It sounds too good to be true: You take a daily nutritional supplement and your pigment spots disappear like snow in the sun. We know that diet can have positive or negative influences on a number of skin conditions such as eczema, acne and premature skin aging. A ‘bad’ diet can make the skin deteriorate and the other way around healthy eating can improve the skin.
But can supplements cause pigment reduction? I have also asked myself this question. What does science say about this?
Blemishes, or hyperpigmentation, is usually a harmless condition where patches of skin are darker in color than the normal surrounding skin. Hyperpigmentation is caused in the skin by an overproduction of pigment known as melanin. There are 2 types of melanin: eumelanin and pheomelanin. Eumelanin is brown-black and it protects us against ultraviolet light (photo-protective). Pheomelanin is yellow-red, photo-reactive and does not protect against ultraviolet radiation.
Pheomelanin is yellow-red and does not protect against UV radiation. Eumelanin is brown-black (brown tint) and protects against UV radiation.
Although almost everyone has the same number of pigment cells (melanocytes), the amount and size of pigment cells (melanosomes) and melanin particles differ greatly, resulting in different skin colors. Fair-skinned people, skin types 1 and 2, produce more pheomelanin and burn faster in the sun. Dark skin types 3-6 have mainly eumelanin and are more resistant to the sun.
| Skintype | Feature | Skin burn | Risk of skin cancer |
| 1 | Light eyes, red hair, freckles | Always | Biggest risk |
| 2 | Light skin and eyes, blond hair | Fast | High risk |
| 3 | Light skin, dark eyes | Seldom | High risk |
| 4 | Dark skin, dark eyes and dark hair (Mediterranean) | Almost never, tans very well | Moderate risk |
| 5 | Dark toned skin (Asian) | Very resistant to sun | Occurs infrequently, but high risk of vitamin D deficiency |
| 6 | Very dark skin (Negroid) | Very resistant to sun | Occurs infrequently, but high risk of vitamin D deficiency |
One pigment spot is not the other. Dermatologists distinguish pigment spots in primary and secondary causes. Simply put, there are 2 pigmentation groups: a primary congenital cause, and a secondary acquired explanation. ‘Acquired’ means: pigment spots have arisen after a skin condition such as acne, eczema, psoriasis or sunburn. Secondary can also result from prolonged zone exposure and tanning bed use. One example is lentigo solaris, or “age spots. Secondary pigment spots can also occur as a result of medication such as contraception, certain antibiotics (minocin) or heart medication (amiodarone). The cause, primary or secondary. determines the success of the treatment. Read more about the different forms of pigmentation.
Most scientific studies focus on skin whitening effects of skin care creams, laser and peeling treatments to remove pigment. On the other hand, there are a number of supplements containing natural extracts and vitamins, often promoted by supplement manufacturers for the treatment of dark spots. I was particularly curious about the evidence of these manufacturers’ claims.
Vitamin B12 deficiency can cause hyperpigmentation, especially on the hands and feet. This is rare, but most common among vegans or strict vegetarians. Hyperpigmentation usually disappears after taking vitamin B12 supplements. Improvement may be noticed within two weeks, but in some cases 6 to 12 weeks of treatment may be required.
Folic acid deficiency is usually caused by chemotherapy or methotrexate use, but can also be caused by pregnancy and birth control pills. Hyperpigmentation on the palms, soles and tongue has been described as a result of folic acid deficiency during pregnancy.
Generalized hyperpigmentation has been described in patients with acute leukemia receiving folic acid antagonists, while another case of folic acid deficiency has been reported in malnourished alcoholics.
Folic acid occurs naturally in healthy foods. Avocado, spinach, liver, asparagus and Brussels sprouts, among others, are among the foods with the highest levels of folic acid. Effective treatment requires a diet high in folic acid or vitamin supplements.
Vitamin A deficiency can cause hyperpigmentation of the skin, also called phrynoderma. It is caused by a combination of insufficient dietary intake of vitamin A and/or β-carotene. In particular, consider people who are on a strict weight loss program or have undergone stomach or intestinal surgery.
The main sources of vitamin A are liver, eggs and butter. Beta-carotene is found in green leaves and most orange and yellow fruits, as well as vegetables such as carrots, yellow bell peppers, watermelon, papaya, and tomatoes. Beta-carotene is converted into vitamin A after absorption.
Glutathione is thought to inhibit pigment on several mechanisms. It inhibits the production of pigment in the melanocytes (pigment cells), and the strong antioxidant effect of glutathione also has an inhibiting effect on pigment production.
In a 2012 randomized placebo-controlled study of 60 volunteers, the volunteers received orally administered glutathione at a dose of 500 mg per day for 4 weeks. It resulted in a lighter skin color of the face and forearms. In itself, glutathione as a supplement is safe, but more research is needed regarding the long-term effects.
In terms of diet, fruits, vegetables and meat are sources of natural glutathione.
