Oxidative stress in patients affected with vitiligo: Possible etiopathogenesis and therapeutical approach

We have recently shown that the epidermis of patients with active vitiligo (AVP) is affected with a strong oxidative stress, which is characterized by the deficiency of CoQ₁₀H₂, vit E, GSH, and CAT, and is probably induced by the hyperproduction of reactive oxygen species (ROS) and other toxic radicals, due to ischaemia - hypoxia - reoxygenation injury. Since it has been reported that the administration of antioxidants or radical scavengers produces protective effects against this type of injury, we have treated daily, both AVP (n = 41) and patients with stabilized vitiligo (SVP) (n = 21), either orally or topically for six months, with a pool of antioxidants. Before therapy, patients were advised to remove or to reduce considerably the psycho-physical precipitating causes of the disease, including long exposures to UV rays, which are capable of generating high levels of reactive oxygen species (ROS) and peroxidation of skin lipids. After six months of the combined therapy, we obtained a significant improvement of vitiligo in about 80% AVP: the progression of the disease stopped, and signs of repigmentation of the most recent lesions were observed, indicating a success against oxidative injury by ROS and other toxic radicals. The improvement was associated with: a)-decreased concentrations of urinary catecholamine metabolite; b)-increased plasma levels of lipophilic antioxidants such as CoQ₁₀H₂ and Vit E; c) increased levels of epidermal CoQ₁₀H₂, vit E and GSH capable of coping successfully with high rates of ROS and other radicals; d)-increased epidermal PL-PUFA levels. The correctness of our combined therapy is justified by the negativity of the Koebner reaction, that we have tried to trigger expressly on all the patients after one month of therapy. After six months, we recommended AVP going on with the antioxidant therapy with three month cycles at least two times a year in order to avoid possible relapses.