Repigmentation Competence in Vitiligo: Integrating Immune, Regulatory, Regenerative, and Microenvironmental Axes

The review discusses "repigmentation competence" in vitiligo, emphasizing the need to consider lesion-specific biological factors beyond just immune suppression. It proposes that successful repigmentation depends on four biological axes: cytokine network and immune memory, local immune regulation, regenerative capacity, and microenvironmental permissiveness. While JAK inhibitors targeting the IFN-γ/CXCL9/CXCL10 axis show some efficacy, they are often insufficient alone. The review suggests that combination therapies engaging multiple axes may improve outcomes, advocating for a shift from drug-centered to lesion-oriented treatment strategies. It highlights the importance of understanding the microenvironment and regenerative capacity, such as melanocyte stem cells, in achieving effective repigmentation.