Chinese Meidicine Treatment for Vitiligo

Vitiligo is a skin condition characterized by white patches (hence, its alternative name, leukoderma; leuko = white; derma = skin). These skin patches are missing the skin pigment melanin; in most cases, the condition is triggered by sunburn. Normally, excessive sun exposure first causes skin reddening, followed by peeling of the outer skin layers, and formation of darker skin in the exposed area ("tanned" skin). However, in some cases, a reaction occurs in which the melanin production is blocked and the skin loses its color. The patches of white are usually at the site of the burn, but it is also possible for additional patches to begin appearing elsewhere. Genetic factors are believed to contribute to susceptibility to experiencing vitiligo, and the condition might be triggered by conditions other than sunburn, such as viral infections and physical trauma to the skin. The disorder appears to have an autoimmune characteristic, in which melanocytes (melanin producing cells) are attacked and destroyed. Vitiligo first appears by age 20, though it can begin later.

The primary treatment for vitiligo for the past several decades has been PUVA (psoralen and ultra-violet A). Psoralen is a chemical compound derived from herbs, especially from Psoralea cordyfolia, a Chinese herb that has been used for centuries to treat vitiligo. There is a broad group of related chemical components, called psoralens, which have the same basic action (see illustration below). Ultra-violet A is light in the UV spectrum that is one frequency range that causes sunburn (in fact, most lotions that block sun burn previously had been designed to block the more intensive UV-B light, but it was recently found that this is insufficient protection, so UV-A blocking is currently advertised for all new products). Psoralens are photo-activators: they make normal skin more susceptible to sunburn. Combining psoralens and sunlight would cause sunburn; in the therapeutic setting, the amount of psoralen and the amount of UV-A is carefully controlled to avoid sunburn and to attempt to rejuvenate affected malanocytes. In traditional practice, the amount of psoralen applied and the amount of UV exposure from sunlight was not controlled, and probably led to variable responses that could be minimized by carefully observing the effects each day.

PUVA therapy is not very satisfactory except for small patches; while some people respond well, the majority attain only partial pigmentation and are not happy with the results (1). The therapy is disruptive, in that it may need to be applied repeatedly (with individual office visits) for many weeks. Over-the-counter, self-applied psoralens have been developed as an alternative; while more convenient, this doesn't necessarily improve the outcomes. The PUVA method is most effective when vitiligo is limited to only one or two clearly defined patches, and less useful when there are multiple patches.

Chinese medicine has been applied to treating vitiligo, and many of the treatments involve combine topical and internal use of psoralea seed extract, rich in psoralens. As with PUVA, there is limited success by this method. However, herbal formulas aimed at treating autoimmune disorders and those aimed at systemic improvements (especially in the blood components) may have a better effect. Reports of successful treatment appear from time to time in the Chinese medical literature and some clinics advertise their treatments with before and after pictures of successful cases. Complex patent herbal medicines and topical applications for vitiligo-aside from psoralea extracts-have been produced by several factories. Some of the Chinese therapies offered are depicted in the following pages, based on their presentation via websites, with editing to improve their clarity. After the descriptions from five clinical sites (in no special order), a summary of the therapies and their effects is provided along with the descriptions found in Chinese medical texts.