Above all, it has long been linked to hypochlorhydria, or hydrochloric acid deficiency in the stomach. Although it is common to associate hyperacidity with heartburn and gastric discomfort, hypoacidity is a much more common cause of such distress. Low stomach acid, linked with such diverse conditions as diabetes and underactive thyroid, is quite a common problem, causing poor protein digestion and chronic malabsorption of most minerals and some vitamins. These deficiencies seem to contribute to the loss of pigment.

Drinking milk can aggravate the condition. It takes so much hydrochloric acid to acidify milk that little is left for other components of the meal. This can result in an incomplete breakdown of the nutritional components (Nebraska Med J, 1931; 16:25-26; Lancet, 1971; i:1331-4).

My own experience is that a large number of vitiligo sufferers have low or even absent hydrochloric acid production in their stomachs. This can be accurately tested (with a Heidelberg pH capsule gastric analysis, for instance). About 45 per cent may stop the condition from progressing or often even reverse it once the hydrochloric levels in their stomachs is corrected.

The herb Angelica atropurpuraea is used to help vitiligo (Am J Hom Mat Med, 1856, 1: 272). However, since it can induce photosensitivity, you must be wary of sun exposure while taking it, restricting exposure to no more than half an hour per day.

In homeopathy, there are no specific homoeopathic remedies for vitiligo, but success may be achieved with the long term use of such remedies as Arsenicum album, Ferrum phosphoricum, Nitricum acidum or Zincum phosphoricum, (F M Dearborn, Diseases of the Skin, New York: William Radde, 1913).

In Ayurvedic Medicine, for over 3000 years, Psoralea coryliforia combined with natural sunlight has been used successfully to treat vitiligo (Pharmacol Ther, 1987; 34: 75-97).

In aromatherapy, bergamot oil is applied to the white skin patches and then exposed to sunlight. Although this has been described as an uncertain method of treatment, I have personally seen several successful cases. Do not use bergamot indiscriminately, and never neat, but always under professional advice.

Supplementation with paraamino benzoic acid (PABA) has on occasion caused vitiligo (J Am Academ Dermatol, 1983; 9: 770). However, nutritional supplementation with copper may be beneficial as it activates tyrosinase, which is necessary for the production of melatonin. Low levels of melatonin can result in vitiligo (Clin Chim Acta, 1972; 37: 207-11).

One highly successful treatment in Egyptian medicine concerns Ammi majus, also known as bishopsweed. A tincture of the herb is painted on the depigmented areas, which are then exposed to the sun for, at most, a half hour. At the same time, powdered Ammi majus seeds are also given internally, 4-6g per day. This is said to have remarkable sucess in restoring pigmentation (R F Weiss, Herbal Medicine, A B Arcanum, Gothenburg, 1988; Fortschritt der Medizin, 1976; 94(29):1595). Nevertheless, WDDTY panellist Melvyn Werbach has unearthed one study demonstrating that applying the herb topically is ineffective, suggesting that taking the herb orally is what actually works (Botanical Influences on Illness, Third Line Press, Tarzana, Ca, 1994).

Harald Gaier is a registered naturopath, homoeopath and osteopath.

As you’re aware, vitiligo is a progressive depigmentation of the skin. It can leave your skin very blotchy and two toned as it progresses, causing mainly psychological damage. For at least a third of cases, vitiligo can be temporary. Although the condition is mainly considered a cosmetic one, with no inherent serious dangers of its own, it is nevertheless considered an autoimmune problem, and may be a marker for the later onset of other autoimmune diseases, such as Addison’s disease (where the adrenals are exhausted), diabetes, pernicious anaemia, overactive or other thyroid disorders.

The most recent evidence is that vitiligo is a deficiency disease, resulting from one of a number of nutritional deficiencies. One study of vitiligo sufferers noted that of the 48 patients, most had a history of poor diet and consequent symptoms of fatigue and irritability. They also had classic autoimmune and allergic symptoms, including joint pain, constipation and headaches. Before investigating further, it’s important to rule out food or chemical allergies (see the WDDTY Allergy Handbook).

