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Vitiligo: Autoimmune Silent and Non-Silent Celiac Sign

Posted Jul 01 2009 4:29pm 1 Comment

At my children's elementary school, I'd conservatively estimate that at least 25% of the children have vitiligo the skin condition that the late Mr. Michael Jackson suffered from (or...self-induced?) that caused loss of skin pigementation (melanocytes). Small patches of whitish areas on their tan or darker-toned faces are the tell-tale signs. I'm not a dermatologist but this is easy to diagnosis. Vitiligo is yet another autoimmune disease with high association with several HLA immune types which leads to destruction of target cells (T-cell cytotoxic lymphocyte destruction of skin melanocytes). This condition is obviously more apparent in darker-skinned individuals (like my daughter) of Asian, Indo-Asian and Middle Eastern descent but paler-toned individuals who have a risk of melanoma also can share the same pathology.

Common treatment is immunosuppressants which dampen the body's own immune responses. In fact we were given steroid creams to apply to the lightened spots on my daughter's face. Does these work? Perhaps for some, but in our case, none worked and we ended up just giving up. We had been on vitamin D (which cured her intermittent asthma) and omega-3s for half-year but noticed no real changes on the white spots until we went gluten-free. Yes, apparently I've ruined my daughter's life since we stopped wheat and gluten (we are the 'weirdos' in her school and understandably she's horribly embarrassed).

Within 4wks of going gluten-free, her skin toned completely evened out and ALL the few mild whites disappeared.

Where did vitiligo come from?? Neither my parents or my in-laws have ever been affected by this skin condition? It's not contagious. It's inherent in the DNA. What promoted its expression?

My parents are Hakka and their ancestors grew up for hundreds of years on the island Taiwan. They grew up eating grains like rice (which is of course non-gluten containing) and had little wheat or flour products. With the Japanese occupation their diet in fact probably improved -- consuming more miso (fermented soy bean), varied seafood, buckwheat (again not gluten), etc. Growing up we ate sashimi from a young age and little bread or cereal (except the bread for succulent roasted Peking duck at restaurants). Below is an excerpt from the WSJ of what modern Taiwanese eat -- many cook traditional Japanese foods like my parents (fusion *haa*).





"...much of what you find in Taiwan that's truly Japanese is a relic of sorts from its days as a colony of the empire of the sun. From 1895 to 1945, Japan occupied Taiwan and the nearby Pescadore Islands -- its spoils of victory over the Chinese in the Sino-Japanese War (1894-95). During that time, the Japanese turned an agrarian backwater into one of the most modern -- and well-educated -- societies in Asia.

The Japanese built grand public buildings, turned the harbors of Kaohsiung and Keelung into key shipping ports, and laid a railroad that stretched along the western coast of the island. In Taipei, they tore down the old city walls and built a grid pattern for the city's streets. Eventually, they extended primary education -- in Japanese, of course -- to ordinary Taiwanese, an effort to nurture literate workers. "


I have been seeing an older 70-something year old gentleman with all 3 diabetic complications -- retinopathy, nephropathy and neuropathy. High Lp(a) and vitiligo. Lp(a) progressess ALL diabetic complications -- specific organ damage including macrovascular disease of the coronary arteries all occur faster, deeper and harder. He declined insulin. So we hammered and hammered the diet and negotiated a few vitamins. He was already very active spending most days working around the house and helping his wife with grandchildren.

New diet:
Breakfast -- 3-6 eggs, bacon occ (nitrate free, organic), menudo (no starches, no hominy, no corn)
Lunch -- salad with protein and olive oil
Dinner -- protein, little starch (yams, few small potatoes (no corn tortillas which are all contaminated with flour/wheat; no bread)

Started:
Magnesium 2-4 daily (all Metabolic Syndrome are depleted)
Taurine (in 3mos -- this resolved all diabetic neuropathy symptoms; we stopped Neurontin)
Omega-3 BOATLOADS EPA DHA 6-8 g daily (for Lp(a), insulin resistance, autoimmunity, etc)
Vitamin D to achieve 25OHD 70 ng/ml
Vitamin A for skin and deficiency
Slo-niacin (vitamin B3) 500mg/d and gradually titrated to 1.5 g/d over sev mos