Cysteine is a semi-essential amino acid, meaning the human body can make it itself. It is an important building block of gluthation. Cysteine occurs in protein-rich foods such as yogurt, meat, but also onions, broccoli, oats, bell peppers and egg yolk.
Cysteine is involved in pheomelanogenesis. At a high concentration there is a shift to pheomelanin (yellow-red, non-UV protective pigment) instead of eumelanin (brown-black pigment, UV-protective pigment). This has been demonstrated in animal experimental studies and tissue cultures. How high the dosage should be for humans is not known.
Tranexamic acid is a synthetic form of the amino acid “lysine. It is a medicine commonly used to prevent bleeding from trauma, surgery, childbirth, heavy periods, and nosebleeds. An off-label use of tranexamine is the treatment of melasma. However, this is under strict medical supervision and with blood tests.
Treatment of melasma with oral tranexamic acid has been described in studies. In one study, a dose of 250 mg twice daily for 6 months resulted in excellent or good improvement in 65% of patients. The use of tranexamic acid to lighten dark spots on the skin carries a potential risk of thrombosis. During tranexamine treatment, it is advised to stop contraception.
The consumption of coffee, which contains high concentrations of antioxidant polyphenols, showed a significant decrease in the pigment spot score in a Japanese study. Other foods rich in polyphenols include oolong tea, green tea, tomatoes, dark chocolate, cloves, peppermint and oregano.
In an animal experimental study on guinea pigs, the effect of vitamin C, L-cysteine and vitamin E was examined. A piece of fur had been shaved away and shone with UV light. The researchers concluded that the skin pigment generated by artificial ultraviolet B light was the least pronounced in the vitamin C, E and L-cysteine supplementation group.
To some extent, diet and supplements can help reduce annoying dark spots on the body. Of course, it is also important to protect the skin from the sun, combined with the right treatment and skin care ingredients. If we may conclude what is most successful, it is reducing pigment spots through nutritional supplements.
If you are deficient in certain nutrients, additional supplements or ‘healthy and varied’ food have the best effect on reducing / preventing pigment spots.
Side note from Dr. Francis Wu: I regularly see melasma due to the use of oral contraceptives. A 2013 study described vitamin and mineral deficiencies due to oral contraceptive use. The deficiencies are B2, B6, B12, C, E, folic acid, magnesium, selenium and zinc. A deficiency of vitamins B12, C, E and folic acid can contribute to pigment spots. Think of the vitamin deficiencies as a drop in a melasma bucket, the drop size can vary. And if your melasma bucket is small and there are many and large drops (vitamin deficiencies due to one-sided diet, unprotected sunbathing, tanning beds, contraception), the bucket will overflow faster and you will have melasma complaints.
If you have spots without deficiencies, oral tranexamic acid intake is possible, but under the supervision of an experienced doctor. If you don’t feel like a hassle, glutathione supplements for 4 weeks can still be worth a try, combined with coffee or tea and dark chocolate. How beautiful can it be, life is good.
Rao VR. Vitamin B12 deficiency presenting with hyperpigmentation and pancytopenia. J Family Med Prim Care. 2018;7(3):642-644.
Downham TF, Rehbein HM, Taylor KE. Hyperpigmentation and Folate Deficiency. Arch Dermatol. 1976;112(4):562.
Bleasel NR, Stapleton KM, Lee MS, Sullivan J. Vitamin A deficiency phrynoderma: due to malabsorption and inadequate diet. J Am Acad Dermatol. 1999 Aug;41(2 Pt 2):322-4.
Villarama CD, Maibach HI. Glutathione as a depigmenting agent: an overview. Int J Cosmet Sci. 2005 Jun;27(3):147–53.
Arjinpathana N, Asawanonda P. Glutathione as an oral whitening agent: A randomized, double-blind, placebo-controlled study. J Dermatol Treat. 2012;23(2):97–102.
Wu S, Shi H, Wu H, Yan S, Guo J, Sun Y, et al. Treatment of Melasma With Oral Administration of Tranexamic Acid. Aesthetic Plast Surg. 2012 May 3;36(4):964–70.
Fukushima Y, Takahashi Y, Hori Y, Kishimoto Y, Shiga K, Tanaka Y, et al. Skin photoprotection and consumption of coffee and polyphenols in healthy middle-aged Japanese females. Int J Dermatol. 2015 Apr;54(4):410–8.
Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci. 2013 Jul;17(13):1804-13
If you prefer not to swallow pills then Targeted Pigment serum is an option. It contains high and low molecular hyaluronic acid for better absorption into the epidermis. It helps pigment reduction through a triple effect, reduction of pigment production, transfer of pigment to your skin cells and gives a light exfoliation. The active ingredients are: Malic Acid, Arbutin and Niacinamide. More about Targeted Pigment serum
If you suffer from sensitive skin and pigment spots, Iconic Elements Spotreducer is another option. Contains 5% Niacinamide and Ectoin. This unique combination provides better skin hydration and pigmentation reduction. More about Spotreducer
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