Vitiligo

Causes

The most likely cause is autoimmune, where the body's own immune system attacks the melanocytes. This type of vitiligo may be associated with other autoimmune diseases such as pernicious anemia (immune system attacks stomach cells resulting in deficient absorption of vitamin B12, leading to anemia), Addison's disease (immune system attacks the adrenal glands), and thyroiditis (immune system attacks thyroid gland). Another theory is that chemical injury leads to depigmentation. Breakdown products of excess neurotransmitters generate free radicals and hydrogen peroxide. These chemicals are toxic to melanocytes and destroy them. Additional theories are stress and heredity (20 to 30 percent of patients have a relative with vitiligo).

Treatment

Treatment of vitiligo can be managed pharmacologically with traditional and herbal medicine as well as surgically, and cosmetically. Treatment can further be divided into repigmentation therapy and depigmentation therapy. Repigmentation therapy includes surgery, and medications such as steroids, calcineurin inhibitors, PUVA, NBUVB, and some herbal remedies.

Depigmentation therapy includes topical use of medication (hydroquinone or monobenzone). This does not stop the disease process, but the depigmentation of unaffected skin may give it a more even appearance. A side effect is local skin irritation.

One traditional treatment approach is the use of topical steroids. These repigment the skin, but side effects include thinning of the skin where they are applied. Another treatment is using calcinurin inhibitors such as tacrolimus and pimecrolimus. These re-pigment the skin like steroids but do not cause skin thinning. However, these products have been linked to lymphoma and skin cancer.

Other repigmentation therapies include using ultraviolet light. For example, UVA light with psoralen (a UV light sensitizer) and narrow band UVB light are used to repigment the skin. A side effect is very tan skin.

Some herbal remedies have been used to repigment the skin as well. Experimentation with many of the herbs listed have increased melanocyte migration and growth in labs only and may show promise in helping those with vitiligo, but they have not been proven in scientific studies. The following herbs may eventually show promise in repigmentation: Gingko (Ginkgo Biloba), Radix Salviae Miltiorrhizae (Danshen), Semen Cuscutae (Cuscuta chinensis Lam), Flos Carthami (Safflower), Fructus Tribuli (Tribulus Fruit), Radix Astragali (Astragalus Root), Fructus Psoraleae (Fruit of Psoralea), Fructus Ligustri Lucidi (Ligustrum seed), Radix Angelicae Dahuricae (Dahurian angelica root), and Piper Nigrum Fruit (Black pepper extract).

Surgery is another treatment option for people with vitiligo. There are three possibilities: (1) using pigmented skin from one area of the body and attaching it to the depigmented area (autologous skin grafting), (2) obtaining melanocytes from a pigmented area, growing more of them in a lab, and then transplanting them onto the depigmented area (autologous melanocyte transplant), (3) tattooing the depigmented area with skin-colored ink.

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