The convergence theory for vitiligo: A reappraisal

Abstract

Vitiligo is characterized by progressive loss of skin pigmentation. The search for aetiologic factors has led to the biochemical, the neurologic and the autoimmune theory. The convergence theory was then proposed several years ago to incorporate existing theories of vitiligo development into a single overview of vitiligo aetiology. The viewpoint that vitiligo is not caused only by predisposing mutations, or only by melanocytes responding to chemical/radiation exposure, or only by hyperreactive T cells, but rather results from a combination of aetiologic factors that impact melanocyte viability, has certainly stood the test of time. New findings have since informed the description of progressive depigmentation. Understanding the relative importance of such aetiologic factors combined with a careful selection of the most targetable pathways will continue to drive the next phase in vitiligo research: the development of effective therapeutics. In that arena, it is likewise important to acknowledge that pathways affected in some patients may not be altered in others. Taken together, the convergence theory continues to provide a comprehensive viewpoint of vitiligo aetiology. The theory serves to intertwine aetiologic pathways and will help to define pathways amenable to disease intervention in individual patients.

Association of Nod‐like receptor protein‐1 (rs2670660) and Toll‐like receptor‐4 (rs4986790) with non‐segmental vitiligo: A case–control study in South Indian population

“…Recent reports suggest that autoimmunity predisposes the melanocyte damage in NSV (Furue & Kadono, ; Kemp, Waterman, & Weetman, ; Rezaei, Gavalas, Weetman, & Kemp, ). Recently, a revised convergence theory elucidates the role of the junction of adaptive and innate immune response with other factors in disease pathogenesis (Kundu, Mhlaba, Rangel, & Le Poole, ). Polygenic inheritance of several susceptibility genes has been reported to contribute NSV susceptibility (Spritz & Andersen, ).…”

HSP70iQ435A-Encoding DNA Repigments Vitiligo Lesions in Sinclair Swine

“…Cytotoxic T cells reactive with melanosomal antigens are primarily responsible for progressive melanocyte loss (Strassner and Harris, 2016). The disease can be triggered by different forms of stress, and skin Koebnerization is common, particularly in confetti-like depigmentation (Kundu et al, 2018;Sosa et al, 2015). Thus, stress proteins might mediate cutaneous depigmentation.…”

Focus Theme Issue: “Vitiligo and other pigmentary disorders”

“…The group of Caroline Le Poole, Chicago, IL, USA, reassesses the convergence theory of vitiligo proposed by the lead author more than twenty‐five years ago . The paper underlines that several factors can drive initial melanocyte loss and trigger autoimmune involvement leading to a progressive loss of melanocytes, and emphasizes that it is no longer justify to label vitiligo as a disease of “unknown” aetiology.…”