What is vitiligo?
Vitiligo is a common depigmenting condition affecting up to 2% of the population and can have a severe impact on quality of life. Vitiligo is an autoimmune skin disorder caused by dysfunctional pigment-producing melanocytes which are attacked by your body's own immune cells (T-cells). Oxidative stress is considered to play a crucial role in activating consequential autoimmune responses related to vitiligo - melanin synthesis by melanocytes being the main intracellular stressor, producing reactive oxygen species (ROS). Additionally, scientists discovered that there is an overproduction of specific cytokines called IFN-γ and when blocked by medication can effectively reverse the condition; however, disease relapse is common after stopping these blocking treatments because of more anti-body memory T-cells starting things back up again (Chang & Ko, 2023; Frisoli et al., 2020).
What is the current medical treatment for vitiligo?
Therapy depends upon the severity and body surface area (BSA) affected. First line therapy will usually include topical and or oral steroids with phototherapy, specifically narrow band ultraviolet light B (NBUVB). However, this will only stabilize or minimize the spread of the patches and if steroids are used too long on an area it can cause thinning of the epidermis. Therefore, If patches are located in sensitive areas such as the face its best to use non-steroidal topicals such as tacrolimus to avoid the down regulation of collagen. Newer research led to the development of medications known as JAK-inhibitors targeted to reduce T-cells in order to promote longer lasting benefit. One such mediation is called ruxolitinib, now available by prescription. Although this new topical is effective, prolonged use could lead to devastating adverse consequences such as immunosuppression and the activation skin cancer.
So than, what alternative therapies work?
There is good news! Multiple studies (Dutta et al., 2022; Jamgochian et al., 2023; JUHLIN & OLSSON, 1997; Zubair & Hamzavi, 2020) reviewing the various forms of alternative therapies such as diet, vitamins, minerals, herbals, protein rich platelets (PRP), and microneedling really do work and in combination can actually induce re-pigmentation. It has previously been established that nutrition plays a crucial role in developing, amplifying, or rehabilitating an array of human disorders including vitiligo. In fact, most studies agree that combining vitamin B12, folic acid, and sun exposure is good for inducing re-pigmentation of vitiligo. Supplementation of zinc and phenylalanine when used in conjunction with topical steroids or UV-B (ultraviolet B) treatment also showed therapeutic effects on vitiligo due to their role in the melanin synthesis pathway. Additional investigations conducted on herbal supplements have revealed that most of them contain antioxidants, which makes sense why they would aid in re-pigmentation.
It is extremely important to talk to a provider well versed in vitamin supplements as some vitamins can make vitiligo worse. For example, an excessive intake of Vitamin C can worsen vitiligo symptoms, so keep it at normal levels. Contraily, studies suggest (Dutta et al., 2022; Jamgochian et al., 2023; JUHLIN & OLSSON, 1997; Zubair & Hamzavi, 2020) that vitamin D3 increases tyrosinase activity and melanogenesis in vitro which may lead to repigmentation in vitiligo skin lesions. Calcipotriol and tacalcitol as mentioned above which are both vitamin D analogs, are also known to induce re-pigmentation in patients with vitiligo.
Microneedling for vitiligo?!
Microneedling was initially introduced for skin rejuvenation. I questioned whether or not microneedling could actually help vitiligo due to the Koebner’s phenomenon effect seen in this condition in which an injury can induce a new lesion. However, an extensive PubMed search (Masoumeh Roohaninasab et al., 2022) was performed on 14 articles on microneedling therapy for vitiligo. All 14 articles evaluated showed improvement of lesions after microneedling treatments proving that microneedling is a very safe and effective treatment for vitiligo. Furthermore, combining microneedling with other treatments like PRP and topical steroids, tacrolimus, 5-FU (a topical chemotherapy) topical calcipotriol or phototherapy of NB-UVB proved more effective than microneedling alone. More recently, exosomes are now being studied for their role in the treatment for vitiligo (Wong et al., 2020). The Med Spa at Clinical Edge leads in this technology with our SKINPEN Microneedling treatments that can be performed in combination with PRP or (plated)™ Exozomes!
So what are exosomes anyway?
Exosomes are best defined as extracellular vesicles that are released from cells in order to send messages for repair of damage. A greater understanding of the role of exosomes show a role in immune regulation, melanocyte–keratinocyte interactions, and melanogenesis. Exosomes provide a means of intercellular communication and of transmission of macromolecules between cells. Exosome therapies are now being explored in anti-cancer clinical trials and recent reports claim taxol-filled exosomes can be used to treat cancers in mice at 50-fold lower doses than conventional treatments, with the additional benefit that exosomes do not invoke an immune response themselves (Wong et al., 2020).
Exozomes, (plated)™ are new topical serums backed by the Mayo Clinic delivering a high concentration of platelet derived Renewosome™ technology. These topicals are sold at the Med Spa at Clinical Edge for topical use at home and/or during and after microneedling treatments. When applied topically at home as solo therapy they been proven to help improve the appearance of challenging skin issues, such as: redness, brown spots, and wrinkles. It will be exciting to see what this technology can do next in the areas of skin disorders including hair loss and vitiligo as research continues. See the results for yourself!
References
Chang, W., & Ko, C. (2023). The Role of Oxidative Stress in Vitiligo: An Update on Its Pathogenesis and Therapeutic Implications. Cells (Basel, Switzerland), 12(6), 936. https://10.3390/cells12060936
Dutta, R. R., Kumar, T., & Ingole, N. (2022). Diet and Vitiligo: The Story So Far. Curēus (Palo Alto, CA), 14(8), e28516. https://10.7759/cureus.28516
Edgar, J. R. (2016). Q&A: What are exosomes, exactly? BMC Biology, 14(1), 46. https://10.1186/s12915-016-0268-z
Frisoli, M. L., Essien, K., & Harris, J. E. (2020). Vitiligo: Mechanisms of Pathogenesis and Treatment. Annual Review of Immunology, 38(1), 621-648. https://10.1146/annurev-immunol-100919-023531
Jamgochian, M., Alamgir, M., & Rao, B. (2023). Diet in Dermatology: Review of Diet’s Influence on the Conditions of Rosacea, Hidradenitis Suppurativa, Herpes Labialis, and Vitiligo. SAGE Publications. https://10.1177/15598276211026592
JUHLIN, L., & OLSSON, M. J. (1997). Improvement of vitiligo after oral treatment with vitamin B12 and folic acid and the importance of sun exposure. Acta Dermato-Venereologica, 77(6), 460-462. https://www-ncbi-nlm-nih-gov.proxy.libraries.rutgers.edu/pubmed/9394983
Masoumeh Roohaninasab, Kimia Gandomkar, & Azadeh Goodarzi. (2022). Microneedling in vitiligo: A systematic review. Surgical & Cosmetic Dermatology, 14https://10.5935/scd1984-8773.20221400123
The Usefulness of Platelet-Rich Plasma (PRP) for the Treatment of Vitiligo: State of the Art and Review.
Wong, P. M., Yang, L., Yang, L., Wu, H., Li, W., Ma, X., Katayama, I., & Zhang, H. (2020). New insight into the role of exosomes in vitiligo. Autoimmunity Reviews, 19(11), 102664. https://10.1016/j.autrev.2020.102664
Zubair, R., & Hamzavi, I. H. (2020). Phototherapy for Vitiligo. Dermatologic Clinics, 38(1), 55-62. https://10.1016/j.det.2019.08.005
Amazing!!! Love exosomes--AND microneedling!!!