Aesthetic medicine blog

Learn about the 6 foods you can eat to improve your vitiligo according to scientific literature.

Vitiligo is a dermatosis that causes white spots on the skin as a result of the destruction of pigment-producing cells (melanocytes).

It affects approximately 1% of the population and even when it produces nothing more than spots on the skin, patients are affected by their image. The cause of vitiligo is not known, but it is known that patients with vitiligo suffer from oxidative stress on your skin that destroys melanocytes.

In this post, I review how some foods can help reduce that stress on the skin and help traditional treatments for vitiligo protect melanocytes. In other words, I am going to tell you several foods that you can eat to improve your vitiligo.

What is vitiligo and how is it treated?

Vitiligo is a dermatosis that affects approximately 1% of the population and produces white spots on the skin. The disfigurement caused by vitiligo affects the quality of life of patients.

The treatment of vitiligo requires the combination of topical treatments in the form of creams and phototherapy (light that imitates the sun on the skin) in more extensive cases to recolor (re-pigment) the spots.

In my experience as a dermatologist, vitiligo treatment is long, requiring a minimum of 6 to 12 months and a lot of patience. Vitiligo requires long-term treatment and is not always effective, so the doctor-patient relationship should be maintained as much as possible. It is essential that the patient feels comfortable and that we honestly explain the treatment and their expectations.

On the other hand, the melanocyte, like the patient, must also be treated with care. And when it appears, in other words, when the patient begins to re-pigment, it is essential that it does not disappear again. This is why, in my opinion, it is essential to promote an environment without oxidative stress in the skin appropriate for the melanocyte.

In more scientific terms, elevated markers of oxidative damage are found in the epidermis and blood of vitiligo patients, producing ROS (oxygen free radicals) and hydrogen peroxide (H2O2) (1). There are several studies that suggest that oxidative stress is crucial in the genesis of vitiligo, causing inflammation, autoimmunity and death of melanocytes in the skin (2).

Discover the 6 foods you can eat to improve your vitiligo

Immunonutrition attempts to modulate the immune system through the supply of nutrients. It is an emerging and promising discipline. Here you can visit the web portal of the International Society for Immunonutrition, ISIS (@ISImmunoNutr).

There are no studies or clinical trials in the reviewed literature that demonstrate how diet affects patients with vitiligo, thus, dietary recommendations are made approximately, looking for antioxidant and anti-inflammatory foods.

And what are the functional foods in vilitigo?

1. Green tea

It has been shown in in vitro (laboratory) and animal studies to protect melanocytes from oxidative stress (3).

2. Indian Gooseberry or Amla Fruit (Phyllanthus emblica)

A powerful oral antioxidant that also enhances the antioxidant action of vitamin C and E. In a group of patients with vitiligo treated with phototherapy, those who were super-supplemented with Amla and vitamins C, E and carotenes repigmented more and faster (4 ). Therefore, it is another of the foods that you can eat to improve your vitiligo.

3. Gingko Biloba

A classic. Its benefits as an antioxidant have been proven in various studies and it is one of the most studied medicinal herbs. In doses of 240 mg per day it is beneficial without producing side effects. In a 12-week clinical trial, Gingko biloba 60 mg daily in patients with vitiligo decreased the affected area (Vitiligo Area Score Index, VASI and European Vitiligo Task Force, VETF) (5).

4. Polypodium leucotomos

It is an extract from the fern grown in South America and is taken orally in doses of 250-720 mg per day. In Spain it is sold in pharmacies, patented under the name Fernblock. It has no side effects except for slight gastric discomfort. It has been shown in two clinical trials to increase repigmentation opportunities and repigmentation area by approximately 50% in vitiligo patients treated with phototherapy (6). As a dermatologist who is an expert in the treatment of vitiligo with phototherapy, I use it on all my patients.

5. Kelina (Ammi visnaga or biznaga extract)

It is an extract from an herb that grows wild in the Mediterranean. At a dose of 100 mg per day, it has been shown in two clinical trials combined with UVA, to increase the chances of repigmentation by approximately 50% on average. It can cause nausea and elevated transaminases (7). Additionally, 3% can be used as a topical cream combined with sun or UVA exposure, in a phototherapy modality called KUVA. As a vitiligo dermatologist, I use it on my vitiligo patients in the summer to avoid trips to the clinic for phototherapy.

