Dr. Nada Elbuluk: Lifestyle & Holistic Approaches in Vitiligo

What initially inspired your Dermatology journey and your interest in Vitiligo?

I became attracted to dermatology early in my medical school education because of several components that made the field feel very unique. I loved that it was a subspecialty that required in-depth knowledge of specific parts of the body, namely the skin, hair, and nails. I also appreciated the versatility of the field: one could build many different types of careers within dermatology, whether in outpatient or inpatient settings, academic and /or private practice, medical and /or procedural work, and across all age groups. I was also drawn to the visual nature of dermatology, and the many exciting research opportunities it offers.

You gave a lecture on “Diet & Supplements in Vitiligo” at the recent AAD meeting. What sparked your interest in this particular area?

I’ve always been interested in holistic approaches to treatment, and in how Eastern and Western medicine can be integrated to provide optimal care for patients. I believe that lifestyle, including diet and nutrition, can influence many dermatological conditions, vitiligo among them.

In fact, growing evidence suggests that nutrition and diet can play a role in a wide range of dermatologic disorders, making it an important factor to consider when approaching vitiligo holistically. As one of the most challenging skin conditions to treat, vitiligo has increasingly drawn attention to complementary strategies that can be used adjunctively with conventional treatments (1).

Lifestyle & Holistic Approaches in Vitiligo:

What is driving the growing interest in holistic and complementary approaches?

I think people are becoming more aware of how their lifestyle can affect their health on multiple levels. As individuals take greater ownership of their well-being, many are actively seeking ways to optimize their health and manage conditions, including options beyond traditional medicine.

Patients themselves are increasingly exploring holistic and alternative approaches. A 2024 survey found that 32.5% of vitiligo patients had tried some form of complementary or alternative therapy, motivated by the desire for more natural solutions, concerns about side effects, or frustration with the limited results of conventional treatments (2).

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Are there specific lifestyle habits, such as diet, exercise, or stress management techniques, that you believe can help mitigate oxidative stress and inflammation in vitiligo patients?

This is a fascinating field that needs more scientific study, but we do know that there’s an increase in reactive oxygen species and alterations in the immune system associated with vitiligo. In clinical practice, we often observe that when patients are under physical or mental stress, they may experience flares of their vitiligo.

With that in mind, I believe that addressing both mental and physical health has the potential to impact the stability of the disease. I would love to see more research exploring how lifestyle habits may influence vitiligo and other immune or inflammation-driven conditions.

Which dietary habits and supplements sound the most promising in supporting re-pigmentation and overall skin health?

There are currently no randomized controlled trials specifically evaluating diet in the treatment of vitiligo. While some studies have looked at the role of vitamins and supplements, we still need more robust, standardized research using standardized outcome measures, before we can make broad, evidence-based recommendations in this area.

When it comes to dietary guidance, recommendations remain inconsistent. Some sources emphasize reducing alcohol intake, others advise avoiding high-fat diets, and some highlight the importance of minimizing exposure to smoking and heavy metals.When we connect current findings, the overarching message seems to be that incorporating anti-inflammatory and antioxidant-rich foods while avoiding pro-inflammatory lifestyle factors may offer some benefit.

When it comes to supplements, e-Table 1 from the publication by Grimes and Nashawati provides a comprehensive overview of those most commonly recommended for vitiligo management, particularly for their antioxidant, anti-inflammatory, and immunomodulatory properties.Vitamin B12 and folic acid are often used alone or in combination with phototherapy to support repigmentation though data and results are mixed and some are inconclusive. Vitamin C has been studied for its antioxidant and immunomodulatory properties. Vitamin E is also commonly used, either on its own or in conjunction with phototherapy.

In addition to vitamins, certain herbal remedies have shown promise. Ginkgo biloba, Polypodium leucotomos, and green tea extracts are of particular interest.Still, the lack of standardized evidence continues to be one of the biggest challenges in drawing firm clinical conclusions.

Anything else exciting on the horizon in the scientific literature on Vitiligo?

I think there’s a lot of exciting research currently underway in the vitiligo space, particularly around the pathophysiology of the disease, its associated comorbidities, and emerging treatment options. As our understanding deepens, I believe we’ll see an expansion of available therapies for vitiligo in the coming years.

One particularly promising area of exploration is the gut microbiome. Several recent publications have examined gut microbiome diversity in individuals with vitiligo, suggesting a possible state of dysbiosis

Similar patterns were observed in the skin microbiome, with notable differences in bacterial diversity between lesional and non-lesional skin. These findings suggest that both gut and skin microbiome alterations may contribute to the pathogenesis of vitiligo. Further research is essential to clarify the clinical significance of these microbiome changes, particularly in relation to modifiable external factors such as diet and lifestyle (4).

This area holds considerable promise for advancing our understanding of disease mechanisms and identifying predictive markers for vitiligo progression.

Bibliography:

1. 1. Dutta RR, Kumar T, Ingole N. Diet and Vitiligo: The Story So Far. Cureus. 2022;14(8):e28516. Published 2022 Aug 28. doi:10.7759/cureus.28516.

2. Poondru S, Yang LJ, Kundu RV. Use of complementary and alternative medicine in vitiligo: a cross-sectional survey. Arch Dermatol Res. 2024;316(5):126. Published 2024 Apr 23. doi:10.1007/s00403-024-02872-x 

3. Grimes PE, Nashawati R. The Role of Diet and Supplements in Vitiligo Management. Dermatol Clin. 2017 Apr;35(2):235-243. doi: 10.1016/j.det.2016.11.012. PMID: 28317532. 

4. Nigro A, Osman A, Suryadevara P, Cices A. Vitiligo and the microbiome of the gut and skin: a systematic review. Arch Dermatol Res. 2025;317(1):201. Published 2025 Jan 8. doi:10.1007/s00403-024-03679-6