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Pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-1 (IL-1), IFN-, and some anti-inflammatory cytokines such as interleukin-5 (IL-5) and IL-10 are increased in patients with active vitiligo (81)

In IDD, there is increased expression of matrix-degrading proteins such as matrix metalloproteinases (MMPs) and a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTs) resulting in deregulation of the normal homeostatic mechanism (Le Maitre et al., 2007)

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Neutrophils that undergo ferroptosis may die and emit damage-associated molecular patterns (DAMPs), which intensifies the inflammatory response (68)

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