Gingko Biloba for Vitiligo

One of the most frequent questions asked by my patients, is whether a “natural” product found on the internet or a dietary supplement, could be used to treat or perhaps even cure their vitiligo. Despite my explanations about the lack of science, the ever-present danger of charlatans and a warning that “if it sounds too good to be true it usually is” patients and their families all too easily part with their hard-earned money. Gluten free diets, vitamin B12 supplements, antioxidant and vitamin C infusions have all been recommended and tried in the hope that it just might work? Unfortunately, disappointment invariably follows.

That said, Dermatologists and scientists are continuing to investigate the potential for herbal supplements to benefit vitiligo sufferers.

Gingko Biloba, from the leaves of the Ginkgo biloba tree, is one such herb which is showing some interesting results in small studies.

Gingko biloba has been shown to possess quite potent anti-inflammatory and antioxidant therapies and in medical studies has been tested using an extract of ginkgo, standardised to 24% flavone glycosides and 6% terpene lactones (60mg dosage form)

In one such trial, therapy with Ginkgo Biloba without any other treatment at 120mg daily for 2 months, arrested disease activity in all patients and led to an average re-pigmentation of 15%. Other studies have shown greater benefit when Ginkgo Biloba is combined with traditional vitiligo therapies particularly medically delivered phototherapy. This combination is best discussed and undertaken under the supervision of a vitiligo patient’s dermatologist

New Treatment Could Be ‘Breakthrough’ for Vitiligo Skin Condition

By Serena GordonHealthDay Reporter (consumer.healthday.com)

MONDAY, Feb. 5, 2018 (HealthDay News) — Doctors have discovered a combination of treatments that can return colour to skin that has been lightened by vitiligo — the skin disease that turned Michael Jackson’s skin white.

he new therapy includes the oral medication Xeljanz (tofacitinib) — a drug already approved for use in rheumatoid arthritis patients that dampens the body’s immune response — and ultraviolet-B light therapy.

The combination has only been used on two vitiligo patients, but according to a study author, the results have been dramatic. Experts add, however, that the findings need to be duplicated in studies with larger groups of people.

The treatment produces “results that are impossible to achieve with common therapies,” said Dr. Brett King, an Associate Professor of dermatology at Yale University School of Medicine.  “I think this is a breakthrough in vitiligo treatment,” he added.

One of King’s vitiligo patients, Shahanaj Akter, agreed. “My skin is so much better. I can use make-up and it blends nicely. I am so excited,” she said. Akter, 34, first noticed a white patch of skin above her eyebrow on her normally brown skin while she was pregnant in her 20s. That patch grew bigger and bigger, and then white patches showed up on her hands and neck.  Akter was living in her native country of Bangladesh when her condition first began, and vitiligo carries even more of a stigma there. Some people said unkind things to her.

“I cried a lot. I wanted to be my normal colour again,” she said. To that end, Akter tried treatment after treatment in Bangladesh and then in the United States. Some therapies caused intolerable side effects, and none brought the results she was hoping for.

“It was terrible. I tried so many things,” she said.

That’s when King suggested she try the new combination therapy.  At the time of treatment, Akter had white patches on about three-quarters of her face. She also had patches on her neck, chest, forearms, hands and shins. She was given 5 milligrams of tofacitinib twice daily, and full body UV-B light therapy twice weekly. After three months, Akter’s face was almost completely free of white patches. About 75 percent of her neck, chest, forearms and shins were re-pigmented with colour. Her hands had only minimal freckling.

How does this treatment work? Dr. Seemal Desai, a clinical Assistant Professor of Dermatology at the University of Texas Southwestern Medical Center in Dallas, explained it this way: “The immune system is attacking the melanocytes, so they go into hiding. Tofacitinib tells them it’s OK to come out of hiding, and the UV light brings them out of hibernation.”

