Is Vitiligo An Autoimmune Disease? Understanding The Immune Connection To This Skin Condition
“Is vitiligo an autoimmune disease?” This is a question I get asked frequently in my telehealth functional medicine clinic. This visually striking skin condition often leads my patients to feeling frustrated and confused on how to move forward. However, once we understand the mechanisms behind vitiligo - including its roots in autoimmunity - we can finally begin to take the proper steps toward healing. If you are someone you know is struggling with vitiligo, read on to get a functional medicine perspective on this condition.
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What is vitiligo?
Vitiligo is a chronic skin disorder that results in the loss of melanin, the pigment that gives skin its color. When this pigment is lost, white patches can develop on the skin on various parts of the body. While vitiligo itself is not physically harmful or painful, it can have significant psychological and emotional effects on individuals, impacting their self-esteem and quality of life.
Vitiligo can manifest in two different forms - segmental which is characterized by unilateral patches affecting a specific area of the body and non-segmental which is characterized by symmetrical patches that appear on both sides of the body. But in general, the symptoms are relatively similar between these two types and can include patches of depigmented skin, early graying of hair, and sometimes a change in eye color.
The autoimmune hypothesis
Unfortunately, researchers don’t have a definitive answer to what causes vitiligo, but they believe it has to do with a combination of factors including genetic predisposition, environmental triggers, and autoimmunity. In this case, your immune system mistakenly targets and destroys the melanocytes in your skin which are the cells responsible for producing melanin. Therefore, the answer to the question “is vitiligo an autoimmune disease?” is a resounding yes. In fact, this autoimmune hypothesis is so strong, vitiligo is officially classified as one of the over 100 known autoimmune diseases. This theory is supported by several lines of evidence:
1. Presence of autoantibodies
Studies have identified the presence of autoantibodies targeting melanocytes in the blood of individuals with vitiligo. These autoantibodies indicate an immune response against melanocytes, supporting the idea of autoimmune involvement in the pathogenesis of vitiligo.
2. Genetic factors
Certain genetic factors have been implicated in the development of vitiligo, many of which are associated with immune system function. Variations in genes involved in immune regulation, such as HLA genes, have been linked (1) to an increased susceptibility to vitiligo.
3. Association with other conditions
Between 15-20% (2) of people with vitiligo also have other autoimmune disorders, such as autoimmune thyroid diseases, rheumatoid arthritis, and type 1 diabetes. This clustering of autoimmune conditions suggests a common underlying mechanism involving dysregulation of the immune system, as people with one autoimmune disease are at an increased likelihood of developing more. This is actually common enough that when someone has three or more autoimmune diseases at a time, it is known as Multiple Autoimmune Syndrome. (3)
4. Response to immunosuppressive therapy
Conventional treatments aimed at suppressing the immune system, such as corticosteroids and calcineurin inhibitors, have been shown to be effective in managing vitiligo by slowing or stopping its progression. This just goes to show us the important role your immune system and any subsequent dysfunction is in the development of this condition.
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How an improper autoimmune response causes vitiligo
While researchers are continuing to learn more about the exact mechanisms behind vitiligo, they do understand that this autoimmune response involves multiple areas of your immune system.
1. T cells
In vitiligo, activated T-cells - specifically CD8+ cytotoxic T cells - infiltrate your skin and target (4) melanocytes for destruction. These T cells release pro-inflammatory cytokines, such as interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α), which further promote inflammation and put you on a vicious cycle of melanocyte damage.
2. Antigens
Autoimmune diseases are like a case of mistaken identity. In a healthy individual, your immune system maintains tolerance to self-antigens, such as melanocytes. However, in the case of vitiligo, your body’s own melanocyte cells are incorrectly identified as foreign, leading to an immune response against these self-antigens.
3. B cells
B cells are another type of immune cell that may also play a role in the pathogenesis of vitiligo by producing autoantibodies that further target melanocytes by binding to melanocytes and triggering additional destruction.
The problem with diagnosing vitiligo in conventional medicine - and most other autoimmune conditions - is that a diagnosis isn’t typically made until a significant amount of tissue has already been destroyed. Whereas in functional medicine, we understand that autoimmune disease is a spectrum that starts long before diagnosis is ever made:
- Silent Autoimmunity: There are positive antibody labs but no noticeable symptoms. Your doctor will likely tell you that you are probably fine, or to come back next year and re-test.
- Autoimmune Reactivity: There are positive antibody labs and symptoms, but still not enough to warrant a formal diagnosis.
- Autoimmune Disease: There’s enough body destruction to be diagnosed.
Once we understand that these autoimmune mechanisms can be brewing underneath the surface long before symptoms even appear, we can better know how to identify and treat autoimmune conditions like vitiligo.
How a functional medicine approach can make a difference
Since the answer is yes to the question “is vitiligo an autoimmune disease”, vitiligo is considered a chronic condition that doesn’t have a cure. However, there are many things that you can do to alleviate symptoms and put this condition into remission. Unlike conventional medicine that relies on medications for symptom relief that come with a wide range of side effects, functional medicine aims to identify the root cause behind your immune system dysfunction in order to calm inflammation and this hyperactive immune response, naturally. These are a few of the natural therapies we recommend in my telehealth functional medicine clinic for people with vitiligo:
- Light therapy
- Microneedling
- Anti-inflammatory diet
- Natural supplements (curcumin, zinc, vitamin B12)
- Adaptogens
For a complete guide to natural remedies for vitiligo, check out my article here.
In my telehealth functional medicine clinic, we have years of experience treating autoimmune conditions like vitiligo. Instead of spending years struggling with your autoimmune condition without any answers, we specialize in giving you answers and personalizing functional medicine care that is tailored to your specific needs and biochemistry. Just because your diagnosis is the same as someone else’s, doesn’t mean your treatment plan should be the same.
If you are ready to take the next step in your health journey, schedule a telehealth consultation today to learn about all the different ways we can help you with functional medicine.
As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.
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References:
- Li, Zhangjun et al. “Meta-Analysis of the Association between Vitiligo and Human Leukocyte Antigen-A.” BioMed research international vol. 2016 (2016): 5412806. doi:10.1155/2016/5412806
- MedLine Plus “Vitiligo” Accessed January 2024. https://medlineplus.gov/genetics/condition/vitiligo
- Cojocaru, M et al. “Multiple autoimmune syndrome.” Maedica vol. 5,2 (2010): 132-4.
- Chang, Wei-Ling et al. “Vitiligo: An Autoimmune Skin Disease and its Immunomodulatory Therapeutic Intervention.” Frontiers in cell and developmental biology vol. 9 797026. 14 Dec. 2021, doi:10.3389/fcell.2021.797026
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BY DR. WILL COLE
Dr. Will Cole, DNM, IFMCP, DC is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is also the host of the popular The Art of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian, Gut Feelings, and The Inflammation Spectrum.
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