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Many studies suggest that vitiligo is associated with insulin resistance, lipid abnormalities, and other metabolic disorders ( Metabolic reprogramming is the modification of different metabolic processes to regulate the function and phenotype of immune cells to meet the regulation and execution of immune functions ( Oxidative stress The reciprocal action of reactive oxygen species and the immune system in vitiligo Reactive oxygen species (ROS) induced oxidative stress triggers a wide range of abnormal organelle functions, disrupts metabolic pathways, and impairs defense mechanisms against oxidant shocks

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It must be noted that in an individual case a clear distinction between the injury types may not always be possible and there may be overlapping

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