Recent research highlights the potential role of diet and nutrition in the development and management of vitiligo. A systematic review investigated the relationship between dietary factors and vitiligo, examining 14 studies published between 2003 and 2023.

SUMMARY

The review revealed that high levels of heavy metals, including Cadmium, Lead, and Mercury, are significantly linked to adverse health outcomes in older adults. Conversely, in younger adults, low levels of Vitamin D and deficiencies in Folic Acid and Vitamin B12 were associated with an increased risk of vitiligo. Additionally, variations in Zinc levels and fatty acids were also connected to vitiligo in this age group. These findings underscore the importance of certain dietary factors in exacerbating or potentially protecting against vitiligo. While dietary interventions alone cannot fully treat vitiligo, they can complement existing treatment strategies.

DISCUSSION

Understanding the relationship between diet and vitiligo pathogenesis is critical, especially as pharmacological and radiation therapies often fall short for some patients by focusing primarily on the autoimmune hypothesis. Dietary supplements and herbal adjuncts represent promising supportive treatments, with emerging research spotlighting their role in mitigating disease activity.

Toxic heavy metals like Cadmium, Lead, and Mercury can adversely affect human health and are implicated in vitiligo through the production of reactive oxygen species (ROS) and disruption of metabolic processes. A case-control study highlighted that elevated levels of these metals are associated with increased health risks in older adults.

Micronutrients like Zinc and Copper are vital for both melanin biosynthesis and the function of the antioxidant enzyme superoxide dismutase. The evidence on their impact on vitiligo is mixed; some studies report decreased levels of Copper and Zinc in patients, while others observe elevated Copper levels. This discrepancy underscores the need for further research to clarify their roles and standardize treatment protocols.

Vitamins C, D, and B12 are known for their anti-inflammatory effects and their role in reducing ROS, which can help manage vitiligo. One study found combining Vitamin C and B12 with topical corticosteroids effective in treating vitiligo, however, hyper doses of Vitamin C may actually worsen vitiligo. Vitamin D's role is also controversial, with one small study showing high-dose, short-term, counter-balanced, oral supplementation improving repigmentation in some vitiligo patients. Yet, a standard dose of up to 4,000 IU daly is generally considered beneficial to all patients. 

Polyunsaturated fatty acids (PUFAs) are thought to benefit vitiligo patients by modulating the immune system. However, a randomized controlled trial showed that Alpha Lipoic acid (ALA), despite its antioxidant properties, did not significantly improve outcomes when used with NB UVB therapy.

CONCLUSION

The rising interest in complementary medicines and natural approaches has underscored the importance of dietary interventions in managing vitiligo. As patients seek alternatives to traditional pharmacological and phototherapy treatments, dietary supplements emerge as valuable adjuncts. These supplements can be used alongside corticosteroids and/or ultraviolet therapy to mitigate disease flares, offering the benefit of lower adverse effect profiles.

While dietary interventions are not standalone treatments, their role as adjuncts is particularly compelling given the pathophysiological nature of vitiligo. To solidify their place in vitiligo management, extensive clinical trials are essential to establish robust evidence and standardized treatment protocols, aiming to reduce reliance on traditional pharmacological approaches.

SUGGESTED READING

• Is there a special diet for vitiligo?
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• Is there a traditional medicine to treat vitiligo?

REFERENCES

• Di Nardo V, Barygina V, França K, Tirant M, Valle Y, Lotti T. Functional nutrition as integrated approach in vitiligo management. Dermatol Ther. 2019; 32(4):e12625.
• Hadi Z, Kaur R, Parekh Z, et al. Exploring the impact of diet and nutrition on vitiligo: A systematic review of dietary factors and nutritional interventions. J Cosmet Dermatol. March 11, 2024.