6. turmeric or turmeric

Another classic to highlight among the foods you can eat to improve your vitiligo. It is capable of reducing the production of ROS in in vitro studies in the skin of patients with vitiligo. Its topical application combined with phototherapy appears to slightly increase the repigmentation rate of vitiligo spots.

Finally

In summary, functional nutrition along with an appropriate diet in vitiligo combined with medical treatments can be another option in the management of patients. Amla Fruit, Gingo Biloba, Kelina and Polypodium have been studied in patients with vitiligo improving the solution to phototherapy, and the latter is the most used in our country.

References

1. Mansuri MS, Jadeja S, Singh M, et al. Catalase gene promoter and untranslated region variants lead to altered gene expression and enzymatic activity in vitiligo. Br J Dermatol 2017; 177: 1590-1600.

2. Marie J, Kovacs D, Pain C. Inflammasome activation and progression of vitiligo/nonsegmental vitiligo. Br J Dermatol 2014; 170: 816-823.

3. Ning W, Wang S, Liu D et al. (2016). Potent effects of peracetylated-epigallocatechin-3-gallate against hydrogen peroxide-induced damage in human epidermal melanocytes through attenuation of oxidative stress and apoptosis. Experimental Clinical Dermatology2016; 41: 616–624.

4. Colucci R, Dragoni, F, Conti R, et al. Evaluation of an oral supplement containing Phyllanthus emblica fruit extracts, vitamin E and carotenoids in the treatment of vitiligo. Dermatological therapy 2015; 28:17-21.

5. Szczurko O, Shear N, Taddio A. et al. Ginkgo biloba for the treatment of vitiligo vulgaris: an open-label pilot clinical trial. BMC Complementary and Alternative Medicine 2011; eleven; twenty-one.

6. Middelkamp-Hup, MA, Bos, JD, Rius-Diaz, F., González, S. and Westerhof, W. (2007). Treatment of vitiligo vulgaris with narrow-band UVB and oral extract of Polypodium leucotomos: a randomized, double-blind, placebo-controlled study. Journal of the European Academy of Dermatology and Venereology, 21 (7), 942–950.

7. Hofer, A, Kerl H, Wolf P. Long-term results in the treatment of vitiligo with oral khellin plus UVA. European Journal of Dermatology 2001; eleven; 225-229.

8. Asawanonda, P, Klahan S. Tetrahydrocurcuminoid cream plus targeted narrow-band UVB phototherapy for vitiligo: a preliminary randomized controlled study. Photomedicine and Laser Surgery 2010; 28; 679-684.

Psoriasis is a very common dermatosis that affects the 2% of the general population with variable severity. Psoriasis is of multifactorial origin, in other words, caused by various factors that act on a genetic predisposition and cause skin inflammation.

Among the risk factors described there is accumulating evidence that nutrition plays a role. This post summarizes the scientific studies made public about nutritional and dietary strategies to improve psoriasis, the benefits of some dietary supplements and probiotics.

What is psoriasis and how is it treated?

The psoriasis It is a very common dermatosis which affects up to 2% of the population worldwide. Its treatment depends on the severity and includes topical treatments in the form of creams, systemic pills and phototherapy.

However, on repeated occasions the patient asks us what to eat, if there is any guideline in his diet to improve the psoriasis he suffers from.

On other occasions, the patient demands a more comprehensive approach, towards modern medicine, in which we treat their psoriasis in a more global way. The link between psoriasis and nutrition is widely studied in scientific literature; we can summarize it in three fundamental points: diet as a strategy, the use of nutritional supplements and probiotics.

Nutrition and diet strategies to improve psoriasis: What should I eat?

Little, undoubtedly. The obesity is a risk factor very important in psoriasis, and it is bidirectional, in other words, obesity worsens psoriasis and psoriasis promotes obesity (1). Obese patients have twice the risk of having psoriasis than those who are not obese.

Several lines of research suggest that adipocytes and their inflammatory molecules, adipokines, play a role in skin inflammation and in the hypothalamus, the main hunger regulatory center. Obesity releases a multitude of mediators into the blood that produce a situation inflammatory in the body. Leptin, a major intake-regulating hormone, is elevated in patients with psoriasis compared to healthy controls (2).

Obesity also has many implications for psoriasis treatments, as follows:

• When the patient loses weight, the response to treatments is better or they even stop needing them.
• Obesity increases the risk of side effects from systemic treatments (pills or injections).

