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These risks can be more significant, but if monitored and done in a controlled way, are minimal, says Calvert

although the pathophysiological mechanism involved in this context is not fully elucidated, whether dependent on the change in the oxidative state, the modification of the immune tolerance system, or the participation of neurokinins.103 In vitiligo, neuropeptide Y is increased in lesional skin and the perilesional area.104 Substance P is increased in the skin of stable vitiligo when compared to unstable disease, suggesting that it is associated with vitiligo stability.105 Extreme physical or psychological stress increases the synthesis of catecholamines and requires the activation of the hypothalamic-pituitary-adrenal axis, which interferes with the immune system regulation