Vitiligo: Diet, microbiome, and immunomodulation

Background: Vitiligo is a chronic autoimmune skin disorder characterized by the progressive loss of melanocytes, resulting in depigmented patches. Its pathogenesis involves genetic predisposition, oxidative stress, immune dysregulation, and, as recent studies suggest, intestinal dysbiosis. Methods: This review analyzes literature sourced from PubMed, PMC, Frontiers, and ResearchGate (2017–2025), focusing on the gut microbiome, the gut-brain-skin axis, and the impact of diet and supplementation on immune responses in vitiligo. Both original and review articles were included, with particular emphasis on studies published between 2022 and 2025. Results: Vitiligo is frequently associated with gut microbiota imbalances, reduced bacterial diversity, a decline in short-chain fatty acid-producing strains ( e.g. , Faecalibacterium , Bifidobacterium ), and an increase in pro-inflammatory bacteria ( e.g. , Escherichia , Proteobacteria ). These alterations may compromise gut barrier integrity, promote systemic inflammation, and activate autoreactive CD8+ lymphocytes. Dietary interventions rich in fiber, antioxidants, and anti-inflammatory compounds, alongside targeted supplementation ( e.g. , vitamins D and B, zinc, probiotics), may help restore microbiota balance, modulate immune function, and support repigmentation. Preliminary data also indicate potential benefits of psychobiotics and phytochemicals. Conclusions: The gut microbiota and diet play a pivotal role in regulating immune responses and maintaining skin homeostasis in patients with vitiligo. Integrated therapeutic strategies, including immunomodulation, microbiome-targeted interventions, personalized nutrition, and psychological support, require further large-scale clinical investigation.