A role for probiotics in the management of vitiligo?

Probiotics, as defined by the World Health Organisation (WHO) and the United Nations Food and Agriculture Organisation (FAO), are "live microorganisms which, when consumed in adequate amounts, confer a health benefit on the host". They are attributed with numerous virtues, whether it's aiding diseases affecting the nervous system or supporting the digestive system. These varied applications, ranging from the medical to the cosmetic sphere, explain why the industry of probiotics is experiencing an estimated annual growth between 15 and 20%.

Nevertheless, to date, the effects of probiotics on vitiligo have not been studied.

It is indeed a pity as several factors suggest that probiotics could be a valuable tool to add to the therapeutic arsenal against vitiligo, starting with the dysbiosis observed in patients. Indeed, it has been observed in several studies that individuals suffering from this dermatosis exhibit significant alterations in their gut microbiota, affecting both the taxonomic and functional profiles of the microorganisms, as well as the structure of their community. These alterations could be partly responsible for the onset of the vitiligo.

To better understand, it is important to recall that vitiligo is an immune disease characterised by the destruction of melanocytes, the cells responsible for skin pigmentation, due to a misdirected attack by the immune system. It has been demonstrated that autoimmune disorders, such as Crohn's disease, psoriasis or even type 1 diabetes, are often associated with imbalances in the gut microbiota that could modulate the immune response. The same mechanism could potentially be at play in the case of vitiligo.

Among the studies that have focused on the dysbiosis exhibited by individuals with vitiligo, one of the most recent was conducted by SHARMA and his team in 2024. It involved 22 patients with vitiligo and 10 controls. The results showed that the phylum Bacteroidota was more abundant in individuals with vitiligo (34.98%) compared to the control group (21.70%), while Firmicutes predominated in the controls (39.96% versus 24.46% in the vitiligo group). At the genus level, Prevotella was significantly more abundant in the vitiligo group (29.80% versus 16.24%), whereas Eubacterium, Pseudomonas, and Lachnospira were in lesser proportion. Finally, certain specific species, such as Prevotella copri, were more present in the vitiligo group, while others, such as Romboutsia ilealis and Peptostreptococcus stomatis, were more commonly found in the controls.

Given the apparent imbalance of the gut microbiome in individuals with vitiligo, it would be worthwhile to conduct studies on the effects of probiotics on these patients. Indeed, the ability of probiotics to balance the microbiota, and thus indirectly act on the immune system, could be a promising avenue in the management of vitiligo.