Neuropsychological Factors in Vitiligo: Mechanisms and Clinical Application

Vitiligo is a chronic autoimmune depigmenting disorder affecting 0.5%-2% of the global population, characterized by bidirectional interplay between psychological stress and disease progression, with accumulating evidence highlighting the central role and translational relevance of the neuro-endocrine-immune-cutaneous axis in its pathogenesis. Epidemiological data indicate over half of patients experience significant psychological stress prior to disease onset, while visible depigmentation markedly elevates the burden of depression and anxiety, establishing a self-amplifying pathogenic loop. Mechanistically, neural crest-derived melanocytes form functional "neuro-pigment units" with intraepidermal nerve endings, enabling bidirectional communication via neuropeptides including calcitonin gene-related peptide (CGRP) and substance P. Dynamic crosstalk among keratinocytes, sensory neurons, and melanocytes integrates neurotrophic and inflammatory signals to tightly regulate melanocyte survival and biological function. Sympathetic activation drives melanocyte injury via norepinephrine-mediated β2-adrenergic receptor signaling, while dopamine metabolites exacerbate apoptosis via the oxidative stress-Akt-Bad axis; context-dependent hypothalamic-pituitary-adrenal axis effects and light-melatonin-circadian clock disruption further promote immune dysregulation and melanocyte loss. Notably, neuromodulatory approaches like transcutaneous auricular vagus nerve stimulation show therapeutic promise by attenuating oxidative stress and limiting pathogenic CD8⁺ T-cell infiltration. These insights have fostered targeted strategies including CGRP receptor antagonists and dual antioxidant-neuroprotective natural compounds. Integrating neuroimmunological modulation with psychological and circadian interventions represents a promising precision medicine framework for vitiligo management.