Vitamin B12 and Folic Acid

It has been seen that there is decreased serum levels of vitamin B12 and folic acid in vitiligo [79, 80].

An association between vitiligo and pernicious anemia has also been noticed [81, 82]. This has led researchers to study the role of vitamin B12 and folic acid supplementation in the management of vitiligo.

Montes et al. reported that among 15 vitiligo patients, 73.3 % had folic acid deficiency, 33.3 % had vitamin B12 deficiency, and 26.6 %6 had vitamin C deficiency. On daily supplementation, repigmentation was seen in all patients and a halt in the progression of disease in 80-100 % patients, over a span of 2 years [83]. In a study by Juhlin and Olsson of 100 vitiligo patients on oral supplementation with vitamin B12 and folic acid along with phototherapy with either sunlight or UVB, repigmentation was seen in 52.2 % cases with halt in progression of vitiligo over a span of

3-6 months [84].

On the contrary, in a randomized clinical trial by Tjioe et al., no significant difference was seen in 27 vitiligo patients on supplementation with vitamin B12 and folic acid (oral cobalamin 1000 ug sustained release and folic acid 5 mg, twice daily) along with UVB phototherapy [85].

Homocysteine levels have been found to be elevated in vitiligo patients and cause direct damage of melanocytes by oxidative stress [80]. It is likely that vitamin B12 and folic acid act by decreasing homocysteine levels in vitiligo [86].

Since vitamin B12 and folic acid are water soluble vitamins, they can be supplemented in vitiligo patients at a low cost and negligible side effect profile. But nevertheless, data supporting its therapeutic effect is limited and the only randomized trial did not show any difference in clinical efficacy on supplementing vitamin B12 and folic acid.

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