Core Messages: The initial evaluation of a vitiligo patient is a step frequently neglected. More epidemiological data could delineate heritability vs. environmental factors and natural history. Clinical data do not support the concept of a common involvement of non skin melanocytes in non-segmental vitiligo (NSV) (with the exception of the oral and genital mucosae, and vitiligo universalis). Major initial determinants are probably situated directly in the skin, and activated in a subset of patients by mechanical stressors (Koebner's phenomenon). NSV can be considered in a subset of patients as a marker of an auto-inflammatory/auto-immune diathesis, but other predisposing inherited traits are involved (including premature melanocyte aging).
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