It has come to my attention that many are still not aware that vitiligo, a condition that causes skin to lose its normal pigmentation, is an autoimmune disorder and must be treated as such. A cursory review of the literature turns up an abundance of evidence:

Frontiers and controversies in the pathobiology of vitiligo: separating the wheat from the chaff

“There is a body of interlocking, compelling evidence supporting an autoimmune basis for most or all cases of generalized vitiligo. The development of an autoimmune disease generally involves three components; the immune system, environmental triggers and other exogenous precipitating factors, and the target tissue. In vitiligo, precipitating factors could induce melanocyte damage in genetically susceptible individuals and consequent cell death, loss of tolerance, and induction of melanocyte-directed autoimmunity.”

Immunological pathomechanisms in vitiligo

“Briefly, circulating autoantibodies and autoreactive T cells that recognise pigment cell antigens have been detected in the sera of a significant proportion of vitiligo patients compared with healthy individuals. In addition, vitiligo is often associated with other disorders that have an autoimmune origin, including Hashimoto’s thyroiditis, Graves’ disease, type 1 insulin-dependent diabetes mellitus and Addison’s disease.”

Autoimmune Etiology of Generalized Vitiligo

“Vitiligo is characterized by progressive skin depigmentation resulting from an autoimmune response targeting epidermal melanocytes…Type I cytokine-mediated immunity to melanocytes in vitiligo involves T cells reactive with melanosomal antigens…”

Autoimmune Destruction of Skin Melanocytes by Perilesional T Cells from Vitiligo Patients

“Our data show that perilesional cytotoxic T cells eradicate pigment cells, the characteristic hallmark of vitiligo, thereby providing evidence of T cells being able to mediate targeted autoimmune tissue destruction.”

Prediction and prevention of autoimmune skin disorders

“Autoimmune diseases can be preceded by a symptom-free phase which is defined by the presence of autoantibodies, and may last for many years…Characteristic autoantibodies and susceptible genes have been identified in many autoimmune systemic and mucocutaneous diseases such as systemic lupus erythematosus, pemphigus, vitiligo, dermatitis hepretiformis and even psoriasis…Prevention of overt disease may be achieved once high-risk individuals are identified and triggering factors are avoided. Numerous environmental factors, such as vitamin D deficiency, ultraviolet light, smoking, drugs, etc., that may trigger autoimmunity have been found.”

Moreover, an interesting and important connection with conditions such as autoimmune thyroiditis and type 1 diabetes has been observed:

Autoimmune Aspects of Vitiligo

“In brief, the disease is frequently associated with other disorders which have an autoimmune origin such as autoimmune thyroiditis and insulin-dependent diabetes mellitus. Furthermore, circulating antibodies and T lymphocytes which react against melanocyte antigens are present in the sera of a significant proportion of vitiligo patients compared with healthy individuals.”

High frequency of thyroid dysfunction in patients with vitiligo

“An association between vitiligo and autoimmune thyroid disease has previously been suspected…There appears to be an increased frequency of clinical as well as subclinical thyroid disease in patients with vitiligo. Our findings support the theory of vitiligo being an autoimmune disease and indicate a need for screening vitiligo patients for thyroid disease.”

Of keen interest and significance is the overlap with genes involved in gluten sensitivity:

HLA-DQA1*0301-Associated Susceptibility for Autoimmune Polyglandular Syndrome Type II and III

“We determined the HLA-DR and HLA-DQA1 association in 112 unrelated patients with APS II (n = 29), APS III (n = 83) and 184 unrelated patients with single-component diseases without further manifestations of APS: Graves’ disease, Hashimoto’s thyroiditis, autoimmune Addison’s disease, vitiligo and alopecia…”

Due to its prevalence, treating the causes of autoimmunity is a major part of a functional medicine practice.