Can vitiligo be controlled?

Yes, but with difficulty. At present there is no magic cure; the best that can be hoped for is to control it and there are several tools available. Let’s look at them.

What you see in vitiligo:  milky-white spots in an otherwise normally pigmented skin.

What we know

Melanocytes are absent in the stratum basale of areas affected by vitiligo.  The causes of vitiligo are only partially understood: autoimmune mechanisms, oxidative stress, and viruses may contribute to it. At present, there is no cure for vitiligo. Children and young adults may need counseling to prepare them for an extended fight to control vitiligo. 

There is a genetic component to vitiligo, but environmental changes, including viral infection, can be triggers. Environmental factors may lead to defective keratinocyte adhesion and lower production of growth factors by keratinocytes. Later on, a secondary event like physical trauma, oxidative stress by ROS* (reactive oxygen species) and other oxidants, or the formation of autoimmune antibodies may lead to the exfoliation of keratinocytes and pigmented cells and the appearance of white spots characteristic of vitiligo.

Are melanocytes in vitiligo actually lost or just inactive? In one study, about half the cells in the epidermis of vitiligo patients contained melanocytes in the affected area. Stem cells, precursors of melanocytes, were also present. When there are viable melanocytes, the objective is to correct the malfunction, not an easy task, but the prospects for improvement are better than if melanocytes were absent rather than malfunctioning.

Take care of your pores!

Stem cells, including those that can produce melanocytes, reside in the pores. When treatment is successful in reversing vitiligo, you will often see the re-pigmentation starting near the pores. 

Skin problems that look like vitiligo but aren’t

Chemical leucoderma or chemical vitiligo is caused by repeated exposure to chemicals like phenol and catechol derivatives.

Sun damage, burns, and other stressors may lead to pigmentation disorders.

Some tools that can help control vitiligo

Antioxidants: prevent and repair

The oxidative pathway is affected in vitiligo, but how it initiates (or contributes) the pathogenesis is not clear. Antioxidants may help in some circumstances, and for this particular skin problem, we suggest our carefully crafted antioxidant products because free radicals may be responsible for disabled melanocytes. Try our antioxidant products, but get permission from the dermatologist first. Also, avoid skin stressors like UV light, benzoyl peroxide, and harsh anti-acne products that contain ethanol and essential oils.

ROS BioNet and catalase. ROS BioNet is an exclusive Skin Actives formulation of antioxidant proteins that include thioredoxin and superoxide dismutase. These antioxidants help disarm free radicals that cause oxidative stress.

Repair: Methionine sulfoxide reductase (MSR) is an antioxidant enzyme that can repair [protein damage caused by ROS*.

Keratinocyte growth factor may stimulate the production of melanin. It is worth using it in conjunction with anti-inflammatory actives, antioxidants, and actives that can help preserve the dermal-epidermal junction’s integrity like apocynin.

Fight inflammation

It is worth trying our anti-inflammatory products because inflammation is somehow involved in vitiligo. Always use our products for at least two months before giving up; it takes time to change the melanocytes’ physiology and for new skin to show. It may take even longer for dormant melanocytes to start producing melanin.

Polypodium extract

This is a fern, and extracts of its aerial parts (PL) have shown antioxidant, photoprotective, and immunomodulatory activities. The chemical composition and mechanisms of action are complex and include several activities: (1) PL diminishes the production of reactive oxygen and nitrogen species (ROS, RNS); (2) PL inhibits the photoisomerization of trans-urocanic acid (t-UCA); (3) PL inhibits apoptosis induced by ultraviolet radiation; (4) PL prevents damage to genetic material and (5) PL enhances DNA repair. PL is not mutagenic and does not induce acute or chronic toxicity. Its biological effects have been proved in cell cultures, animal models, and humans. Photoprotective activity has been assessed in healthy volunteers as well as in patients suffering from several cutaneous diseases such as vitiligo, psoriasis, idiopathic photodermatosis, or melasma. PL results to be an efficient treatment especially for sensitive cutaneous phototypes and add extra protection when ultraviolet radiation (UVR) exposure cannot be avoided, such as wide or narrow-band UVB phototherapy or treatment with psoralens plus UVA exposure radiation.

