What is the role of Ginkgo biloba in treating vitiligo?

Ginkgo Biloba for Vitiligo Treatment

Ginkgo biloba extract appears to be a simple, safe, and fairly effective therapy for arresting the progression of vitiligo, with some evidence supporting its role in promoting repigmentation, particularly in limited and slow-spreading forms of the disease. 1

Mechanism of Action

Ginkgo biloba works in vitiligo treatment through:

• Antioxidant properties that combat oxidative stress, a key factor in vitiligo pathogenesis 2, 1
• Immunomodulatory effects that may help regulate autoimmune responses involved in melanocyte destruction 1
• Ability to arrest active progression of depigmentation, which is as important as inducing repigmentation 1

Evidence for Effectiveness

The British Journal of Dermatology guideline identifies Ginkgo biloba as the only satisfactory RCT of any systemic treatment for vitiligo, noting its antioxidant and immunomodulatory properties 2. Key findings include:

• In a double-blind placebo-controlled trial, Ginkgo biloba extract demonstrated statistically significant cessation of active progression of depigmentation (p=0.006) 1
• Marked to complete repigmentation was observed in 10 patients treated with Ginkgo biloba compared to only 2 patients in the placebo group 1
• A standard dosage of 40 mg three times daily was well-tolerated with no significant adverse effects 1

A subsequent open-label pilot trial using 60 mg of standardized Ginkgo biloba twice daily for 12 weeks found:

• Improvement in total Vitiligo Area Scoring Index (VASI) by 0.5 (p=0.021) 3
• Cessation of vitiligo progression in all participants 3
• Average repigmentation of vitiligo lesions of approximately 15% 3
• Significant improvement in Vitiligo European Task Force (VETF) spreading score (p<0.001) 3
• No statistically significant changes in coagulation factors (platelets, PTT, INR) 3

Treatment Algorithm

1. Patient Selection:

   • Best for patients with limited and slow-spreading vitiligo 1
   • Particularly effective for arresting disease progression 1, 3
   • Can be used as monotherapy or in combination with other traditional therapies 4

2. Dosage and Administration:

   • Standard dosage: 40 mg three times daily 1 or 60 mg twice daily 3
   • Treatment duration: Minimum 12 weeks to assess initial response 3
   • Monitor for treatment response using validated measures like VASI or VETF 3

3. Monitoring and Follow-up:

   • Assess for cessation of disease progression and repigmentation at 2-3 month intervals 5
   • Use serial photographs to document changes 5
   • Continue treatment if positive response is observed

Advantages Over Other Treatments

• Oral Ginkgo biloba is less invasive than phototherapy options like NB-UVB or PUVA 2, 5
• Avoids the skin atrophy risk associated with potent topical corticosteroids 5
• Does not have the treatment limit concerns of NB-UVB (200 treatments maximum) or PUVA (150 treatments maximum) 5
• Well-tolerated with minimal side effects 1

Limitations and Considerations

• Repigmentation may be modest (around 15%) compared to other treatments 3
• More effective for arresting progression than inducing complete repigmentation 1
• May work better when combined with phototherapy for enhanced repigmentation 4
• Most studies have focused on limited or slow-spreading vitiligo rather than extensive disease 1

Conclusion

Ginkgo biloba represents a valuable option in the vitiligo treatment armamentarium, particularly for arresting disease progression in limited, slowly spreading vitiligo. Its favorable safety profile and oral administration make it an attractive option, especially for patients who cannot tolerate or do not respond to topical therapies or phototherapy. While it may not produce complete repigmentation in all cases, its ability to halt disease progression addresses a critical aspect of vitiligo management.