TCM for Vitiligo

Chinese Herbs to Alleviate Depigmentation of the Skin

By Adina Stanescu

Vitiligo is a condition characterized by patches of depigmented skin, made famous by Michael Jackson. In fact, vitiligo is more common in blacks and Asians (2-3% of the population), than whites (1-2%). The cause has not been firmly established although most specialists favour an autoimmune explanation, where antibodies begin to attack the body’s own melanocytes, the melanin pigment producing cells. Additionally there is a genetic component in 30% of cases. The peak incidence of vitiligo is between the ages of 10 and 30, and like many autoimmune conditions, it is more common in women. Surprisingly, perhaps, 50% of sufferers are children.

Whatever the cause, we can generalize about vitiligo’s basic tendencies and modes of expression. It tends to manifest in areas of maximum sun exposure, often after an intense period in the sun. The face, neck and backs of hands are typical in such cases. There is a large increase of incidence in war zones, giving support to extreme emotional stress as a co-factor or trigger in susceptible individuals. Once it begins, chances of spontaneous remission are remote, although intitial onset and advance of the patches may sometimes halt for many years.

Conventional medicine has largely unsatisfactory treatments for this difficult condition. Steroids are sometimes prescribed but may make it worse. If vitiligo is very widespread and the hope of improvement very small, modern medicine offers bleaching treatments that depigment the rest of the skin to make it all uniformly white. This seems to be the route that was taken in Michael Jackson’s case, and in fact for such patients it is a relatively good option.

Psoralen Ultraviolet A (PUVA) light therapy involves application of psoralens to the depigmented skin, followed by exposure to ultraviolet rays. Psoralens are chemicals found in many plants which make the skin more sensitive and responsive to the sun with the hope that this will stimulate melanin production to resume. As we will see, this therapy has some common ground with the treatments of TCM.

TRADITIONAL CHINESE MEDICINE

Traditional Chinese Medicine can offer a solid hope of improvement or cure to about 30% of vitiligo patients. This statistic shows what is already well known: vitiligo is not an easy thing to treat.   

Prompt treatment early in the course of the illness makes a world of difference to the chance for success. This is the case with all skin disease, and in fact with all conditions that have a tendency to become chronic: if one is able to intervene decisively before the symptoms are very entrenched and the body has adapted to having them, the problem can often be cured. It is for this reason that I wish dermatology patients would reverse the order of their therapy seeking — try TCM first, and modern medicine or other treatments second, if still required. It still amazes me to see how well a severe but recent case responds to herbs compared to a mild case of many years duration. Note that a skin condition may be considered “recent” for up to two to three years, in the context of its tendency to persist for decades.

HERBAL TREATMENT

This consists of two parts, topical and internal. Unlike many other skin problems that are treated largely from the inside, topical treatment is primary in vitiligo. TCM has used psoralen- containing herbs for this condition for thousands of years. An alcohol based tincture is painted on the depigmented patches and the skin is exposed to mild morning or afternoon sunlight in very small increments of three minutes. Great care must be taken to limit exposure due to the very real risk of burning due to the photosensitizing effect of the medicine, although this is also its beneficial therapeutic effect.

Internally, TCM considers hypo or hyper pigmentation diseases to be an expression of disharmony of qi and blood, leading over the years to a deficiency of liver and kidneys. In practice this means that recent cases are treated with herbs that assist qi (energy) and blood circulation, using medicinals such as angelica dang gui, curcuma yu jin with medicinals known to possess specific anti-vitiligo effect such as angelica bai zhi.
Longstanding cases will need kidney tonification with the well-known longevity root he shou wou, as well as astragalus huang qi, black sesame seed and others. In all cases medicines that “guide” the prescription to the affected part of the body are included.

PROGNOSIS

As we said, recent cases have the greatest hope of a cure, and improvement can be evident very quickly, within the first two to three weeks. This improvement begins as spotty repigmentation around the hair follicles, and if this is seen it is a very good sign. The face responds best to treatment, luckily, while the back of the hands are most stubborn.

In longstanding cases it may take up to eight weeks to see if the treatment is working, and consistency and diligence with internal and topical treatment are paramount.

Finally, while it is possible to predict to some degree, based on clinical features and duration of illness, who is likely to respond and who is not, ultimately “the proof is in the pudding.” The best thing is to try the therapy for a few weeks, preferably in summer, and see if it has worked.