Vitiligo, the most common de-pigmentation disorder
What is vitiligo?
Vitiligo is the most common de-pigmentation disorder of the skin, hair and mucosal surfaces, which manifests with white patches as a consequence of the destruction and selective function loss of melanocytes. Melanocytes are very specific cells located at the bottom layer of the skin that, through a process called melanogenesis, produce melanin, a dark pigment responsible for our skin colour. Its function is to protect against UV light; put simply, the darker your skin, the more melanin you have.
Vitiligo can affect between 0.5% and 1% of the population and can be differentiated into two main categories. Segmental vitiligo is confined to a section of the skin supplied by a single spine nerve; generalised vitiligo may appear first on areas sensitive to pressure and friction, but also on the face, scalp and back of the hands. Vitiligo onset is more common around age 24, has no prevalence between men or women, and no difference in rate according to skin type.
The aetiology factors of this skin condition are still unclear, but they could be of a different nature. Some hypotheses have suggested the involvement of genetic variations, neural, biochemical, oxidative stress, endo and exotoxins exposure, low vitamin D, and autoimmunity. Also, emotional and physical stress, especially if prolonged over time, could trigger or worsen vitiligo.
Anyway, the pathological pathway which is possibly most understood and common is mediated by T-cells and has an auto-immune component to it. In simple words, this means that the immune system of the person affected by vitiligo is sabotaging and destroying its own melanocytes, with consequent skin de-pigmentation. The reasons for this self-destruction aren’t completely clear, but they certainly involve genetic and environmental components.
Conventional treatments for vitiligo see the use of topical corticosteroids as the first line approach, with a success rate of 75% of re-pigmentation, mainly on the neck and face - those areas exposed to sunlight. The downside of this approach is the possible severe local and systemic side effects.
Other orthodox approaches use plus UVA radiation, so-called photo-therapy, for widespread vitiligo. Its efficacy is equivocal and may increase the risks of different types of skin cancer. Laser therapy may also be used, which is a more targeted form of photo-therapy treatment with possibly fewer side effects.
An important aspect to consider in people with vitiligo is the impact that this disease has on the person’s self-esteem, which may vary depending on the severity, skin type and cultural background. In extreme cases, when the person physically and emotionally withdraws from social interactions, a talking therapy like counselling or psychotherapy may be advised.
What else can be done?
First and foremost, never self-diagnose or self-prescribe. Always consult a healthcare professional who can assess you correctly and guide your journey to possible recovery, but please bear in mind that there is no 100% success rate guaranteed in any therapeutic approach.
In clinical practice, a nutritional therapist will fully assess the clients’ present and past medical and health history, dietary and lifestyle choices, social interactions and emotional well-being, stress levels and sleep patterns. This in-depth screening will give clues of what might be the triggers and mediators of vitiligo. Some functional tests may also be used to more precisely evidence biochemical imbalances or genetic variations that may further allow for a more accurate understanding of the possible reason/s of vitiligo, and to guide the formulation of a nutritional, supplemental and lifestyle plan.
The protocol that is most followed in clinical practice is the one that involves the management of an over-active immune system, which is causing melanocytes damage. As named above, the reasons for this self-destruction are many, and may include, but are not limited to:
- consuming the wrong food and drinks
- anything else that can deteriorate gut health, which may cause gut inflammation, leading to a condition called “leaky gut”
Leaky gut means that the gut-lining has become hyperpermeable and allows entry into the body of unwanted particles, like bacteria, microscopic parasites and undigested food. This will activate an immune system response, which over time may initiate a cascade of events that may then develop into an auto-immune disease.
There are many actions that can be taken to help manage vitiligo. The list that follows is not exhaustive, as this will be different according to individual cases, and it is not to be used without directions from a healthcare practitioner.
1. Prevent further melanocytes stress and damage:
- eat as much organic food as you can afford
- increase antioxidant intake from whole food like fruits and vegetables, or supplements
- decrease toxin exposure
- eliminate alcohol for sometime
- eliminate possible allergens, like gluten and dairies
- avoid inflammatory food like red meat, refined carbohydrates and deep fried food
- decrease stress levels
2. Manage the auto-immune self-harming mechanisms
- supplemental vitamin A and vitamin D
- supplemental glutamine and glucosamine
- whole leaf aloe vera juice
- good quality, high dose probiotics, containing multi strains of Bifidobacterium and lactobacillus
3. Stimulate re-pigmentation
- support thyroid function
- supplemental tyrosine, copper and zinc
- laser therapy
As I mentioned earlier there is no guaranteed success in any approach, but only the hope and the belief that as the body gets ill, the body can also get better by removing what is causing the problem and introducing healing agents.
Thank you for reading this article and I hope that you found it useful.
Yamaguchi, Y., Hearing, V. J., (2014). Melanocytes and Their Disease. Cold Spring Harbor Perspectives in Medicine; v.4(5)
Allam, M., Riad, H., (2013). Concise Review of Recent Studies in Vitiligo. Qatar Medical Journal; 1-19.
Dos Santos VIdeira, I.F et al (2013). Mechanisms regulating melanogenesis. Anais Brasileiros de Dermatologia; 88:76-83.
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