The hypocaloric diet (800-1200 Kcal/day) combined with aerobic exercise at least 3 times a week for 30 minutes has been shown to improve psoriasis in a few weeks in many studies (3,4).

Components of the diet to improve psoriasis (3,5):

Diet rich in fish oils (omega-3 polyunsaturated fatty acids, PUFA), present in oily fish. They are the ones with the most evidence, due to their ability to reduce arachidonic acid and promote an anti-inflammatory environment.

Diet rich in monounsaturated fatty acids (MUFA) present in extra virgin olive oil, rich in oleic acid. Low MUFA intake worsens psoriasis and may cause it to progress. This study is in line with several others published about MUFAs and their anti-inflammatory capacity.

Regarding the type of global diet, Mediterranean diet takes the cake (3,4,5). We have plenty of scientific evidence that eating patterns rich in fruits, vegetables and fish are associated with a reduction in global markers of inflammation. In this situation it seems logical as it has been shown in numerous studies that the Mediterranean Diet improves psoriasis.

exist others publications that address different diet options to improve psoriasis, but with more limited scientific evidence, so their recommendation is not clear today (3):

• Gluten-free diet: it has been clearly shown to be beneficial in patients with celiac disease, also latent, and psoriasis (5).
• Vegetarian diet.
• Low carbohydrate diet.

Beneficial food supplements to treat psoriasis

Vitamin D. has been shown to have an anti-inflammatory role through the regulation of regulatory T lymphocytes. It should undoubtedly be supplemented in cases of deficiency since its deficiency can worsen psoriasis (3,4). However, its supplementation in patients with normal levels of vitamin D has not shown clear benefit (5,6). As a dermatologist who is an expert in psoriasis and phototherapy in Madrid, I do use it as a supplement in the patients I treat for psoriasis with phototherapy, due to its ability to protect the skin from the sun.

Fish oil and omega 3 supplements. They have been shown in numerous clinical trials to be beneficial in patients with psoriasis and other dermatoses (6). They must be maintained for long periods of up to 6 months to achieve effective benefit in psoriasis.

Supplements antioxidants In general, with vitamins (Vitamins A, E, C, folic acid, group B vitamins), trace elements such as Copper, Zinc, Iron, Magnesium and Selenium, coenzyme Q10 for its antioxidant capacity. They have demonstrated their positive effects in important studies (7,9).

• Zinc Supplements: Zinc is a trace element that is capable of regulating the immune response. The evidence of supplementing zinc in psoriasis is controversial, thus we find studies in which they have shown improvement and others have not (7,8).
• Selenium supplements: This is a trace element with antiproliferative capacity. Low selenium levels can worsen psoriasis (9).

Complementary medicinal plants or as an option to improve psoriasis

Medicinal plants are increasingly used and we have various studies and clinical trials published in quality scientific literature in which they demonstrate effectiveness in psoriasis. Such is the case of Dunaniella. bardawil, TwHF( Tripterigium wilfordii), Azadirachta indica (Neem tree) or Turmeric. Longa. However, at the current time we do not have guides for its use.

Polypodium Leucotomos

It is an extract of a fern (patented under the name of Fernblock) which has been shown to reduce the response of CD4 lymphocytes when taken orally. Studies of this compound were carried out in Spain years ago and demonstrated a mild to moderate benefit in half of the treated patients (10).

It is available sold in pharmacies and until a few years ago it was financed by the National Health System. We can say that it is the only plant available in Western medicine for the treatment of psoriasis.

This compound is also of special interest as an antioxidant and oral sunscreen.

Probiotics, prebiotics and synbiotics that help against psoriasis

Probiotics, prebiotics and synbiotics are other components to consider along with herbal remedies and dietary advice to improve psoriasis.

As a brief introduction, I will first break down what each of them is:

• Probiotic: a microorganism that, taken, produces health benefits.
• Prebiotic: a substance that is ingested promotes the growth of some bacteria in the colon that are beneficial for health
• Symbiotic: It is the mixture of the previous two

Bifidobacterium infantis

To date we only have one study of a probiotic in psoriasis: it is Bifidobacterium infantis 356624 (yes, probiotics have a serial number along with the name of the bacteria).

This bacteria was ingested for 8 weeks by psoriasis patients who were compared to psoriasis patients who did not take it. It was shown that it is capable of reducing the classic markers of inflammation in psoriasis such as TNF-alpha and the interleukin 6 or C-reactive protein; However, it did not translate into a clear benefit for skin lesions, so, even though it seems promising, B. infantis more studies are needed.

