Similar autoimmune etiologies and global incidence rates suggest an association between, celiac disease (CD) and vitiligo, according to findings published in World Journal of Clinical Cases.
Researchers searched for studies related to vitiligo, CD, and gluten-free diets (GFD) in the PubMed, Ovid, Web of Science, and Cochrane databases from their inception until February 2021. Researchers screened 776 studies and selected 15 for further review. Of these, 4 studies examined the relationship between vitiligo and CD, 7 reported a relationship between CD and vitiligo, and another 4 studies studied a relationship between a gluten-free diet (GFD) and vitiligo.
In 1 of the 2 cross-sectional studies, 5 of 176 (2.8%) patients with vitiligo also had celiac disease. However, in the other cross-sectional study, researchers found no incidence of CD in 198 patients with vitiligo.
In 1 of the case-controlled studies, investigators studied the seroprevalence rates of anti-endomysial IgA antibodies in 61 patients (including 21 children) with vitiligo compared with 60 individuals serving as control participants. They identified seropositivity in 11 patients with vitiligo compared with 1 patient in the control group, resulting in rates of 23.8% amongst children and 15% amongst adults with vitiligo. Intestinal biopsies confirmed a 3.2% prevalence of celiac disease in these seropositive patients.
In the second case-control study, investigators studied EMA and anti-tTG IgA in 64 patients with vitiligo compared with 64 patients serving as control participants. They reported a seropositivity in 2 women (3.1%) with vitiligo compared with 0% incidence in the control group.
The researchers noted 2 case reports describing the recoloring of vitiligo lesions after gluten-free diet initiation, suggesting that dietary gluten elimination may improve vitiligo. Also, 2 case reports detailed coexistence of vitiligo and dermatitis herpetiformis in which a gluten-free diet improved the dermatitis herpetiformis, but either aggravated or had no effect on the vitiligo.
“A review of existing evidence supports the association between CD and vitiligo,” the study authors concluded. This finding is particularly important, they believe, as patients with vitiligo frequently present with nonspecific intestinal symptoms that are “often ignored by doctors and patients.” They suggest that those with vitiligo may benefit from CD screening and that patients with CD in whom vitiligo is detected early consider a GFD as it can can address both disorders.
Zhang JZ, Abudoureyimu D, Wang M, Yu SR, Kang XJ. Association between celiac disease and vitiligo: A review of the literature.World J Clin Cases. 2021;9(34):10430-10437. doi:10.12998/wjcc.v9.i34.10430