An Integrative and Complementary Approach to Vitiligo: Testing, Nutritional Considerations, and Complementary Therapies

While many people think of vitiligo as an uncommon skin condition that causes patches of lighter skin, it is actually a fairly common autoimmune condition that impacts an estimated 1.9-2.8 million people in the United States and over 1% of the population around the world. The skin loses its color pigment or melanin and turns a milky white due to the body attacking the melanocytes. This depigmentation can occur anywhere on the skin, mucous membranes of the mouth and nose, and in the hair. 

Several factors contribute to the development of this autoimmune disease, including genetic and environmental factors that lead to abnormalities in oxidative stress, immune function, and inflammation. A personalized functional medicine approach to the treatment of vitiligo aims to rebalance the immune system, calm oxidative stress, and stop the loss of pigmentation.

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What is Vitiligo?

Vitiligo is a chronic condition that causes patches of skin and hair to lose color. This can impact the skin anywhere on the body, including inside of the mouth. It usually begins with a few smaller patches on the hands, forearms, feet, and face and may then spread or shift to different locations over time.

There are several different types of vitiligo. The most common type is generalized and causes depigmented spots in various parts of the body. In the segmental type, light patches develop on only one side of the body or one body area like the hands or face. Mucosal vitiligo only impacts the mucous membranes of the mouth, nose, and/or genitals. If depigmentation only occurs in a small area and doesn't spread within one to two years, it is known as focal vitiligo. When there is a small area with a bullseye that has a white or colorless center, then an area of lighter pigmentation, and an area of your natural skin tone, it is known as trichrome vitiligo. On the other hand, universal vitiligo causes depigmentation of more than 80% of the body.

Vitiligo can develop at any age but most commonly starts to appear before age 20, often in early childhood.

Vitiligo Signs & Symptoms

The most recognizable sign of vitiligo is a loss of color in the skin and hair. This depigmentation can cause pale patches anywhere on the body. People with vitiligo often experience:

• Milky white patches of depigmented skin on any part of the body but especially on the hands, feet, arms, and face.
• Graying or white areas of hair in areas where the skin loses pigmentation.
• Patches of loss pigment on mucous membranes, such as the inside of the mouth or nose.
• Uveitis or inflammation in the eye.
• Inflammation in the ear.

In generalized vitiligo, the loss of skin pigmentation in vitiligo often appears symmetrically on both sides of the body and can sometimes cover a large area. On the other hand, people with the segmental subtype of vitiligo usually develop white patches only on one side or part of the body. This type of vitiligo is less common and usually develops at an early age, progresses for 6 to 12 months, and then stops. If the affected skin is limited to the face and hands and around openings like the nose, ears, and eyes, this is called acrofacial vitiligo.

Vitiligo can also impact the eyes. People with vitiligo sometimes have retinal abnormalities in the inner layer of the eye that contains light-sensitive cells or variations in the color of their irises or colored part of the eye, and inflammation can occur. 

Vitiligo Possible Causes 

Vitiligo is an autoimmune condition that involves dysfunction in the body's immune response. In people with vitiligo, the body's immune system attacks melanocytes, the cells found in the skin and hair that produce melanin that gives the skin its color. This causes the melanocytes to stop functioning or die so that they no longer produce pigment in the skin. When this happens, patches of milky white skin or graying hair occur. 

Around 30% of vitiligo cases are genetic, with several genes identified as contributing. For example, people with vitiligo seem to be more susceptible to oxidative damage to melanocytes in the skin with lower levels of systemic antioxidant capacity (glutathione peroxidase reduction) compared to individuals without vitiligo, People with other autoimmune conditions like Addison's disease, pernicious anemia, psoriasis, Rheumatoid arthritis, systemic lupus erythematosus, Hashimoto's thyroid disease, and type 1 diabetes are also at an increased risk of vitiligo. 

Environmental triggers like ultraviolet radiation and chemical exposures also impact the function of melanocytes. In some cases of vitiligo, there can be a rapid loss of color, while in other cases, small patches of lost pigment develop over time. A stressor like a sunburn, emotional distress, injury, or exposure to a chemical can sometimes trigger vitiligo or make it worse.

Toxic exposures and other contributing factors to imbalances in the skin and gut microbiomes can further dysregulate the immune system and cause inflammation contributing to the development of autoimmunity. People with vitiligo seem to have imbalances in the microbes on their skin with a lack of protective Bifidobacterium and Bacteroides but increased Proteobacteria, Streptococcus, and Mycoplasma which contribute to imbalances in immune responses that underlie depigmentation.

Functional Medicine Labs to Test for Root Cause of Vitiligo

A functional medicine approach to vitiligo aims to uncover the root causes contributing to the autoimmune attack with laboratory testing to develop a personalized plan to rebalance the immune system, calm oxidative stress, and stop the loss of pigmentation.

Comprehensive Stool Test

A comprehensive stool test, like the GI-MAP + Zonulin test by Diagnostic Solutions or the GI Effects® Comprehensive Profile from Genova Diagnostics, looks at the composition of the gut microbiome, which can contribute to the immune dysregulation underlying the development of autoimmune disease. 

Vitamin D

Vitamin D acts on the skin receptors and influences the development of melanocytes, and impacts the immune system. Vitamin D can be measured in the blood.

