Dietary Interventions May Serve as Worthwhile Adjunct Therapy in Patients With Vitiligo

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Recent research has shed light on the role of diet and nutrition in the development and management of vitiligo. This subject is not new, however. Researchers have previously explored the potential of functional nutrition as an integrated approach to vitiligo treatment. Antioxidants and vitamin D derivatives, have played a role in repigmentation, according to past research.¹

In a recently-published systematic review, researched aimed to explore the relationship between dietary factors and vitiligo, investigating the potential implications for treatment and prevention strategies.

The systematic review, published in the Journal of Cosmetic Dermatology,² involved a comprehensive search conducted across electronic databases, including PubMed, Google Scholar, and European PMC, from June to July 2023. Researchers employed specific search terms related to vitiligo, diet, and nutrition interventions. Inclusion criteria encompassed English-language studies focusing on human participants and the impact of diet on vitiligo from 2003 to 2023. Case-control and cross-sectional study designs were prioritized in the review.

The screening process identified 14 studies meeting the inclusion criteria, comprising both case-control and cross-sectional designs. These studies investigated various dietary factors and their associations with vitiligo across different age groups and genders.

In Muczyńska et al.'s (2020) case-control study involving older adults, where there were more females than males, the sample size being less than 100, the authors found significant associations between exposure to heavy metals, specifically Cadmium (Cd), Lead (Pb), and Mercury (Hg), and adverse health outcomes. The study suggested that higher levels of these heavy metals were linked to increased health risks in the older adult population.

Similarly, Soltani et al. (2023) conducted a case-control study on younger adults, with more females than males, and reported an association between lower levels of vitamin D and the health outcome they investigated. This suggests that vitamin D deficiency may be a risk factor for vitiligo in younger adults.

In another case-control study on younger adults, Singh et al. (2012) found associations between lower levels of folic acid, vitamin B12, and higher levels of homocysteine with health outcomes. This suggests that deficiencies in these nutrients may contribute to the development of vitiligo in younger adults.

Mogaddam et al. (2017) conducted a cross-sectional study on younger adults and observed differences in zinc levels between groups, with a male predominance in both cases and controls, the sample size being more than 100. The study suggested that zinc levels might be related to the a loss of pigmentation.

In a cross-sectional study on younger adults, Rishehri et al. (2019) found associations between fatty acids and health outcomes. There were differences in gender distribution between cases and control groups, with more females in cases and more males in controls with a sample size of more than 200.

Garg et al. (2019) conducted a cross-sectional study on younger adults with a sample size of less than 100 and reported associations between protein intake, having an adequate diet, and health outcomes. There was also a relation found between skipping breakfast and vitiligo. The study also had a predominantly female gender distribution.

In a pilot study with a sample size of less than 100, Kulkarni et al. (2016) conducted on younger adults with a female predominance mentioned the role of an incompatible diet. The modulation of diet was significantly felt more in the control group than in the vitiligo-diseased group. However, the study did not specify a clear association with the health outcome.

The CASP tool checklist scores indicated a low risk of bias across all 14 studies, ensuring the quality and validity of the evidence synthesized in the review.

While certain dietary factors, such as heavy metals and vitamin D deficiency, may exacerbate the condition, others like folic acid and zinc could have protective effects. Understanding these associations is crucial for developing targeted interventions and dietary guidelines to support vitiligo management, wrote Hadi et al.

Potential study limitations, they noted, included the limited quantity of databases searched, an exclusion of randomized controlled trials in the review, and a small sample size.

"Interest regarding complementary medicines and natural approaches to tackle diseases such as vitiligo, has in general, grown over recent times. While dietary interventions cannot be thought of as a standalone therapy, they still make a case for being used as adjuncts," according to Hadi et al. "Many items that have antioxidants can be used in therapy for this disease, because of a pathophysiological nature of the disease. Further 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 own adverse effect profiles."

References

1. 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. Accessed March 19, 2024. doi:10.1111/dth.12625
2. 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. Accessed March 19, 2024. https://doi.org/10.1111/jocd.16277