Neural Hypothesis
The neural hypothesis of vitiligo is based on observations of segmental vitiligo. Segmental vitiligo is a unique form of vitiligo. It manifests in a dermatomal, rather than Blaschkoid, distribution and is therefore postulated to involve segmental nerves that innervate affected areas. In 1 study, segmental vitiligo lesions were found to have 3 times the level of cutaneous blood flow of normal contralateral skin. Because sympathetic nerves induce vasoconstriction as they control blood flow to the skin, it is thought that vitiligo may be mediated by inadequate sympathetic innervation. This hypothesis is supported by a finding that the sympathetic nerves in vitiligo lesions have an abnormally increased adrenoceptor response to oxidative stress. Segmental vitiligo does not Koebnerize, does not increase in size after the first year, and is relatively recalcitrant to treatment. Understanding the possible difference in pathogenesis may allow for development of more effective treatments.
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