Environmental factors

Exposure to environmental toxins such as toxic metals, solvents, organic pollutants, and endocrine disruptors can contribute to the development of autoimmune diseases like vitiligo and imbalanced inflammation. The RTL Tox Complete by RealTime Laboratories assesses environmental toxin exposure.

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Conventional Treatment for Vitiligo

The goal of vitiligo treatment is to stop the loss of pigmentation and/or make it less noticeable either by restoring lost melanin production or by eliminating remaining pigment in the skin to have a more even appearance. The conventional treatment for vitiligo is adjusted depending on age, how much skin is involved and where, and how quickly the disease is progressing. In some cases, medications and/or light treatments are used to help control inflammation and restore some pigmentation. 

In the early stages of vitiligo, corticosteroid cream may be used topically to address the autoimmune inflammation in the skin. If the condition is more severe and/or progressing rapidly, oral corticosteroid pills or injections may be used. Since steroids can cause side effects like skin thinning, calcineurin inhibitor ointments, such as tacrolimus (Protopic) or pimecrolimus (Elidel), are sometimes used as an alternative, although these carry a possible risk of skin cancer.

Phototherapy using narrow-band ultraviolet B (UVB) can stop or slow the progression of active vitiligo, especially when combined with corticosteroids or calcineurin inhibitors. Sometimes, a plant-derived substance called psoralen is taken by mouth before applying light therapy (photochemotherapy) to return color to the light patches.

If these therapies are not successful or large areas of the skin are depigmented, some people may opt to use a topical depigmenting agent to remove the remaining color or undergo a type of skin grafting surgery to even out skin tone. 

Afamelanotide is a medication that is currently being studied to promote the growth of melanocytes and restore color to the skin. Another potential emerging treatment for vitiligo to help normalize melanocyte function is prostaglandin E2 gel.

Functional Medicine Treatment for Vitiligo

A functional medicine approach to treating vitiligo looks at underlying contributing factors and helps bring the body back into balance. Nutrition, supplements, and lifestyle approaches can be used in an integrative approach to help manage oxidative stress, inflammation, toxicity, and the immune response. 

Nutrition 

Oxidative stress occurs when toxins, natural wear and tear, stress, and dietary factors lead the body to produce more free radicals that can damage and alter our DNA and cells, like melanocytes. Since oxidative stress is known to play a role in the melanocyte dysfunction that occurs in vitiligo, an anti-inflammatory diet rich in antioxidants is important. Antioxidant-rich foods include colorful fruits, vegetables, and legumes that also help balance inflammation by keeping the gut microbiome balanced. Overly processed foods and barbequed meats can increase the production of free radicals and carcinogens in the body while lowering levels of antioxidants, so these should be minimized in the diet.

Glutathione is a key antioxidant that is important for oxidative stress and melanocyte survival.  Foods such as asparagus, avocado, spinach, and red pepper contain high levels of glutathione or its precursors to help increase glutathione levels in the body.

Supplements & Herbs

Several supplements, herbs, and vitamins have been studied to help restore pigmentation to the skin and/or modulate the immune response and inflammation that underlies vitiligo. 

The herb Ginkgo biloba has antioxidant and immunomodulatory properties that can help halt the progression of skin depigmentation and return skin color in people with vitiligo. In addition, 25- hydroxyvitamin D3 (calcifediol) acts on receptors on melanocytes to stimulate melanin secretion. 35000 IU of vitamin D3 taken daily for six months helped decrease disease progression. 

Small studies have shown that folic acid and vitamin B12 supplementation combined with sun exposure can help the skin regain pigment, although precise doses and length of treatment are still under study. Similarly, zinc and phenylalanine supplementation, together with topical steroids or UVB phototherapy, helps support melanin synthesis in vitiligo patients.

Other small studies suggest that the antioxidant alpha-lipoic acid may restore skin color. Alpha lipoic acid can be taken as a supplement in doses ranging from 300 to 1,800 mg daily and is also found in tea, broccoli, spinach, fruits, and soy products. 

Complementary and Integrative Medicine

Stressful life events may trigger vitiligo flares, and the condition contributes to much stress and anxiety, so utilizing a meaningful stress management practice can help with management. Mind-body practices, including breath work, yoga, tai chi, qi gong, and relaxation exercises, help to shift the body from a sympathetic state into a parasympathetic one, which allows for a more relaxed physiologic state and decreases inflammation.  

A study of 50 patients with vitiligo showed significant improvement in skin symptoms when using Apamraga Kshara Yoga, an Ayurvedic herbal formulation.

Careful sun exposure and protecting your skin from tanning or burning can help prevent flares of vitiligo and prevent painful burns on sensitive, depigmented skin.

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Summary

Vitiligo is a chronic autoimmune disease that causes patches of skin color to be lost in many parts of the body, hair, and/or the inside of the mouth. It is an autoimmune condition with hereditary influences and also involves oxidative stress and cell dysfunction. The loss of pigmentation of the skin occurs due to the immune system attacking the melanocytes in the skin or hair that normally produce color. This condition usually begins before age 30 and can progress over time. 

Functional medicine testing can help uncover imbalances in the gut microbiome, vitamin D levels, and environmental toxin exposures that can contribute to immune dysfunction and autoimmunity. A comprehensive treatment approach utilizes an anti-inflammatory diet rich in antioxidants from fruits and vegetables, along with supplementation with vitamin D, B vitamins, and other antioxidants that can complement conventional treatment strategies.