What is vitiligo?
Vitiligo is a common autoimmune skin disease that causes gradual loss of the natural brown pigment melanin in the skin. It affects about 1% of persons worldwide irrespective of gender, age, race, or nationality. It occasionally is associated with other autoimmune diseases such as psoriasis, alopecia areata, thyroid illness, diabetes, and pernicious anemia.
How does vitiligo behave?
When vitiligo first appears, the affected skin gets lighter in slowly enlarging dots and circles which may join together. In light-skinned people the difference between vitiligo and their normal skin may be difficult to detect until they get tanned. In dark-skinned individuals, the early changes are very obvious and distressing and eventually become bone-white. If the affected skin is hairy, the hair will turn white also.
Vitiligo can occur on any part of the body skin, but it does have a tendency to involve skin overlying joints or bony prominences. The face, neck, underarms, and private areas are also frequently affected.
Can vitiligo be treated?
In my experience, topical creams have been largely ineffective for vitiligo. Sometimes treating an underlying condition such as hyperthyroidism helps to improve vitiligo, and occasionally one sees spontaneous repigmentation. By far, the treatments that work best include exposure to ultraviolet light.
Sunlight
Natural sunlight alone is usually ineffective because the depigmented skin burns easily before the remaining pigment-producing cells can be stimulated enough to make melanin. Moreover, a burn or any other type of injury to the normal skin may induce more vitiligo.
Psoralen + UVA light = PUVA
Many years ago, a plant extract called Psoralen was discovered which when combined with long wave ultraviolet light called UVA, helped to repigment vitiligo. This treatment is now called PUVA. Recently, it has been determined that after many PUVA treatment exposures which are required for vitiligo, the risk of skin cancer is markedly increased.
Narrowband UVB
Short wave narrowband ultraviolet B (NBUVB) without Psoralen was tried next and found to be just as successful as PUVA at repigmenting skin. The dose of UVB is gradually raised to avoid burning of the normal skin while producing “pinking” of the vitiligo. The risk of skin cancer does not seem to be increased by NBUVB, but this possibility must always be borne in mind.
Polypodium leucotomos (fern plant) extract
Another plant that has attracted our attention is the tropical fern Polypodium leucotomos (PL). Extracts of PL when ingested have been shown to prevent sunburn and protect skin of people who have photosensitive skin. It has several different actions on skin: 1) potent anti-oxidant; 2) reduces cell death caused by sunburn; 3) prevents DNA damage caused by UVB which could lead to skin cancer; 4) reduces number of mast cells in skin which can release inflammatory chemicals such as histamine.
Study of fern extract in treatment of vitiligo
In 2007 Polypodium leucotomos extract was investigated in the treatment of vitiligo in 50 patients at a university in the Netherlands. Half of the patients received narrowband ultraviolet B (NBUVB) twice weekly plus the fern extract daily in capsiules by mouth and half received NBUVB alone for 6 months. Results showed that about twice as many patients receiving the fern extract experienced repigmentation of the head and neck areas.
After reviewing the above investigations, we have been recommending that our patients receive the treatment of first choice, NBUVB, delivered by a full body cabinet or by an excimer laser for targeted therapy of vitiligo skin lesions. We also advise patients to obtain Polypodium leucotomos extract and take one or two capsules daily, especially if vitiligo involves the head and neck areas, to enhance repigmentation.
How to obtain Polypodium leucotomos extract (Heliocare)
Polypodium leucotomos extract is an over the counter product that is usually purchased over the internet. It is classified as a supplement rather than a drug and is therefore not FDA-approved. I found many sources after a search. The brand that I am most familiar with and have clinical experience with is called Heliocare. It was mentioned briefly as a sunscreen pill in recent issues of the popular magazines For Women First and Consumer Reports. Heliocare contains 240 mg of the fern extract plus green tea extract and beta-carotene. It costs less than a dollar per capsule, but prices vary, so please shop around. We sell Heliocare in the office for the lowest price we could find on the internet as a convenience for patients.