After 3-6 mos, the Creatinine (kidney measuremented) improved from 1.5 to 1.2 (maybe better now -- that was 12/08), HDL increased from 33-35 to 48 (again probably better now -- 12/08 labs), he lost 4-6 inches on his large expansive belly, and his sugars were well controlled (no insulin EVAH; a1c 6.9% from 8%). In fact, the oral medications have all had to be cut back (Prinzide, Amlodipine, Glipizide); Actos and Neurontin entirely stopped. Simvastatin 20mg cut back to once weekly... yeah... the dose: licks the tablet once a week. He also conceded that he felt younger, more energetic and glad for the diet changes. We actually had some ... ummm... disagreements for the first 3 mos! Giving up food he had been eating for 70yrs was ahhh let's say DIFFICULT.



Mild vitiligo on his face completely disappeared.

The extensive vitiligo on his hands and fingertips (similar to the wiki picture posted above) stabilized and did not worsen.

He attended several large family reunions and get togethers and he reported to me that many were shocked and surprised... they told him he looked much younger. He told me that he doesn't miss eating bread, cereal or tortilla's. Or upset that he has to wear suspenders to keep his pants from falling off of his tight skinny little *ss... (ok that's my clinical assessment and eval *ehe*).



References:

Genetic variation of promoter sequence modulates XBP1 expression and genetic risk for vitiligo.
Ren Y, Yang S, Xu S, Gao M, Huang W, Gao T, Fang Q, Quan C, Zhang C, Sun L, Liang Y, Han J, Wang Z, Zhang F, Zhou Y, Liu J, Zhang X.
PLoS Genet. 2009 Jun;5(6):e1000523. Epub 2009 Jun 19.


Vitiligo and melanoma-associated hypopigmentation (MAH): shared and discriminative features.
Hartmann A, Bedenk C, Keikavoussi P, Becker JC, Hamm H, Bröcker EB.
J Dtsch Dermatol Ges. 2008 Dec;6(12):1053-9.


Autoimmune etiology of generalized vitiligo.
Le Poole IC, Luiten RM.
Curr Dir Autoimmun. 2008;10:227-43. Review.

Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists.
Collin P, Reunala T.
Am J Clin Dermatol. 2003;4(1):13-20. Review.


Lack of functionally active Melan-A(26-35)-specific T cells in the blood of HLA-A2+ vitiligo patients.
Adams S, Lowes MA, O'Neill DW, Schachterle S, Romero P, Bhardwaj N.
J Invest Dermatol. 2008 Aug;128(8):1977-80. Epub 2008 Mar 13.


[ssociation of HLA class I and II alleles with generalized vitiligo in Chinese Hans in north China]
Wang J, Zhao YM, Wang Y, Xiao Y, Wang YK, Chen HD.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2007 Apr;24(2):221-3. Chinese.


Association of HLA loci alleles and antigens in Saudi patients with vitiligo.
Abanmi A, Al Harthi F, Al Baqami R, Al Assaf S, Zouman A, Arfin M, Tariq M.
Arch Dermatol Res. 2006 Dec;298(7):347-52. Epub 2006 Sep 22.


Linkage and association of HLA class II genes with vitiligo in a Dutch population.
Zamani M, Spaepen M, Sghar SS, Huang C, Westerhof W, Nieuweboer-Krobotova L, Cassiman JJ.
Br J Dermatol. 2001 Jul;145(1):90-4.


HLA class II haplotype DRB1*04-DQB1*0301 contributes to risk of familial generalized vitiligo and early disease onset.
Fain PR, Babu SR, Bennett DC, Spritz RA.
Pigment Cell Res. 2006 Feb;19(1):51-7.


Autoimmune diseases in vitiligo: do anti-nuclear antibodies decrease thyroid volume?
Zettinig G, Tanew A, Fischer G, Mayr W, Dudczak R, Weissel M.
Clin Exp Immunol. 2003 Feb;131(2):347-54.


Possible transfer of vitiligo by allogeneic bone marrow transplantation: A case report.
Mellouli F, Ksouri H, Dhouib N, Torjmen L, Abdelkefi A, Ladeb S, Othman TB, Hmida S, Hassen AB, Béjaoui M.
Pediatr Transplant. 2008 Nov 18.
Comments (1)
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