Folic acid and vitamin B12 supplementation recently have been shown to repigment the skin, particularly if also “cooked” by sun exposure. In one recent study of 100 patients given 10 mg per day of folic acid and 2,000 mcg per day of B12 and advised to include sun exposure, 52 patients had clear repigmentation, six of whom achieved total repigmentation. The best results occurred in areas of the body which had been exposed to the sun, demonstrating that the vitamin therapy is enhanced by sun exposure (Acta Derm Venereol, 1997; 77: 460-2).

WDDTY panel member Melvyn Werbach has discovered numerous other deficiencies which can bring on vitiligo. The evidence about the role of para amino benzoic acid, the B vitamin most associated with protecting the skin in the sun, and now added to just about every sunscreen product, is contradictory. In one 10 month study, 48 patients with the condition were given PABA 100 mg three to four times per day, in addition to a B complex supplement. Since the effect of the PABA taken orally was slow, 100 mg of monoethanolamine PABA injected twice a day was added to the regime. Although the study reports that improvement was initially slow, by the sixth month of treatment, results were “striking” (Virginia Med Monthly, January 1945: 6-17).

Nevertheless, there is also evidence that supplements of PABA can actually bring on vitiligo (J Am Aca Dermatol, 1983; 9: 770). This suggests that excessive PABA in sunscreens may do more harm than good in exposing the body to excessive amounts of the nutrient.

Tyrosine is an amino acid that is vital in the creation of melanin, which gives skin its pigment,, and tyrosinase is an enzyme which helps to convert tyrosine into melanin. Since adequate copper is necessary for proper tyrosinase activity, copper supplementation may be beneficial, even for children, according to one study (Vestn Dermatol Vernerol, 1979; 3: 48-50.

Another way to stimulate tyrosine in the body is to give patients l-phenylalanine, which is a precursor to tyrosine, with ultraviolet-A (UVA) radiation. In the best study of this regime, of 13 children who underwent the treatment, three had a complete repigmentation, and six had between a 50 and 90 per cent improvement. Only four failed to respond (Pediatri Dermatol, 1989; 6: 332-5). In another study of the treatment with adults, some patients in the study both took oral l-phenylalanine and applied a cream containing 10 per cent phenylalanine to the affected areas. Those who used both, plus had UVA exposure, enjoyed the best results (Int J Dermatol, 1989; 28: 545-7). Neither study reported any side effects.

Other studies show that this treatment will repigment, at best, only half the vitiliginous patches (Z Hautkr, 1987; 62: 519-23). But at least the treatment helps patients to tolerate more sun, which is often a problem in people suffering from vitiligo (Arch Dermatol Res, 1985; 277: 126-30).

Besides nutritional deficiencies, you should also look to heavy metal poisoning as a possible cause, and the source could be as close to hand as the front of your nose. Chronic skin contact with nickel has been implicated in vitiligo, and in two patients studied, the cause was put down to the metal frames of their eyeglasses, which were made of nickel. Both patients turned out to have nickel hypersensitivity, which in turn caused low production of melanin (Yonsei Med J, 1991; 32: 79-81).

Besides heavy metal, make sure that you aren’t being exposed to high levels of arsenic. Chronic arsenic poisoning is also associated with vitiligo (N J Med, 1989, 86: 377-80). Arsenic can be used in the garden but is also present in cigarettes, so if you are a smoker, it’s yet another reason to quit (BMJ, 1998: 317: 101).

Finally, get your digestive system checked out. For 50 years, medicine has known that vitiligo results from low stomach acid. In one study, The extent of the vitiligo correlated with the extent of the patient’s deficiency of stomach hydrochloric acid (South Med J, 1945; 38: 235-41).

If you are found to be low in stomach acid, you can remedy the situation by supplementating with Hcl plus pepsin. In one small study, four patients all had their vitiligo resolve within two years of starting a regime of 15 cc Hcl with each meal (Neb Med J, 1931; 16: 25-6).

