinical research on the cause, treatment, and ultimate cure.
Vitiligo Support International
P.O. Box 4008
Valley Village, CA 91617-0008
Phone: 818-752-9002
Website: www.vitiligosupport.org
This organization, with more than 30,000 active members, promotes awareness and education about vitiligo, provides information and interaction to people living with vitiligo, and works to encourage and support medical research to find better treatments and a cure for vitiligo.
American Vitiligo Research Foundation
P.O. Box 7540
Clearwater, FL 33758
Phone: 727-461-3899
Fax: 727-461-4796
E-mail: vitiligo@avrf.org
Website: www.avrf.org
The AVRF strives to raise awareness, educate, and help patients live with a greater understanding and acceptance of vitiligo.
Autoimmune Information Network, Inc.
PO Box 4121
Brick, NJ 08723
Phone: 732-262-0450
Fax: 732-262-0450
E-mail: autoimmunehelp@aol.com
Website: www.aininc.org
SUPPORT ORGANIZATIONS
Support groups and organizations are available to help people learn more about vitiligo, understand treatment options, and find support from other people with vitiligo.
Vitiligo Support International is the largest vitiligo organization in the world. The non-profit organization provides free access to online message boards, chat rooms, frequently asked questions, information and articles, as well as a patient-referred health care provider search. The group advocates on behalf of patients, conducts patient conferences and has local support groups.
The National Vitiligo Foundation (NVF) is a 501(c)(3) non-profit organization that provides access to online resources, health care provider listings, frequently asked questions (etc); funds research through grants and sponsors local support groups and workshop style conferences.
The American Vitiligo Research Foundation Inc. (AVRF) is a non-profit, tax-exempt charity that aims to increase public awareness about vitiligo and to help those affected by vitiligo, focusing specifically on children and their families. It supports finding a cure through alternatives to animal research.
The Vitiligo Society is a registered charity and a company limited by guarantee. It is the only organization which offers support and understanding to people with vitiligo and their families in the UK and the Republic of Ireland. The Vitiligo Society strives to support people anywhere in the world who asks for help and provides reliable information to the general public and health professionals about vitiligo and available treatment for the condition.
The VitiligoTURK is the first and only vitiligo support organization in Turkish Republic.
PUBLIC FIGURES WITH VITILIGO
Michael Jackson was diagnosed in 1986 with vitiligo and lupus; the latter is potentially lethal but is in remission in Jackson's case. In a 90-minute interview with Oprah Winfrey in February 1993, Jackson's dismissed suggestions that he bleached his skin, admitting for the first time that he had the illness. It also started a public debate on the topic of vitiligo, a relatively unknown condition before then.
Graham Norton, has white patches in his hair as a result of vitiligo.
Lee Thomas, a news anchor and entertainment reporter for WJBK (Fox) Detroit.
Krizz Kaliko, singer/rapper of the Strange Music record label. He has even named his debut album after the condition, Vitiligo.
VITILIGO IN DOMESTIC ANIMALS
Vitiligo along with poliosis is seen as a familial trait in domestic animals. It is especially common in Arabian horses (called Arabian Pinky Syndrome) and in Rottweiler dogs. Vitiligo is sometimes considered a cosmetic defect in the Rottweiler. It may also cause constant itching in very rare cases.
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
If you see a suggested Amazon product "not there" as indicated by an orange box with the Amazon logo, this only means the specific product link has been changed by Amazon.com. Use the "click here" icon on the orange box and it will bring you to Amazon.com and you can do a search for a specific product using keywords and a new list of available products and prices will show. Their product and resource links are constantly changing and being upgraded. Many times there are more than one link to a specific product. Prices will vary between product distributors so it pays to shop around and do price comparisons.
Educational materials and health products are available through Amazon.com. Use the search box provided below to search for a particular item.
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Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
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