A systematic review of natural health product treatment for vitiligo.
BACKGROUND
Vitiligo is a hypopigmentation disorder affecting 1 to 4% of the world population. Fifty percent of cases appear before the age of 20 years old, and the disfigurement results in psychiatric morbidity in 16 to 35% of those affected.


METHODS
Our objective was to complete a comprehensive, systematic review of the published scientific literature to identify natural health products (NHP) such as vitamins, herbs and other supplements that may have efficacy in the treatment of vitiligo. We searched eight databases including MEDLINE and EMBASE for vitiligo, leucoderma, and various NHP terms. Prospective controlled clinical human trials were identified and assessed for quality.


RESULTS
Fifteen clinical trials were identified, and organized into four categories based on the NHP used for treatment. 1) L-phenylalanine monotherapy was assessed in one trial, and as an adjuvant to phototherapy in three trials. All reported beneficial effects. 2) Three clinical trials utilized different traditional Chinese medicine products. Although each traditional Chinese medicine trial reported benefit in the active groups, the quality of the trials was poor. 3) Six trials investigated the use of plants in the treatment of vitiligo, four using plants as photosensitizing agents. The studies provide weak evidence that photosensitizing plants can be effective in conjunction with phototherapy, and moderate evidence that Ginkgo biloba monotherapy can be useful for vitiligo. 4) Two clinical trials investigated the use of vitamins in the therapy of vitiligo. One tested oral cobalamin with folic acid, and found no significant improvement over control. Another trial combined vitamin E with phototherapy and reported significantly better repigmentation over phototherapy only. It was not possible to pool the data from any studies for meta-analytic purposes due to the wide difference in outcome measures and poor quality ofreporting.


CONCLUSIONS
Reports investigating the efficacy of NHPs for vitiligo exist, but are of poor methodological quality and contain significant reporting flaws. L-phenylalanine used with phototherapy, and oral Ginkgo biloba as monotherapy show promise and warrant further investigation.
Szczurko
Orest
O
Leslie Dan Faculty of Pharmacy, University of Toronto, Canada. oszczurko@utoronto.ca
Boon
Heather S
HS
D003131:Combined Modality Therapy; D018849:Controlled Clinical Trials as Topic; D020441:Ginkgo biloba / Q000009:adverse effects; D006801:Humans; D008516:Medicine, Chinese Traditional; D010649:Phenylalanine / Q000627:therapeutic use*; D017319:Photosensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use*; D010789:Phototherapy / Q000009:adverse effects; D008517:Phytotherapy / Q000009:adverse effects; D028321:Plant Preparations / Q000627:therapeutic use*; D014815:Vitamins / Q000009:adverse effects / Q000627:therapeutic use*; D014820:Vitiligo / Q000628:therapy*
D017319:Photosensitizing Agents; D028321:Plant Preparations; D014815:Vitamins; D010649:Phenylalanine