Hi All,
I would like to share with you my understanding about non-segmental vitiligo development.
In my opinion, the sequence is like this:
1)Genetic pre-disposition (PRIMARY cause) => Can or can not be triggered by oxidative stress or emotional reasons or physical traumas (3 SECONDARY causes).
2)Once vitiligo is triggered => Koebner effect takes control. That means that now your body knows "how to make" vitiligo patches appear at specific places (see picture below). So you have to avoid the 3 SECONDARY causes above at any cost. Now you body is just waiting an opportunity to "make" new vitiligo patches appear.
3) Non-segmental vitiligo => white patches happen because melanocytes are detached from the basal membrane. The reasons above plus the genetic pre-disposition stimulate the production of a protein (called MIA) that detaches melanocytes causing the white patch. This protein can be removed if some actions are taken right away. If not, they stay around and increase their amount. That's why old patches are harder to be treated. ( www.vitiligomap.com )
See the Koebner picture bellow and avoid friction:
Replies
Several widespread studies have shown that only ~10-15% of vitiligo cases exhibit the Koebner Effect. Take me for example, I have vitiligo but after a massive number of stitches (32 in two locations due to an exploding glass pane) about 9 months ago, I have shown no Koebner Effect thus far. Typically the Koebner Effect take 4-6 weeks after trauma to show up.
Another thing this does not explain is how vitiligo spreads so fast in many children who have to yet even started many of the activities you mention.
Another thing you may see from the picture above is that many of the locations are where the skin isn't deep, thus there are limited melanocyte reservoirs. Hence, regeneration once vitiligo has started becomes almost non-existent.
This isn't to say that vitiligo isn't going to be displayed via the Koebner Effect but there are plenty of extreme cases of non-segmental vitiligo where the patches begin and expand in areas that aren't subjected to repeated stresses. :)
Remember that there are 4 causes: 1 Primary (genetic) and 3 Secondaries.
The weight of each is very personal. The sequence explains how it gets triggered.
About your examples:
1- If you are under a real oxidative stress, you don't need Koebner effect to see vitiligo spreading. It spreads because of hydrogen peroxide production and lipid peroxidation that destroy the melonocyte adhesion (integrins) and mutate melanocyte DNA.
2- In children, there are 2 theories. Either high weight of the Primary cause or friction caused by the parents when they use tissues to clean them up. These tissues rub their skin a lot. So they develop Koebner effect very early.
3-The fact some that regions have less melanocyte reservoirs (hands, feet, etc.) doesn't explain why melanocytes detach from there. They were supposed to remain there. Melanocytes come from three possible sources: from the hair follicle unit which is the main provider of pigment cells, from the border of vitiligo lesions, and from unaffected melanocytes within depigmented areas; pigment cells at these locations originate a perifollicular, border spreading and a diffuse repigmentation pattern.
So, the real fact is that the absence of reservoirs would certainly slow down repigmentation, but doesn't explain it. The repigmentation can occur anyware in the body, as long as you remove protein MIA that was generated wrongly by the own melanocytes. This is what really causes NSV. Melanocyte can come/migrate easily from the border. It doesn't happen because protein MIA don't let them adhere during migration. Old patches become even more difficult to repigment because they accumulate too much MIA, day by day, generated by the 3 SEC causes.
Certainly, there are different types of vitiligo and its causes, but NSV (non-segmental vitiligo) is definitely caused by the above causes described in the first post ( 1 PRI and 3 SEC) and the cure is coming soon (www.researchforvitiligo.com). More details can be found at: ( www.vitiligopuzzle.com ).
I'm pretty much open to any possibility.
There is however something that really hasn't been discussed much: while the end result is the same (white patches due to a lack of melanocytes), there may very well multiple ways that the patches are caused. While one person may have it as an auto-immune disease, someone else may have a different underlying issue. If that's the case, even if there was a "cure", it may not work for everyone. That could also point to why some treatments are so effective for certain people but have no effect for others.
I'm sure that there are many types of vitiligo. Many are correlated to other auto-immune diseases, lead toxicity, adrenal fatigue, whatsoever. But NSV, the one that is symmetrical, that spreads in the regions described in the drawing, can be managed with a good universal protocol until cure comes.
I hope next year.