Analysis of Online Diet Recommendations for Vitiligo
Internet platforms have become a common source of information for individuals with skin diseases such as vitiligo, and the vitiligo community frequently turns to online sources for diet modifications that may be beneficial for their disease. In this study, our objective was to summarize information from the most frequently visited websites providing diet suggestions that reportedly affected vitiligo symptoms. Notable diet categories for food components included vitamins, fruits, omega-3 fatty acids, grains, minerals, vegetables, and nuts. Evidence supporting online dietary recommendations for vitiligo is limited in the published scientific literature. Further controlled clinical trials are warranted to assess the relationship between diet and vitiligo and evaluate the accuracy of online diet recommendations for vitiligo.
Practice Points
- There are numerous online dietary and supplement recommendations that claim to impact vitiligo but most are not authored by medical professionals or dermatologists.
- Scientific evidence supporting specific dietary and supplement recommendations for vitiligo is limited.
- Current preliminary data support the potential recommendation for dietary supplementation with vitamin D, vitamin B12, zinc, and omega-3 fatty acids.
Eleven of 31 (35%) web pages recommended inclusion of vitamin B12 supplementation in vitiligo. A 2-year study with 100 participants showed that supplementation with folic acid and vitamin B12 along with sun exposure yielded more effective repigmentation than either vitamins or sun exposure alone.5 An additional hypothesis suggested vitamin B12 may aid in repigmentation through its role in the homocysteine pathway. Although the theory is unproven, it is proposed that inhibition of homocysteine via vitamin B12 or folic acid supplementation may play a role in reducing melanocyte destruction and restoring melanin synthesis.6
There were mixed recommendations regarding vitamin C via supplementation and/or eating citrus fruits such as oranges. Although there are limited clinical studies on the use of vitamin C and the treatment of vitiligo, a 6-year prospective study from Madagascar consisting of approximately 300 participants with vitiligo who were treated with a combination of topical corticosteroids, oral vitamin C, and oral vitamin B12 supplementation showed excellent repigmentation (defined by repigmentation of more than 76% of the originally affected area) in 50 participants.7
Fruits—Most web pages had mixed recommendations on whether to include or avoid certain fruits. Interestingly, inclusion of mangoes and apricots in the diet were highly recommended (9/31 [29%] and 8/31 [26%], respectively) while fruits such as oranges, lemons, papayas, and grapes were discouraged (10/31 [32%], 8/31 [26%], 6/31 [19%], and 7/31 [23%], respectively). Although some web pages suggested that vitamin C–rich produce including citrus and berries may help to increase melanin formation, others strongly suggested avoiding these fruits. There is limited information on the effects of citrus on vitiligo, but a 2022 study indicated that 5-demethylnobiletin, a flavonoid found in sweet citrus fruits, may stimulate melanin synthesis, which can possibly be beneficial for vitiligo.8
Omega-3 Fatty Acids—Seven of 31 (23%) web pages recommended the inclusion of omega-3 fatty acids for their role as antioxidants to improve vitiligo symptoms. Research has indicated a strong association between vitiligo and oxidative stress.9 A 2007 controlled clinical trial that included 28 vitiligo patients demonstrated that oral antioxidant supplementation in combination with narrowband UVB phototherapy can significantly decrease vitiligo-associated oxidative stress (P<.05); 8 of 17 (47%) patients in the treatment group saw greater than 75% repigmentation after antioxidant treatment.10
Grains—Five of 31 (16%) web pages suggested avoiding gluten—a protein naturally found in some grains including wheat, barley, and rye—to improve vitiligo symptoms. A 2021 review suggested that a gluten-free diet may be effective in managing celiac disease, and it is hypothesized that vitiligo may be managed with similar dietary adjustments.11 Studies have shown that celiac disease and vitiligo—both autoimmune conditions—involve IL-2, IL-6, IL-7, and IL-21 in their disease pathways.12,13 Their shared immunogenic mechanism may account for similar management options.
Upon review, 2 case reports were identified that discussed a relationship between a gluten-free diet and vitiligo symptom improvement. In one report, a 9-year-old child diagnosed with both celiac disease and vitiligo saw intense repigmentation of the skin after adhering to a gluten-free diet for 1 year.14 Another case study reported a 22-year-old woman with vitiligo whose symptoms improved after 1 month of a gluten-free diet following 2 years of failed treatment with a topical steroid and phototherapy.15
Seven of 31 (23%) web pages suggested that individuals with vitiligo should include wheat in their diet. There is no published literature discussing the relationship between vitiligo and wheat. Of the 31 web pages reviewed, 10 (32%) suggested including whole grain. There is no relevant scientific evidence or hypotheses describing how whole grains may be beneficial in vitiligo.
