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Folic Acid for Vitiligo
Folic acid is one of the B vitamins used in the treatment of vitiligo. Find out how folic acid stops depigmentation and stimulate increased production of melanin.
Folic acid refers to a group of water-soluble B vitamins also called vitamin B9, vitamin Bc and folate.
Folic acid, the form of the vitamin supplied in supplements, is actually biologically inactive but it is converted to the active forms of the vitamin in the liver.
Once converted to its active form, tetrahydrofolate, folic acid is used in a number of important biochemical reactions in the body. It is needed for the synthesis, repair and utilization of DNA. Therefore, it is essential for driving cell growth through rapid division. Folic is also required for the synthesis of some amino acids.
While the dietary sources of folic acid are diverse, the foods with high levels of the vitamin include leafy vegetables, legumes, yeast, egg yolk, liver, kidney and fortified grains and cereals.
Moderate levels of folic acid are also found in fruits of the citrus, beets, broccoli, corn and beer.
The best dietary sources of the vitamin are found in raw food. Cooking heat and ultraviolet irradiation destroys the natural form of folate found in foods. Also, since the vitamin is water-soluble it is easily leached into cooking fluids.
Folate is also easily destroyed by the acidic environment of the stomach as well as by oxidation. Therefore, the bioavailability of folic acid is reduced when taken on empty stomach.
The recommended daily intake values of folic acid for adults range from 400 – 600 micrograms per day and the upper limit is between 800 to 1000 micrograms per day.
Folic acid deficiency takes a while to develop. This is because the body normally retains a rich store of the vitamin.
However, vitamin B9 deficiency can be accelerated by some other factors including alcohol consumption.
When this deficiency occurs it can cause anemia, diarrhea, inflammation of the tongue, confusion and depression. The most damaging symptoms of folic acid deficiency are seen in fetuses (vitamin B9 deficiency can cause neural tube and brain defects in fetuses).
Folic acid deficiency is closely tied to vitamin B12 or cobalamin deficiency. Vitamin B12 deficiency may cause folate deficiency. However, vitamin B12 deficiency may go unresolved even with high levels of folic acid.
Because megaloblastic anemia is the chief symptom of both forms of deficiencies, large doses of folic acid may correct this anemia and mask vitamin B12 deficiency.
Therefore, although folic acid is safe even in very large doses (since it is a water-soluble vitamin, it is simply eliminated in urine), supplementation should be below the upper limit to prevent the silent worsening of any attendant vitamin B12 deficiency.
Vitiligo is a skin pigmentation disorder caused by the progressive destruction of melanocytes.
Melanocytes are the skin cells responsible for producing the skin pigment, melanin. When sunlight penetrates the skin, it activates the melanocytes and the production of melanin. Therefore, melanin protects the skin from damage from sunlight.
However, when the production of melanin falls off, the skin loses its color and turns white.
Vitiligo affects 1 – 2% of the population and it is usually first diagnosed between the ages of 20 and 40 although it has been known to affect children and the elderly. Vitiligo affects male and female equally. It is also affects people of all races although it is more noticeable in dark-skinned people.
There are a number of theories regarding what causes vitiligo.
Vitiligo first appears as white spots on the skin. While it mostly affects the face, hands and wrists, it can quickly spread to the trunk and lower parts of the body.
The white spots of vitiligo are also commonly seen around the orifices of the body including the mouth, nostrils, eyes, navel and genitals.
These spots can also affect the scalp, the inner ear, the choroid of the eyes and mucosal surfaces.
Each vitiligo spot is made up of at least 3 color zones. These include the white zone where most of the melanocytes are lost; the surrounding tan zone where the loss of melanocytes is in progress; and an outer ring of brown zone that forms a border with normal, pigmented skin.
When a vitiligo spot expands, it grows out from the center and changes in both size and shape. Multiple spots soon merge to form large white patches on the skin.
While camouflaging can help hide a few, localized white spots, treatment is required to repigment vitiligo spots.
One of the first studies to take the nutritional approach in understanding and treating vitiligo was done by L. F. Montes et al. and published in the journal, Cutis: Cutaneous Medicine for the Practitioner in 1992.
In that study, the levels of folic acid and vitamin B12 in a group of vitiligo patients and another group of normal patients were compared. The results showed that the levels of both vitamins were lower in the vitiligo group than the normal group.
A few of the vitiligo patients also had low levels of vitamin C.
The results showed improvements in the repigmentation of vitiligo spots with sustained supplementation with a combination of folic acid, vitamin B12 and vitamin C.
Another study published in Egyptian Dermatology Online Journal in 2012 confirmed the low levels of folic acid and vitamin B12 in vitiligo patients. It also showed that homocysteine levels were high.
A third study published in 1997 in the journal, Acta Dermato-Venereologica involved 100 vitiligo patients. The study took 2 years and involved the use of the combination of folic acid and vitamin B12 supplementation along with sun exposure.
The results of the study showed that further depigmentation stopped in 64% of the patients; clear repigmentation was observed in 52% and total repigmentation seen in 6% of the patients.
During the study, patients were asked to combine these nutritional supplements with sun exposure during the summer months and UVB lamps during the winter.
The results clearly showed that the combination of folic acid, vitamin B12 and UV exposure was more effective than each of the 3 treatment options for vitiligo.
The high homocysteine levels observed in vitiligo patients are caused by low levels of folic acid and vitamin B12. However, the oxidation of homocysteine produces some reactive oxygen species that build up in the skin and increases the oxidative stress placed on melanocytes.
The level of harmful free radicals rises along with that of homocysteine just as the level of folic acid falls.
This means that melanocytes are increasingly destroyed and melanin production is reduced. Therefore, folic acid supplementation can stop the depigmentation of the skin and even repigment vitiligo spots because it reduces oxidative stress and acts as an antioxidant.
Another mechanism by which folic acid works for vitiligo is through the supply of the needed cofactors required for melanin production. High homocysteine levels mean low methionine levels and methionine is needed for melanin production.
Tyrosine is another amino acid necessary for the synthesis of melanin.
The transfer of a hydroxyl group to tyrosine is a required step in the pathway of melanin production. However, tetrahydrobiopterine is needed as a cofactor for the reaction to proceed.
Humans do not make the pterine part of the molecule but get it from dietary folate or folic acid supplements.
Therefore, increasing the level of folic acid supplies the pterine group needed for the hydroxylation of tyrosine and the onward production of melanin.
In this role, folic acid is not the only B vitamins needed to reduce homocysteine levels. Vitamins B6 and B12 can also lower homocysteine levels and help treat vitiligo.
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