Stem cell support

Apocynin inhibits an enzyme, NADPH oxidase, and in so doing it decreases oxidative stress; it also has anti-inflammatory activity. It promotes the survival of stem cells and the cells derived from stem cells by promoting synthesis of collagen 17, a protein crucial to the anchoring of the new cells to the dermal/epidermal junction, preventing skin thinning and premature aging.

Your MD will know how to help, but here are some options.

Calcineurin inhibitors(e.g. tacrolimus, pimecrolimus) require a prescription. The mechanism of action may include: immune suppression, melanocyte migration and proliferation, and melanogenesis.

Minocycline (oral) has several activities: anti-inflammatory, immunomodulatory, and scavenging of ROS*.

Corticosteroids will decrease inflammation, but long-term use of corticosteroids can lead to other problems like skin thinning and acne-like eruptions.

Vitamin D analogs (e.g. calcipotriol, 50 microg/gm). Vitamin D analogs, particularly calcipotriol and tacalcitol, have been used as topical therapeutic agents in vitiligo. They target the local immune response and act on specific T-cell activation. They do this by inhibition of the transition of T cells (early to late G1 phase) and inhibition of the expression of various proinflammatory cytokines that encode tumor necrosis factor-alpha and interferon-gamma. These vitamin D3 compounds influence melanocyte maturation and differentiation, in addition to up-regulating melanogenesis through pathways that are activated by specific ligand receptors 

Don’t make rash decisions

Vitiligo can hit hard emotionally, especially when the afflicted is young. Remember that desperate measures may lead to results that are worse than the initial condition and may be ireversible.

Skin Actives products

Skin Actives Antioxidant cream

Seakelp  Bioferment, Ferulic Acid, Aloe Barbadensis (Aloe Vera) Leaf Extract, Beta Glucan (Oat), Beta Glucan (Yeast), Fucoidan, Galactoarabinan, Pyrus Malus (Apple) Pectin, Opuntia Prickly Pear Extract, Coffee Fruit Extract, Acai Fruit Extract, Bilberry Fruit Extract, Pomegranate Seed Oil, Tocotrienols, Vitamin E, Astaxanthin, Lycopene, Xanthophyll, R-Alpha Lipoic Acid, Beta-Carotene, Fucoxanthin, Porphyridium Polysaccharide, Glutathione, sh-Polypeptide-2 (thioredoxin, TRX), sh-Polypeptide-77 (Glutaredoxin (GRX)), Superoxide Dismutase.

In the SAS skin-soothing serum

Seakelp Bioferment, Sodium PCA, Bisabolol,  Cocos Nucifera (Coconut) Fruit Juice, Fucoidan, Astaxanthin, Fucoxanthin, Porphyridium Polysaccharide, Guaiazulene.

Gargoom AM, Duweb GA, Elzorghany AH, Benghazil M, Bugrein OO. Calcipotriol in the treatment of childhood vitiligo. Int J Clin Pharmacol Res. 2004;24(1):11-4. PMID: 15575172.

Lee, J. H., Kwon, H. S., Jung, H. M., Lee, H., Kim, G. M., Yim, H. W., & Bae, J. M. (2019). Treatment Outcomes of Topical Calcineurin Inhibitor Therapy for Patients With Vitiligo. JAMA Dermatology. doi:10.1001/jamadermatol.2019.0696 

Lee, B. W., Schwartz, R. A., Hercogová, J., Valle, Y., & Lotti, T. M. (2012). Vitiligo road map. Dermatologic Therapy, 25, S44–S56. doi:10.1111/dth.12006 

Nestor M, Bucay V, Callender V, Cohen JL, Sadick N, Waldorf H. Polypodium leucotomos as an Adjunct Treatment of Pigmentary Disorders. J Clin Aesthet Dermatol. 2014;7(3):13-17.