Is there an association between gluten intolerance and vitiligo?

The vitiligo is a skin pigmentation disorder characterized by depigmented white patches. It is caused by the destruction of melanocytes, the pigment-producing cells that synthesize melanin. Activation of the immune system and oxidative stress are the key pathways leading to melanocyte destruction in vitiligo. Some studies suggest that gluten may also play a role in the development of vitiligo in certain patients. Indeed, in individuals with celiac disease, an autoimmune condition, gluten intake triggers an abnormal immune response that can damage not only the intestinal mucosa but also other tissues, leading to systemic inflammation. These inflammatory processes, if chronic, can disrupt immune homeostasis and elicit additional autoimmune reactions, which could worsen vitiligo.

Some researchers suggest that celiac disease and the vitiligo may share a common immune trigger, particularly linked to a gluten-rich diet. A study of 128 participants (50% controls and 50% with vitiligo) revealed the presence of various antibodies associated with celiac disease, uncovering an abnormal autoimmune response similar to that seen in vitiligo patients. Indeed, two women with vitiligo were found to be seropositive for hallmark celiac disease antibodies (anti–tissue transglutaminase and anti-endomysium), known to target the small intestine after gluten ingestion. Their detection suggests that similar autoimmune mechanisms could be at play. However, the fact that only two cases were observed in a cohort of 64 vitiligo patients calls for cautious interpretation of these results.

Thus, although the study opens an intriguing avenue concerning the existence of shared autoimmune mechanisms that may explain the association of vitiligo with other autoimmune disorders such as celiac disease, further larger-scale studies are required to confirm this link.

To date, there is no officially recognized dietary treatment for vitiligo. Nevertheless, some nutritional approaches are being explored to better understand their influence on the disease’s progression. Diet, by modulating inflammation and immune responses, could indeed play an indirect role in managing vitiligo.

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

Some case studies have reported 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. For example, a 9-year-old girl had been affected by vitiligo for three years. Despite various treatments—including PUVA phototherapy for 9 months, topical 0.25% prednicarbate for 6 months, and pimecrolimus for one year—no improvement was observed. At the same time, the child had well-controlled hypothyroidism and had just been diagnosed with celiac disease. A gluten-free diet was then implemented. Progressively, without any other vitiligo-specific treatment, a visible repigmentation of the depigmented macules appeared after one year, with a remarkable result after three years. The pigmentation remained stable over the long term.

However, these results remain anecdotal and cannot be generalized.

It is important to emphasize that these potential benefits appear to apply primarily to patients with both vitiligo and gluten intolerance (celiac disease or non-celiac sensitivity). In other patients, no solid evidence shows that a gluten-free diet alone can significantly improve disease progression. Therefore, 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 evaluate the efficacy of a gluten-free diet in this context.

In conclusion, dietary interventions may serve as an adjunctive strategy in the management of vitiligo, but they do not replace existing medical treatments. In patients with both vitiligo and celiac disease, a strict gluten-free diet appears to be a promising avenue that deserves further investigation.

• SANCHEZ R. & al. Repigmentation of vitiligo lesions in a child with celiac disease after a gluten-free diet. Pediatric Dermatology (2011).

• FAHIMIPOUR F. & al. Vitiligo and autoantibodies of celiac disease. International Journal of Preventive Medicine (2013).

• NASHAWATI R. & al. The role of diet and supplements in vitiligo management. Elsevier (2017).

• KALPACKI Y. & al. Frequency of celiac disease in patients with vitiligo. International Advances in Medicine (2020).

• KANG X. J. & al. Association between celiac disease and vitiligo: A review of the literature. World Journal of Clinical Cases (2021).

• IQBAL J. & al. Gluten intolerance and its association with skin disorders: A narrative review. Cureus (2023).