Can essential oils be used in the treatment of vitiligo?

Vitiligo is a condition resulting from a malfunction of the immune system. The mechanism behind vitiligo corresponds to the loss of melanocytes, the epithelial cells whose main function is the synthesis of melanin, responsible for skin pigmentation and its protection against UV rays. In vitiligo, cytotoxic T lymphocytes attack the melanocytes, leading to their destruction and the depigmentation of the skin. IFN-γ and TNF-α are two major pro-inflammatory cytokines involved in vitiligo. IFN-γ attracts and activates cytotoxic T lymphocytes, which target melanocytes. TNF-α, on the other hand, reinforces this inflammatory response by promoting the apoptosis of melanocytes and disrupting their environment.

Although there are very few studies regarding the use of essential oils in the management of vitiligo and their effectiveness, some sources suggest that essential oils with antioxidant properties could slow the progression of vitiligo or strengthen the skin's immune system.

Essential oils are complex mixtures extracted from various parts of plants through steam distillation or using specific solvents. Essential oils are known to boost the immune system. Some can stimulate the proliferation of immune-competent cells, including polymorphonuclear leukocytes, macrophages, dendritic cells, natural killer cells, and B and T lymphocytes. For instance, constituents of essential oils produced by eucalyptus stimulate phagocytosis by macrophages, while the essential oil of Nigella sativa halts the proliferation of CD4+ and CD8+ lymphocytes in vitro. According to some studies, essential oils may exhibit immunomodulatory properties similar to, or even superior to, those of conventional medicines.

• Bergamot oil, when combined with UVB phototherapy, appears to be effective in reducing the effects of vitiligo.

  Photodynamic therapy is commonly used to treat vitiligo. The principle of this technique is based on the activation of photosensitisers by a specific light source, producing reactive oxygen species that destroy the cells responsible for vitiligo. Bergamot oil is used in this type of therapy as it contains psoralen, a photosensitiser. However, bergamot essential oil, like essential oils in general, struggles to penetrate the skin barrier. To enhance its penetration, a nanocarrier is incorporated to help cross the skin barrier by providing flexibility to the lipid bilayers. Twenty-three patients with vitiligo were divided into two groups. Each group received a different treatment: one was exposed to a wavelength of 311 nm (group A), and the other was exposed to the same wavelength after receiving a topical application of a combination of nanocarrier and bergamot essential oil at a concentration of 6.9%.

  The findings demonstrated that patients treated with the combination of bergamot essential oil and the nano-carrier achieved better results than those who received phototherapy alone. Indeed, over 40% of patients in group B reported good repigmentation of affected areas (between 51 and 75%), over 50% observed moderate repigmentation (between 26 and 50%), and 10% noted excellent repigmentation (between 76 and 100%). In comparison, in group A, the majority of patients only showed grade 1 repigmentation (between 1 and 25%). These results suggest a clear improvement in the repigmentation of areas affected by vitiligo through the use of bergamot essential oil. However, the limited number of participants does not allow for a definitive confirmation of this hypothesis.

• The oil of Nigella sativa to reduce vitiligo lesions.

  Another study was conducted to compare the effectiveness of Nigella sativa oil and fish oil on vitiligo lesions. This study included 52 patients with vitiligo, divided into two equal groups. The first group applied Nigella oil topically twice a day on the lesions. The second group similarly applied fish oil. Both these oils have properties that seem beneficial in the treatment of vitiligo. Indeed, Nigella oil is known for its anti-inflammatory, antioxidant, and immunomodulatory properties, while fish oil is rich in omega-3 and also has anti-inflammatory properties. The results of the study showed that Nigella sativa oil was more effective on the lesions of patients with vitiligo than fish oil. Indeed, the results of the Vitiligo Area Scoring Index indicate that the average score went from 4.98 to 3.75 in patients who applied Nigella sativa oil, compared to 4.98 to 4.62 in those who used fish oil. However, these results should be interpreted with caution, as the number of patients included is not sufficient to conclude a significant benefit.

Further studies are still required, but essential oils appear to be a promising supplement to traditional treatments in the event of vitiligo.

• DISALA J.C. & al. Studies on the composition and standardization of "Bakuchi oil", an ayurvedic medicinal oil prepared from Psoralea corylifolia L. used in the treatment of vitiligo. International Journal Of Research in Ayurveda and Pharmacy (2012).

• ROKHAFROOZ D. & al. Comparing Nigella sativa Oil and Fish Oil in Treatment of Vitiligo. Iranian Red Crescent Medical Journal (2014).

• OTUKI M.F. & al. Pre-clinical evidences of Pyrostegia venusta in the treatment of vitiligo. Journal of Ethnopharmacology (2015).

• SAMMOUR O. & al. Novel bergamot oil nanospanlastics combined with PUVB therapy as a clinically translatable approach for vitiligo treatment. Drug Delivery and Translational (2019)

• SAMMOUR O. & al. Bergamot oil as an integral component of nanostructured lipid carriers and a photosensitizer for photodynamic treatment of vitiligo: Characterization and clinical experimentation. Expert Opinion in Drug Delivery (2020).