Conclusion

Psoriasis benefits from antioxidant rich diet (fruits, vegetables), fish, especially blue, and olive oil in a controlled calorie intake. Approximately, Mediterranean diet.

Furthermore we can add blue fish and antioxidant supplements diet to improve psoriasis. Supplementing with vitamin D or selenium makes sense in patients with a deficiency, since this situation can worsen psoriasis.

There is evidence of improvement in psoriasis with some oral plants (herbal medicine), but we currently have no guidelines for its use. The extract of Polypodium leucotomos It is safe orally and can improve in about half of patients. And at probiotics they have abandoned.

Bibliography

1. Carrascosa JM, Rocamora V, Fernandez-Torres RM et al. Obesity and psoriasis: inflammatory nature of obesity, link between psoriasis and obesity and therapeutic implications. Actas Dermosifiliofr 2014; 105: 31-44.

2. Zhu KJ, Zhang C, Li M. Leptin levels in patients with psoriasis: a meta-analysis. Clin Exp Dermatol 2014; 222: 113-127.

3. Barrea L, Nappi F, Di Somma C, et al. Environmental risk factors in psoriasis: the nutritionist's point of view. Int J Environ Res Public Health 2016; 13: 743-755.

4. Zuccotti E, Oliveri M, Girometa C, et al. Nutritional strategies for psoriasis: current scientific evidence in clinical trials. Eur Rev Med Pharmacol Sci 2018; 22: 8537-8551.

5. Ford A, Siegal M, Bagel J. A dietary recommendations for adults with psoriasis or psoriatic arthritis from the medical board of the national psoriasis foundation. JAMA Dermatol 2018; 154: 934-950.

6. Millsop JW, Bathia BK, Debbaneh M, et al. Diet and psoriasis, part III: role of nutritional supplements. J Am Acad Dermatol 2014; 71: 561-569.

7. Smith N, Weyman A, Tausk et al. Complementary and alternative medicine for psoriasis: a qualitative review of the clinical trial literature. J Am Acad Dermatol 2009; 61: 841-856.

8. Wacemicz M, Socha K, Soroczyska J, et al. Selenium, zinc, copeer concentration, Cu/Zn binding, total antioxidant status and serum c-reactive protein of psoriasis patients treated with narrowband ultraviolet B phototherapy: a case-control study. J Trace Elem Med Biol 2017; 44: 109-114.

9. Kharaeva Z, Giostova E, De Luca et al. Clinical and biochemical effects of supplementation with coenzyme Q10, vitamin E and selenium in patients with psoriasis. Nutrition 2009; 25: 295-302.

10. Padilla HC, Laínez H, Pacheco JA. A new agent (hydrophilic fraction of polypodium leucotomos) for the treatment of psoriasis. Int J Dermatol 1974; 13: 276-282.

11. Groeger D, O'Mahoni L, Murphy EF, et al. Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the intestine. Gut Microbes 2013; 4: 325-339.

Learn 10 of the main benefits of melatonin on the skin and its use in dermatology.

Melatonin is a hormone produced by the pineal gland whose secretion is influenced by the sleep-wake or light-dark cycle. Its main function in the body is to regulate sleep cycles.

The production of melatonin by the human body decreases with age. It is known that its supplementation has anti-aging effect, improving the quality of the skin and protecting it from ultraviolet radiation and other environmental damage such as tobacco.

What is melatonin?

Melatonin is a hormone produced by the pineal gland whose secretion follows a circadian rhythm, influenced by the cycles of light and darkness. It has a wide variety of properties at the cellular level including a high antioxidant power.

Like the entire body, the skin undergoes the oxidation and aging process, caused by internal and external factors, such as ultraviolet light or the production of free radicals. Melatonin levels increase at night and in mammals it has been shown to modulate immune response, body weight, anti-jet-lag effects, reduce the toxic effects of chemotherapy and be an anti-cancer agent.

The benefits of melatonin on the skin are varied. It has anti-aging effects and is a powerful antioxidant, useful as adjuvant in various dermatoses.

Melatonin in dermatology can be used as an oral supplement at bedtime or safely formulated into creams for topical use.

