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