Does Diet Affect Vitiligo?
The Role of Diet in Vitiligo
Vitiligo is a progressive disorder of skin pigmentation which commonly presents as development of well defined white patches on which the skin color is completely gone. It is estimated that vitiligo affects up to 2% of the world’s population, and can affect people of all ages, but commonly develops before age 20. In this disease, skin cells called melanocytes that produce melanin (or pigment) are destroyed, leading to the loss of skin color. The exact cause of vitiligo is unknown, but multiple components are believed to play a role, including immune system dysfunction and oxidative stress. There is evidence that damaging reactive oxygen species may trigger destruction of melanocytes in people who are genetically susceptible. This has led scientists to investigate how diet, supplements, and other lifestyle factors play a role in sparking the cycle of damage in vitiligo.
Does Gluten Make Vitiligo Worse?
There is an increased risk for a wide range of autoimmune diseases in people with vitiligo, including thyroid disease and diabetes. There has been controversy on whether or not there is an association between celiac disease and vitiligo. Several reports have described patients with both vitiligo and celiac disease, supporting a possible association.[3,4] Investigators have even described improvement in symptoms when people who were positive for celiac autoantibodies removed gluten from their diets. However, these are only preliminary results, and more scientific studies are needed to know whether foods containing gluten worsen vitiligo.
Could Beta-Carotene Foods be an Option?
Beta-carotene, part of a group of compounds called carotenoids, is found abundantly in many bright orange and yellow fruits and vegetables, and is converted to vitamin A within the body. Carotenoids are powerful antioxidants, which fight against damaging free radicals within the body and in the skin. In one study, patients with vitiligo were treated with conventional standard of care including topical medications and phototherapy, but only half of the subjects received an antioxidant supplement containing carotenoids, vitamin E, and the herb Amla (also known as Indian Gooseberry), for 6 months. The patients who received the antioxidant supplement had significantly greater return of skin color compared to the patients who did not receive the supplement. Although this study does not prove that carotenoids and foods rich in beta-carotene improve vitiligo, it may be beneficial to add more of these foods into your diet. Foods rich in beta-carotene include: carrot juice, pumpkin, spinach, sweet potato, kale, cantaloupe, and many more.
Vitamins B, C, and E
Several studies have looked at how vitamin supplementation might improve vitiligo.
In one study, patients received vitamin B12 and folic acid supplements and had significant return in skin color after 3 months. Foods rich in vitamin B12 include animal proteins such as meat, dairy, eggs, and fish. Dark leafy green vegetables legumes are fantastic sources of folate.
Vitamin C, abundant in citrus fruits and green vegetables, is a strong antioxidant with controversy of whether or not to use it in vitiligo. Some suggest that people with vitiligo should not consume vitamin C, because it may lighten the skin further. However, other researchers have concluded that its strong antioxidant benefits outweigh the risk of skin lightening.
Vitamin E is also a vitamin with potent antioxidant activity, and people with vitiligo have been shown to have lower blood levels of vitamin E than people without vitiligo. Several studies have shown that supplementation with vitamin E alone or along with light treatment significantly increased the rate of repigmentation and protected against sun damage.[11-13] Increasing intake of foods such as sunflower seeds, avocado, almonds, and spinach may raise levels of vitamin E in the blood.
Metabolic Syndrome and Vitiligo
Researchers have found that people with vitiligo are at increased risk for a cluster of conditions called metabolic syndrome, which consists of high blood pressure, high blood sugar and cholesterol, and excess fat around the waistline.[14,15] This is important, because metabolic syndrome is associated with increased risk for heart disease, diabetes, and stroke. While the exact link in how vitiligo and metabolic syndrome are connected is still under research, healthier dietary choices and body weight management may become important factors as we learn more in the future.
There is strong evidence that diet plays an important role in several diseases, including acne, hidradenitis suppurativa, rosacea, and even eczema.[16-18] However, we still do not fully understand how diet may influence vitiligo. There is currently only a small amount of evidence suggesting that gluten may play a role in some people. In addition, those with vitiligo may be at higher risk for developing metabolic syndrome, an important relationship that needs further investigation.
- Passeron T, Ortonne JP. Physiopathology and genetics of vitiligo. J Autoimmun.2005;25 Suppl:63-68; PMID: 16298511 https://www.ncbi.nlm.nih.gov/pubmed/16298511.
