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On the other hand, Langerhans cells are increased in the epidermis, the basement membrane is thickened, and cytoplasmic vacuolization phenomena are observed.44,45 It should be noted that Dickkopf 1 (DKK1) protein, involved in reducing melanogenesis, is overexpressed in fibroblasts in lesional skin.46 There is also increased fibronectin expression and reduced elastin in lesional dermis, with no changes observed in collagen fibers.47,48 Genetic changes involved in the etiopathogenesis of vitiligo Vitiligo is a complex disease with a significant genetic component, estimated between 75% and 83%

The manipulation that forms the basis of this change is called altered peptide ligand (APL) protein therapy

Ther Adv Med Oncol 9(8):551-564, 2017

McLeay et al