Vitiligo and gluten: a potential link to consider?

Vitiligo and gluten intolerance: a common autoimmune response.

The vitiligo is a disorder of skin pigmentation characterised by depigmented white patches. This arises from the destruction of melanocytes, the pigment-producing cells that generate melanin. Activation of the immune system and oxidative stress are the key pathways leading to melanocyte loss in vitiligo. Some studies suggest that gluten may also play a role in the development of vitiligo in certain patients. Indeed, in individuals with coeliac disease, an autoimmune condition, gluten intake triggers an abnormal immune response that can cause damage not only in the gut but also in other parts of the body and provoke systemic inflammation. If such inflammation is chronic, they can disrupt immune homeostasis and trigger further autoimmune responses, which may exacerbate vitiligo.

Certain researchers suggest that coeliac disease and vitiligo could share a common immune trigger, particularly associated with a gluten-rich diet. A study conducted with 128 participants (50% controls and 50% vitiligo patients) highlighted the presence of various types of antibodies linked to coeliac disease, revealing an abnormal autoimmune response similar to that observed in those with vitiligo. Indeed, two women with vitiligo were identified as seropositive for antibodies characteristic of coeliac disease (anti-tissue transglutaminase and anti-endomysial), which are known to target the small intestine following gluten ingestion. Their detection suggests that similar autoimmune mechanisms may be involved. However, the fact that only two cases were observed in a cohort of 64 vitiligo patients prompts cautious interpretation of these findings.

Thus, although the study provides an intriguing lead regarding the existence of common autoimmune mechanisms that may account for the association of vitiligo with other autoimmune disorders such as coeliac disease, further large-scale research is required to confirm this link.

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Does a gluten-free diet play a role in the treatment of vitiligo?

To date, there is no officially recognised dietary intervention for the vitiligo. Nevertheless, specific nutritional strategies are currently under investigation to better understand their impact on disease progression. Diet, by modulating inflammation and immune responses, could indeed play an indirect role in vitiligo management.

In the specific case of gluten, several observations suggest that its exclusion could have a beneficial effect for certain patients. In individuals with coeliac disease, a strict gluten-free diet reduces systemic inflammation and partially restores immune balance. This mechanism could be extrapolated to vitiligo : by reducing autoimmune responses triggered by gluten, one could potentially limit immune attacks against melanocytes.

Certain case studies report that adopting a gluten-free diet in patients with vitiligo, particularly those who also exhibit gluten sensitivity or intolerance, has been associated with clinical improvement. One illustrative example is a nine-year-old girl who had suffered from vitiligo for three years. Despite various treatments – including nine months of PUVA phototherapy, topical application of 0.25 % prednicarbate for six months, and pimecrolimus for one year – no improvement was noted. At the same time, the child had well-controlled hypothyroidism and had just been diagnosed with coeliac disease. A gluten-free diet was then introduced. Progressively and without any other vitiligo-specific treatment, a visible repigmentation of the depigmented macules appeared after one year, with results deemed remarkable after three years. The pigmentation was maintained long-term.

Avant / Trois ans après avoir commencé un régime alimentaire sans gluten. — Before / Three years after commencing a gluten-free diet.
Source: SANCHEZ R. & al. Repigmentation of vitiligo lesions in a child with celiac disease after a gluten-free diet. Pediatric Dermatology (2011).

However, these results remain anecdotal and cannot be generalised.

It is important to emphasise that these potential benefits appear to relate primarily to patients presenting both vitiligo and gluten intolerance (coeliac disease or non-coeliac gluten sensitivity). Among other patients, no solid evidence shows that a gluten-free diet alone can significantly improve the course of the disease. Thus, while gluten elimination may be considered in certain specific cases, it should not be regarded as a universal treatment for vitiligo. Larger-scale clinical studies are essential to scientifically assess the effectiveness of a gluten-free diet in this context.

In conclusion, diet may offer a complementary tool in the management of vitiligo, but it does not replace existing medical approaches. In patients with dual affliction (vitiligo and coeliac disease), a strict gluten-free diet nevertheless appears to be an interesting avenue that warrants further investigation.