- Grimes PE, Nashawati R. The Role of Diet and Supplements in Vitiligo Management. Dermatol Clin.2017;35(2):235-243; PMID: 28317532 https://www.ncbi.nlm.nih.gov/pubmed/28317532.
- Reunala T, Collin P. Diseases associated with dermatitis herpetiformis. Br J Dermatol.1997;136(3):315-318; PMID: 9115907 https://www.ncbi.nlm.nih.gov/pubmed/9115907.
- Shahmoradi Z, Najafian J, Naeini FF, et al. Vitiligo and autoantibodies of celiac disease. Int J Prev Med.2013;4(2):200-203; PMID: 23543680 https://www.ncbi.nlm.nih.gov/pubmed/23543680.
- Donaldson MR, Book LS, Leiferman KM, et al. Strongly positive tissue transglutaminase antibodies are associated with Marsh 3 histopathology in adult and pediatric celiac disease. J Clin Gastroenterol.2008;42(3):256-260; PMID: 18223500 https://www.ncbi.nlm.nih.gov/pubmed/18223500.
- Igielska-Kalwat J, Goscianska J, Nowak I. [Carotenoids as natural antioxidants]. Postepy Hig Med Dosw (Online).2015;69:418-428; PMID: 25897101 https://www.ncbi.nlm.nih.gov/pubmed/25897101.
- Colucci R, Dragoni F, Conti R, et al. Evaluation of an oral supplement containing Phyllanthus emblica fruit extracts, vitamin E, and carotenoids in vitiligo treatment. Dermatol Ther.2015;28(1):17-21; PMID: 25285994 https://www.ncbi.nlm.nih.gov/pubmed/25285994.
- Juhlin L, Olsson MJ. Improvement of vitiligo after oral treatment with vitamin B12 and folic acid and the importance of sun exposure. Acta Derm Venereol.1997;77(6):460-462; PMID: 9394983 https://www.ncbi.nlm.nih.gov/pubmed/9394983.
- Yoon J, Kim TH, Sun YW. Complementary and alternative medicine for vitiligo. In: KK P, JE M, eds. Vitiligo: management and therapy: INTECK; 2011.
- Ramadan R, Tawdy A, Abdel Hay R, et al. The antioxidant role of paraoxonase 1 and vitamin E in three autoimmune diseases. Skin Pharmacol Physiol.2013;26(1):2-7; PMID: 22986950 https://www.ncbi.nlm.nih.gov/pubmed/22986950.
- Elgoweini M, Nour El Din N. Response of vitiligo to narrowband ultraviolet B and oral antioxidants. J Clin Pharmacol.2009;49(7):852-855; PMID: 19553407 https://www.ncbi.nlm.nih.gov/pubmed/19553407.
- Akyol M, Celik VK, Ozcelik S, et al. The effects of vitamin E on the skin lipid peroxidation and the clinical improvement in vitiligo patients treated with PUVA. Eur J Dermatol.2002;12(1):24-26; PMID: 11809591 https://www.ncbi.nlm.nih.gov/pubmed/11809591.
- Dell'Anna ML, Mastrofrancesco A, Sala R, et al. Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial. Clin Exp Dermatol.2007;32(6):631-636; PMID: 17953631 https://www.ncbi.nlm.nih.gov/pubmed/17953631.
- Atas H, Gonul M. Increased Risk of Metabolic Syndrome in Patients with Vitiligo. Balkan Med J.2017;34(3):219-225; PMID: 28443562 https://www.ncbi.nlm.nih.gov/pubmed/28443562.
- Pietrzak A, Bartosinska J, Hercogova J, et al. Metabolic syndrome in vitiligo. Dermatol Ther.2012;25 Suppl 1:S41-43; PMID: 23237037 https://www.ncbi.nlm.nih.gov/pubmed/23237037.
- Fiedler F, Stangl GI, Fiedler E, et al. Acne and Nutrition: A Systematic Review. Acta Derm Venereol.2017;97(1):7-9; PMID: 27136757 https://www.ncbi.nlm.nih.gov/pubmed/27136757.
- McCusker M, Sidbury R. Nutrition and skin: Kids are not just little people. Clin Dermatol.2016;34(6):698-709; PMID: 27968929 https://www.ncbi.nlm.nih.gov/pubmed/27968929.
- Danby FW. Diet in the prevention of hidradenitis suppurativa (acne inversa). J Am Acad Dermatol.2015;73(5 Suppl 1):S52-54; PMID: 26470617 https://www.ncbi.nlm.nih.gov/pubmed/26470617.