Oral Silymarin Plus Hair Follicle Transplantation Efficacious in Refractory Vitiligo

Combination therapy including oral silymarin and hair follicle transplantation yielded a significant decrease in measurable vitiligo extent, according to a study published in the Journal of Cosmetic Dermatology.¹

Researchers also reported an increase in perifollicular repigmentation following combined treatment.

Image Credit: © DermNet

Background and Methods

In 2011, researchers explored the potential of silymarin, an immune-modulator with anti-oxidant properties derived from Silybum marianum (S. marianum). Silibinin, a major active component of silymarin, may enhance melanogenesis and stimulate melanocyte activity by affecting key transcription factors and promoting cell proliferation.²

Given its ability to counteract oxidative damage and modulate immune responses, silymarin could be a valuable addition to existing vitiligo treatments, researchers wrote. In order to test its efficacy, they conducted a retrospective, double-blind, randomized controlled trial at a single study site in Iran. The study involved 20 participants with refractory vitiligo.

Twelve patients were allocated to receive hair transplantation combined with silymarin, while 10 patients were allocated to receive hair transplantation with placebo. In total, 2 patients, both from the combination therapy group, were lost to follow-up.

The trial lasted for 3 months, during which participants' perifollicular pigmentation was assessed monthly.

Findings

Members of both treatment groups demonstrated a statistically significant increase in perifollicular repigmentation over the 3-month study period. Specifically, the silymarin plus transplantation group exhibited a more pronounced increase in pigmentation compared to the transplantation-only group. The statistical significance of these results was strong, with p-values less than 0.001 for the silymarin group and 0.029 for the transplantation-only group.

A month-by-month analysis revealed that the improvement in pigmentation was consistent across the study duration. The silymarin group showed significant differences from the transplantation-only group at the first, second, and third months.

The study also examined whether gender played a role in the outcomes. Among participants in the silymarin plus hair follicle transplantation group, males displayed higher average levels of repigmentation compared to females at each assessment point. Although these differences were not statistically significant, all patients exhibited significant improvement by the end of the 3-month period regardless of sex.

Regarding safety and adverse events, researchers reported 1 iisolated grafting complication, suggesting that while the intervention is largely safe, minor issues may arise.

Conclusions

"The current trial demonstrates the efficacy of adding oral silymarin to hair follicle transplantation in vitiligo-diagnosed participants," wrote Feily et al. Therefore, silymarin can be considered as a new therapeutic option for vitiligo."

Moving forward, study authors recommended further research into the efficacy of both silymarin and combination therapies for vitiligo, as the study may have been limited by its small sample size. Researchers called for larger studies involving topical formulations of S. marianum and the inclusion of dose assessments.

References

1. Feily A, Hosseinpour M, Samipour L, et al. Silymarin in combination with hair follicle transplantation as a potential treatment for refractory vitiligo: a double-blind randomized controlled trial. J Cosmet Dermatol. August 20, 2024. https://doi.org/10.1111/jocd.16525
2. Feily A, Namazi M. Silymarin as a potential novel addition to the limited anti-vitiligo weaponry: an untested hypothesis. Int J Clin Pharmacol Ther. 2011; 49(7): 467-468.