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  1. Vitiligo is a skin pigmentation disorder. It is the hypopigmentation of parts of the skin due to the destruction of melanocytes.

    Melanocytes are the specialised skin cells found at the bottom of the epidermis and responsible for producing the skin pigment, melanin. Melanocytes are activated when sunlight penetrates the skin. To protect the skin from damage, they secrete melanin which absorbs most of the harmful ultraviolet radiation in sunlight.

    However, if melanocytes are increasingly destroyed, the amount of melanin produced in the skin gets reduced dramatically. This causes a color change and white vitiligo spots appear on the skin.

    Vitiligo affects about 1% of the population. It is usually first diagnosed between the ages of 20 and 40.

    This skin disorder affects people of both sexes equally. It also affects people of all races although it is most visible in dark-skinned people due to the sharp contrast between those white spots and the normal, pigmented skin surrounding them.

    Although everyone agrees that it is the increased destruction of melanocytes that cause vitiligo, there are various theories regarding its cause. The most popular theories regarding the cause of vitiligo are listed in the table below.

    Causes of Vitiligo

    Autoimmune destruction of melanocytes
    Weakened or defective melanocytes
    Increased oxidative stress in the skin
    Nerve damage
    Toxic chemicals
    Vitiligo spots first appear on the face, hands and wrists. It is also commonly found around the various orifices of the body including the mouth, nostrils, navel, genitals and eyes.

    These spots may stay localised or soon spread to other parts of the body especially the trunk. When spots expand, they grow out from the centre and change size and shape. These spots can merge together to form large white patches all over the skin.

    Vitiligo can also affect the scalp, eyes, inner ears and choroid of the eyes.

    If there are only a few vitiligo spots and they do not expand to other areas of the skin, camouflaging with makeup and self-tanning lotions may be recommended. However, if the vitiligo is spreading, treatment may be required to stop further depigmentation and repigment the vitiligo lesions.

    Recently, vitiligo has been studied as the product of nutritional deficiencies. This approach is supported by the low levels of certain vitamins and minerals in vitiligo.

    When these nutrients are supplied through nutrients, it is possible to stop further skin depigmentation and help restore pigmentation to the white spots of vitiligo.

    What Studies Say About Vitiligo and Vitamin B12

    A study published in the journal, Clinical and Experimental Dermatology in January 2012 tested the relationship between vitamin B12, homocysteine levels and vitiligo depigmentation. This study confirmed the results of a number of similar studies that concluded that vitiligo patients do have higher homocysteine levels and lower vitamin B12 (and folic) levels.

    In this new study, 69 vitiligo patients and 52 control subjects were recruited.

    The vitiligo patients had higher levels of homocysteine and hemoglobin but the lower levels of vitamin B12, holotranscobalamine (a metabolite of vitamin B12) and folic acid.

    The study’s author concluded that low vitamin B12 levels and high homocysteine levels should be taken as risk factors for vitiligo. They also deduced that vitamin B12 deficiency and hyperhomocysteinemia shared common genetic roots.

    In another study published in Acta Dermato-Venereologica in 1997, vitamin B12 was tested as a vitiligo treatment.

    The 2-year study recruited 100 vitiligo patients who were given a course of vitamin B12 and folic acid combined with exposure to sunlight or UVB lamps.

    The results showed that 6 patients experienced total repigmentation; 52% of patients experienced some form of appreciable repigmentation and in 64% of patients, depigmentation of the skin was stopped.

    Another study published in the Egyptian Dermatology Online Journal in 2012 further confirmed the benefits of vitamin B12 supplementation in vitiligo patients. In that study, vitiligo patients had lower serum levels of folic acid and vitamin B12 but higher levels of homocysteine.

    How Vitamin B12 Works for Vitiligo

    Vitamin B12 deficiency leads to a disturbance in the oxidation-antioxidant system of the skin.

    When there is not enough vitamin B12, the conversion of homocysteine to methionine does not proceed. This leads to metabolic diseases arising from low levels of methionine but, just as importantly, it causes other conditions related to the buildup of homocysteine.

    The breakdown of homocysteine produces reactive oxygen species which are harmful free radicals that increase the oxidative stress on the skin. These free radicals overwhelm the antioxidants found in the skin and cause the destruction of melanocytes.

    By a similar mechanism, vitamin B12 deficiency may increase oxidative stress through folic acid deficiency.

    The folic acid ingested in humans is needed to supply the pterine group of tetrahydrobiopterine, an important cofactor in the production of melanin. However, when this cofactor is unavailable, there is an accumulation of a group of related compounds called pteridines.

    Oxidised pteridines are responsible for the distinctive yellow-green and bluish fluoresce of vitiligo skins under special lights. They also promote the release of hydrogen peroxide which breaks down the melanocytes.

    In summary, vitamin B12 is useful in the treatment of vitiligo because it reduces the oxidative stress on melanocytes. By its antioxidant protection, it increases the lifespan of melanocytes. As long as some melanocytes are still active, vitamin B12 can also stimulate the repigmentation of vitiligo spots.

    Different clinical trials have established that vitamin B12 supplementation works better for vitiligo when it is combined with folic acid (and some amount of UV exposure). Therefore, when looking for a vitiligo supplement to help treat the hypopigmentation disorder, you should get a supplement that includes both vitamins.

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