About one in every 200 persons in the US and Europe have this puzzling condition. Although it’s mostly considered a cosmetic problem with no serious ill-effects, it can be psychologically very distressing to sufferers.

For a third of patients, the condition is temporary and resolves spontaneously. But for the rest, the condition is permanent, and may be a sign of a general autoimmune disorder heralding the later development of other conditions such as Addison’s disease (where the adrenals are exhausted), diabetes, pernicious anaemia, an overactive or other thyroid disorders and even patchy hair loss (alopecia areata).

What causes it?
Although all experts agree that the condition results from the destruction of melanocytes in the epidermis, no one has a clue as to why it happens. It is generally agreed that oxidative stress plays some role in the process. The latest research from the National Vitiligo Foundation in Tyler, Texas, advances the hypothesis that melanocytes of patients with vitiligo have a molecular alteration that makes them more susceptible to cell death when challenged by, say, too much sunlight (ultraviolet B radiation) or exposure to phenol (disinfectants) or catechol (used in dyeing and tanning). Some believe there is a link with emotional and physical stress.

Studies at Loyola University Medical Center in Chicago have shown that immune cells are present in the skin when it is actively losing pigment. What’s more, the immune cells appear to be in direct contact with the cells that normally produce skin pigment.

This suggests that an immune response is in some way involved in the process that results in the destruction of pigmentation cells (Lab Invest, 2000; 80: 1299-309). Although scientists still do not know what the immune cells are responding to, it is believed that it is the proteins that are found exclusively in melanocytes. Again, the findings suggest that the trigger mechanism may be too much sun exposure, which vitiligo sufferers are especially sensitive to.

What doctors tell you
The usual treatment is to cosmetically disguise, attempt to repigment the skin, or take the if-you-can’t-beat-’em approach and strip the rest of the skin of its pigment.

In mild cases, the usual treatment is topical corticosteroids such as triamcinolone acetonide, which appears to be effective, but at a cost, particularly in younger patients who have to use them long term. Topical steroids have the same effects as their oral cousins, including thinned skin, a humpback, osteoporosis, growth problems and immune disorders. Doctors also suggest that patients expose patches the affected skin to the sun in the hope that the ultraviolet radiation will promote repigmentation.

For more extreme cases, the most accepted treatment is to attempt to attract more pigmented cells to the skin surface using psoralen plus ultraviolet A (PUVA) radiation. This can cause nausea, skin blistering, and liver and eye damage, such as cataracts. Doctors may also attempt to destroy pigment, usually with benoquin, a mix of monobenzone and hydroquinone. This leaves the skin a ghostly white, and may also cause skin inflammation, contact dermatitis, greying hair, photosensitivity and corneal pigment deposits.

Lynne McTaggart

In a double-blind placebo-controlled trial, 52 patients with slow-spreading disease were given either Ginkgo extract 40 mg three times daily or a placebo. In around 80 per cent of the treated patients, the condition was halted (compared with 36 per cent taking the placebo), and extensive-to-complete repigmentation was seen in 40 vs 9 per cent of the treated vs placebo group (Clin Exp Dermatol, 2003; 28: 285-7).

Two of the treated group experienced nausea with the herb.

Make sure that you take an extract which is standardised to contain 24 per cent ginkgoflavonglycosides. Also, Ginkgo can, albeit rarely, cause some gastrointestinal discomfort, headache and dizziness.

Other helpful supplements include B vitamins (10 mg/day of folic acid and 2000 mcg/day of B12), copper and L-phenylalanine, a precursor to tyrosine, along with ultraviolet A (UVA) radiation treatments. Watch out for heavy-metal poisoning.

Vitiligo may also be the result of low stomach acid, so have yours checked out via the Biolab Medical Unit in London (020 7636 5959) and, if needed, remedy the situation by supplementating with hydrochloric acid plus pepsin.

There is certainly a familial incidence. – Dr P.C. Tatham, Durham