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Triggering Factors Against a genetically predisposed background, certain triggering events can precipitate the onset or worsening of vitiligo: Intense emotional stress (grief, separation, psychological shock) particularly frequent Skin trauma : phenomenon of Koebner (appearance of spots on friction areas, cuts, burns, tattoos) Severe sunburn Pregnancy, childbirth, menopause (hormonal fluctuations) Viral or bacterial infections Certain medications (rare cases of induction by interferons, cancer immunotherapies) Key takeaway: vitiligo is never "the patient's fault"

In mice, dietary iron deficiency leads to increased HIF2 in intestinal epithelial cells, where it promotes the transcription of DMT1 and other genes involved in the absorption of dietary iron (

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In particular, topiramate may control the flow of glutamate and cysteine through System Xc-, which could impact GSH synthesis and improve the ability of GPX4 to change harmful lipid hydroperoxides into safe lipid alcohols