Diet and Vitiligo: The Story So Far

Canadian Consensus Guidelines for the Management of Vitiligo

INTRODUCTION

Vitiligo remains a highly burdensome disease associated with significant autoimmune and psychosocial comorbidities. Although the therapeutic landscape has long been dominated by off-label therapy, new treatments are emerging. Limited guidance on how to safely and effectively utilize available therapies poses challenges for healthcare providers. Herein, we provide generally accepted principles, consensus recommendations, and a treatment algorithm for the management of vitiligo, as developed by a panel of ten Canadian dermatologists with expertise in managing vitiligo.

METHODS

The three-phase process consisted of identifying themes and research questions; conducting a systematic literature review; and discussing/voting on generally accepted principles, consensus statements, and a treatment algorithm using an iterative consensus process.

RESULTS

Experts agreed to 27 generally accepted principles, ten consensus statements, and a treatment algorithm. Education about vitiligo pathogenesis and repigmentation biology can help patients, caregivers, and healthcare providers set realistic expectations for treatment. Treatment should focus on repigmentation or stabilizing progression, rather than on depigmentation. Topical therapies include topical corticosteroids, topical calcineurin inhibitors, and the topical Janus kinase inhibitor ruxolitinib cream. Phototherapy, such as narrow-band ultraviolet B and excimer laser/lamp, can be used as monotherapy or in combination with other treatments. Off-label systemic therapies may be appropriate for patients with unstable or rapidly progressing disease. Surgical therapy may be suitable for patients with localized or stable recalcitrant disease. Maintenance therapy may help mitigate the risk of disease relapse.

CONCLUSION

Improved clarity around the benefits, risks, and limitations of available therapies has supported the development of robust guidelines and a treatment algorithm for vitiligo. Disease stabilization and repigmentation are goals that can largely be achieved, particularly when patients share a mutual understanding of vitiligo and its treatment options. A Graphical Abstract is available for this article.

Beyond skin deep: exploring the complex molecular mechanisms and holistic management strategies of vitiligo

Vitiligo is a multifactorial skin disorder characterized by the progressive loss of pigmentation due to the destruction of melanocytes, affecting 0.5-2% of the global population. This condition not only impacts physical appearance but also has profound psychosocial effects on patients. In this review, various aspects of vitiligo are explored, including its clinical forms, epidemiology, and underlying mechanisms. Advances in research have identified key molecular pathways, such as Wnt/β-Catenin, JAK-STAT, and AhR signaling, which are essential for melanocyte survival and immune regulation. These pathways provide valuable insights into the disease's progression and potential treatment targets. Furthermore, the role of microbial imbalances in the gut and skin microbiomes, stress-related factors, and nutritional deficiencies in influencing the onset and progression of vitiligo is investigated. The potential of herbal treatments to stimulate repigmentation is also discussed. By presenting a comprehensive overview, this review aims to deepen the understanding of vitiligo's complex pathology and foster the development of effective therapeutic strategies to enhance patient care.

Identification of disease-specific gut microbial markers in vitiligo

There is a potential correlation between vitiligo and gut microbiota, although research in this area is currently limited. The research employed high-throughput sequencing of 16S rRNA to examine the gut microbiome in the stool samples of 49 individuals with vitiligo and 49 without the condition. The study encompassed four comparison groups: (1) DI (disease) group vs. HC (healthy control) group; (2) DI_m group (disease group of minors) vs. HC_m group (healthy control group of minors); (3) DI_a group (adult disease group) vs. HC_a group (adult healthy control group); (4) DI_m group vs. DI_a group. Research findings have indicated the presence of spatial heterogeneity in the gut microbiota composition between individuals with vitiligo and healthy controls. A significant reduction in gut microbiota diversity has been observed in vitiligo patients across both minors and adult groups. However, variations have been noted in the composition of disease-related differential microbial markers among different age groups. Specifically, Bacteroides and Parabacteroides have been identified as specific markers of the intestinal microbiota of vitiligo patients in both minor and adult groups. Correlative analyses have revealed a positive correlation of these two genera with the Vitiligo Area Scoring Index (VASI) and disease duration. It is noteworthy that there are no significant differences in diversity between the DI_m group and the DI_a group, with similarities in microbiota composition and functional characteristics. Nevertheless, correlative analyses suggest a declining trend in Bacteroides and Parabacteroides with increasing age. Individuals with vitiligo exhibit distinct features in their gut microbiome when contrasted with those in the healthy control group. Additionally, the microbial marker genera that show variances between patients and healthy controls vary among different age groups. Disease-specific microbial marker genera (Bacteroides and Parabacteroides) are associated with VASI, duration of the condition, and age. These findings are essential for improving early diagnosis and developing potential treatment strategies for individuals with vitiligo.

"Understanding and treating baras (vitiligo) in unani medicine: historical perspectives, pathophysiology, and therapeutic approaches"

Vitiligo, also known as baras in Unani medicine, causes patches of depigmented skin due to the loss of melanocytes. According to ancient Unani scholars, factors like excessive phlegm in the blood and weakened color-controlling power were believed to be the cause. This study dives into the historical insights of luminaries like Majūsī and Hakim Akbar Arzānī, alongside modern medical understanding. It explores the pathophysiology, epidemiology, and clinical features of vitiligo, while also addressing confusing definitions, dietary influences, and demographic patterns. We take a close look at the classification, prognosis, and investigative methods. The aim of this research is to bring together traditional and modern perspectives to fully understand vitiligo, covering its cultural, historical, and scientific aspects. By incorporating epidemiological data, dietary considerations, and insights into the underlying mechanisms, we enhance diagnostic and treatment approaches. In conclusion, this study establishes a cohesive connection between the historical wisdom of Unani medicine and the current scientific discourse on vitiligo. By merging these perspectives, we gain a comprehensive understanding of the condition, enabling a more holistic approach to diagnosis and management. As dermatological research continues to evolve, the integration of traditional and modern insights becomes crucial in effectively addressing complex skin disorders like vitiligo.

Exploring the impact of diet and nutrition on vitiligo: A systematic review of dietary factors and nutritional interventions

BACKGROUND

Vitiligo, an autoimmune skin disorder linked to hormonal and genetic factors, results in reduced pigmentation due to a gradual decline in melanocyte activity. This systematic review delves into the role of dietary intervention and nutrition in managing vitiligo.

METHODS

A comprehensive search on PubMed, Google Scholar, and European PMC identified 214 studies, with 14 meeting inclusion criteria post-screening. The selected studies primarily explored the impact of dietary supplements on disease activity.

RESULTS

Heavy metal exposure, specifically Cd, Pb, and Hg, indicated potential links to heightened reactive oxygen species and vitiligo development. Conflicting evidence emerged regarding the role of trace minerals (Zn and Cu), with some studies suggesting deficiencies and others proposing excesses in vitiligo patients. Vitamins with anti-inflammatory properties like vitamin C, D, and B12, along with antioxidants, were investigated for their potential in repigmentation strategies. Additionally, polyunsaturated fatty acids (PUFAs), especially in varying types of fat consumption, were implicated. Emphasizing the need to reduce reliance on pharmacological and phototherapy interventions, the review uncovers novel roles for dietary supplements as adjuncts or flare reducers.

CONCLUSION

While dietary interventions cannot be thought of as a standalone therapy, they still make a case for being used as adjuncts. Large scale clinical trials are warranted to establish strong evidence and protocols, and might also help reduce the dependency on pharmacological methods, which come with their adverse effect profiles.