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Vitiligo
Vitiligo is a disorder of skin pigmentation characterized by progressively widening areas of depigmented very white) skin. The phenomenon is associated with the local destruction of melanocytes, the cells that produce melanin pigment to darken the skin. It affects 1 - 4% of the world's population.1

Nutritional supplements that may be helpful: A clinical report describes the use of vitamin supplements in the treatment of vitiligo.2 Folic acid and/or vitamin B12 and vitamin C levels were abnormally low in most of the fifteen people studied. Supplementation with large amounts of folic acid (1-10 mg per day), along with vitamin C (1 gram per day) and intramuscular vitamin B12 injections (1,000 mcg every two weeks), produced marked repigmentation in eight people. These improvements became apparent after three months, but complete repigmentation required one to two years of continuous supplementation. In another study of 100 individuals with vitiligo, oral supplementation with folic acid (10 mg per day) and vitamin B12 (2,000 mcg per day), combined with sun exposure, resulted in some repigmentation after three to six months in fifty-two cases.3 This combined regimen was more effective than either vitamin supplementation or sun exposure alone.

Supplementation with the amino acid L-phenylalanine may have value when combined with ultraviolet (UVA) radiation therapy. Several clinical trials, including one double blind trial, indicated that L-phenylalanine given in amounts of 50 mg per kilogram body weight per day (3,500 mg per day for a 154-pound person) or less, increased the extent of repigmentation induced by UVA therapy. L-phenylalanine alone also produced a more modest repigmentation in some people.4 Another study of vitiligo in children reported that L-phenylalanine plus UVA was an effective treatment in the majority of children.5 Recently, a group of Spanish doctors reported on their experience using L-phenylalanine over a six-year period. Some of the 171 patients with vitiligo received L-phenylalanine (50 or 100 mg per kg body weight per day) for up to three years. Between April and October of each year, the patients also applied a 10% L-phenylalanine gel, prior to exposing their skin to the sun for thirty minutes. Some improvement was seen in 83% of the patients, and in 57% the results were rated as good (75% improvement or better).6

In one early report, lack of stomach acid (achlorhydria) was found to be associated with vitiligo. Administration of dilute hydrochloric acid after meals resulted in gradual repigmentation of the skin (after one year or more).7 Hydrochloric acid, or its more-modern counterpart betaine hydrochloride (HCl), should be taken only under the supervision of a nutritionally oriented doctor.

Another early report described the use of PABA (para-aminobenzoic acid)_a compound that is commonly associated with B-complex vitamins. Persistent use of 100 mg of PABA three or four times per day along with an injectable form of PABA and a variety of hormones tailored to individual patients' needs, resulted, in many cases, in repigmentation of areas affected by vitiligo.8

Herbs that may be helpful: An extract from khella (Ammi visnaga) may be useful in repigmenting the skin of those with vitiligo. Khellin, the active constituent, appears to work like psoralen drugs_it stimulates repigmentation of the skin by increasing sensitivity of remaining pigment-containing cells (melanocytes) to sunlight. Studies have used 120-160 mg of khellin per day.9

Another herb that may prove useful for vitiligo is St. John's wort.10 As with khella, it increases the response of the skin to sunlight. However, to date no studies have demonstrated the effectiveness of St. John's wort for vitiligo.

References:
1. Ortonne JP, Bose SK. Vitiligo: where do we stand? Pigment Cell Res 1993;6:61-72.
2. Montes LF, Diaz ML, Lajous J, Garcia NJ. Folic acid and vitamin B12 in vitiligo: a nutritional approach. Cutis 1992;50:39-42.
3. Juhlin L, Olsson MJ. Improvement of vitiligo after oral treatment with vitamin B12 and folic acid and the importance of sun exposure. Acta Derm Venereol 1997;77:460-62.
4. Siddiqui AH, Stolk LM, Bhaggoe R, et al. L-phenylalanine and UVA irradiation in the treatment of vitiligo. Dermatology 1994;188:215-18.
5. Schulpis CH, Antoniou C, Michas T, Strarigos J. Phenylalanine plus ultraviolet light: preliminary report of a promising treatment for childhood vitiligo. Pediatr Dermatol 1989;6:332-35.
6. Camacho F, Mazuecos J. Treatment of vitiligo with oral and topical phenylalanine: 6 years of experience. Arch Dermatol 1999;135:216-17.
7. Francis HW. Achlorhydria as an etiological factor in vitiligo, with report of four cases. Nebraska State Med J 1931;16(1):25-26.
8. Sieve BF. Further investigations in the treatment of vitiligo. Virginia Med Monthly 1945;Jan:6-17.
9. Abdel-Fattah, Aboul-Enein MN, Wassel GM, El-Menshawi BS. An approach to the treatment of vitiligo by khellin. Dermatologica 1982;165:136-40.
10. Brown DJ. Herbal Prescription for Better Health. Rocklin, CA: Prima Publishing, 1996, 294-95.

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