King and his colleagues also reported on a white man in his 50s who had long-standing vitiligo. He had previously received treatment to remove all pigment so he would be uniformly white. But he still had patches of whiter skin on 90 percent of his face. He also had patches on his torso and arms.  After three months of treatment on his face, he had about 50 percent re-pigmentation. After six months, he had about 75 percent re-pigmentation of his face. King was surprised at how effective the treatment was because the man had previously undergone chemical destruction of the pigment cells.

Desai said the findings “look promising, and that new treatment options are great.”

But, he added, this study needs to be replicated in a larger group of people.

And he noted that right now, people will likely have a hard time getting reimbursed for tofacitinib because it’s not approved for treating vitiligo. Both King and Desai said the drug seems to be well tolerated. King said he doesn’t know how long people would need to take the drug, but suspects some would be on it long-term, possibly for life.

Details of the cases were published online Jan. 31 in a research letter in the journal JAMA Dermatology.

Topical JAK inhibitor shown to be effective for facial vitiligo

Sadly, over the past decades there has been little to excite Dermatologists and Vitiligo patients with regard to potential new helpful treatments. A class of drug known as a JAK inhibitor however, may hopefully soon change that situation.

Skin conditions such as vitiligo, eczema and psoriasis all involve specific forms of abnormal inflammation beneath the skin’s surface. The chemicals in the skin responsible for promoting this unwanted inflammation are known as cytokines. Cytokines play key roles in controlling cell growth and the immune response within the skin. Many of these cytokines function by binding to and activating their targets by attaching to receptors on skin cells known as type I and type II cytokine receptors. A good analogy is to think of the cytokine as a key that fits a receptor which acts as the lock. Once the key (cytokine) fits the receptor (the lock) these receptors in turn rely on the Janus kinase (JAK) family of enzymes to enable the cytokine to activate the cell into action (this is called signal transduction) Hence JAK inhibitors are drugs that inhibit the activity of cytokines to cause unwanted inflammation in by blocking their target (receptor)

A recent study published in the Journal of the American Academy of Dermatology by Dr. David Rosmarin at Tufts University (June 2017, Volume 76, Issue 6, Pages 1054–1060) reported that a topical formulation of ruxolitinib 1.5% cream induced significant results in 12 vitiligo patients (see an example in the picture below). For reasons unclear, ruxolitinib 1.5% cream was most effective on the face, and not very effective on the hands.

Based on these results, further clinical trials are planned in the United States and will be commencing soon. We all await wit fingers crossed the results of these exciting studies

Excimer light treatment shows promise in vitiligo

The Vitiligo Centre Australia is excited to be trialling Excimer light treatment.

Whilst available overseas, the Excimer system has only recently arrived in Australia.  The Excimer lamp is a form of targeted phototherapy that delivers a specific wavelength (308 nm) of ultraviolet B radiation to the skin. The 308-nm wavelength is reported to be particularly effective at disrupting the immune cells (T-lymphocytes) responsible for destroying the pigment cells in the skin (melanocytes) resulting in the development of vitiligo. The 308nm wavelength has also been shown to stimulate pigment cell (melanocyte) proliferation and migration from within the hair follicles of the skin.

The Excimer 308nm system appears to have many potential advantages when compared to traditional phototherapy (light treatment) for vitiligo:

  • Only the vitiligo skin is treated without the normal surrounding skin being exposed to ultraviolet radiation
  • Different sized templates are available to treat difficult areas such as around the eyes ears, mouth and genitals
  • Since the treatment is targeted only to vitiligo areas, and only a specific wavelength (308nm) is utilised, a higher dose of ultraviolet radiation can be safely delivered to skin
  • The treatment duration is much less than traditional phototherapy (light treatment)
  • Being smaller and less “frightening” in appearance compared to traditional phototherapy, children can be more easily treated

The Vitiligo Centre Australia is currently trialling the 308 Excimer Lamp on a number of our paediatric and adult vitiligo patients. If we are happy with the results we will purchase the technology and offer this treatment to all suitable patients for the treatment of their vitiligo.