Integrating neuronal involvement into the immune and genetic paradigm of vitiligo.

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In this review we show how the neuronal theory is relevant to the convergence theory for the mechanism causing vitiligo, especially the segmental type. Neuropetides and neurotransmitters, e.g. neuropeptide-Y and dopamine, can be central to the pathological mechanisms of melanocyte destruction. They link into a bidirectional network connecting cutaneous nerves, the neuro-endocrine axis, and the immune system, and, through their local influence on cutaneous inflammation, to the antigen-specific regulatory T cells and the chemokine ligand type 9 (CXCL9)/ chemokine receptor type 1 (CXCR1) axis that are thought to be the final pathway for melanocyte destruction.

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