10 benefits of melatonin on the skin and main uses in dermatology

1. Anti-aging and anti-wrinkle.: Melatonin is a sunscreen and has an anti-wrinkle effect. Its main action focuses on the keratinocytes and fibroblasts of the skin, protecting them from damage from ultraviolet radiation. It has also been shown to reduce the production of free radicals in the skin (1,2).
2. Sun tanning: its intake before sun exposure reduces the risk of sunburn and its application in a 0.5% cream is the most powerful concentrate capable of removing the erythema or redness caused by a sunburn (ultraviolet light) (3).
3. Atopic dermatitis: Preliminary studies have shown the beneficial effects of melatonin in patients with atopic dermatitis, both in cream and supplemented form (4). Despite everything, it should not be routinely recommended in cases where the patient also has asthma, since it can increase bronchial reactivity (5).
4. Skin damage from radiotherapy (Radiodermatitis): Melatonin has been shown to have a radioprotective effect, reducing skin damage caused by radiotherapy and increasing its therapeutic effect. Treatment must be prolonged (6).
5. Spots on the skin (melasma, solar lentigines): melatonin is a promising and safe treatment to reduce skin imperfections. Its mechanism of action is based on the inhibition of the action of tyrosine oxidase on the skin, responsible for the appearance of spots or pigmentation (7).
6. Androgenic alopecia: It can be used topically or orally as a complementary treatment for androgenic alopecia and other forms of alopecia due to its powerful antioxidant action (8).
7. Squamous cell carcinomaRecent in vitro studies have found that melatonin induces squamous cell carcinoma cell death (9). Its use in this indication is not widespread, but it is in the context of being a powerful sunscreen that predisposes to the development of skin cancer, this being one of the main benefits of melatonin on the skin.
8. smoker's skin (skin and tobacco) and postmenopausal women: supplemented melatonin has anti-aging action in this group of patients, reducing wrinkles and imperfections and increasing skin elasticity. It is capable of reversing the changes of tobacco on the skin (10).
9. Vitiligo: in vitiligo we find a sensitivity of melanocytes to oxidative stress that leads to their destruction. Melatonin has a powerful antioxidant action on the skin and a protective role for the melanocyte, which is why it can be associated with other treatments (11).
10. Melanoma: Melatonin has action against cancer, so it can be beneficial as an adjuvant treatment in breast, liver, prostate or melanoma cancer.

Bibliography

1. Kleszczynski K, Fisher T. Melatonin and human skin aging. Dermatoendocrinol 2012; 4: 245-252.

2. D-Day, Burgees CM, Kircik LH. Evaluation of the potential role of topical melatonin in an anti-aging skin regimen. J Drugs Dermatol 2018; 17: 966-969.

3. Banha E, Elsner P, Kistler GS. Suppression of UV-induced erythema through topical treatment with melatonin (N-acetyl-5-methoxytryptamine). A dose response study. Arch Dermatol Res 1996; 288: 522–6.

4. Shi K, Lio PA. Alternative treatments for atopic dermatitis. Am J Dermatol 2018; E-publishing ahead of print.

5. Marseglia L, D'Angelo G, Manti T, et al. Melatonin and atopy: role in atopic dermatitis and asthma. Int J Mol Sci 2014: 15: 13482-13493.

6. Shabeed D, Najafi M, Musa AE, et al. Biochemical and histopathological evaluation of the radioprotective effects of melatonin against skin damage induced by gamma rays. Curr Radiopharm 2018; E-publishing ahead of print.

7. Juhasz MLV, Levin MK. The role of systemic treatments for skin lightening. J Cosmet Dermatol 2018; 17: 1144-1157.

8. Hatem S, Nasr M, Moftah NH, et al. Vitamin C-based melatonin nanovehicles for the treatment of androgenic alopecia. Eur J Pharm Sci 1028; 122: 246-253.

9. Kocyigit A, Guler EM, Karatas E, et al. Dose-dependent proliferative and cytotoxic effects of melatonin on human squamous cell carcinoma and normal skin fibroblast cells. Mutat Res 2018; epub before printing.

10. Sagan D, Stepniak J, Gesing A, et al. Melatonin reverses increased oxidative damage to membrane lipids and improves the biophysical characteristics of the skin in former smokers. Ann Agric Enviton Med 2017; 24: 659-666.

11. Patel S, Rauf A, Khan H et al. A holistic review on the autoimmune disease vitiligo with emphasis on causal factors. Biomed Pharmacother 2017; E-publishing ahead of print.

12. Srinivasan V, Pandi-Perumal SR, Brzezinski A, et al. Recent immune drug discovery by Pat Endocr Metab 2011; 5: 109-123.