Vitiligo pp 121-124 | Cite as

Environmental Triggers and Occupational/Contact Vitiligo

  • Charlotte VrijmanEmail author


Different factors, including the genetic ones, predispose an individual to developing vitiligo, but a trigger event initiates the actual depigmentation. The triggers are environmental factors that are encountered in everyday life. When the development of vitiligo is influenced by occupational exposures like chemical exposure, frequent physical trauma, or sun exposure, it is called occupational or contact vitiligo. Phenolic/catecholic derivatives are major chemicals known to be associated with vitiligo since they interfere in the melanin synthesis and induce oxidative stress. Other chemicals mentioned as causative agents are nickel, chrome, cobalt, leather, hair dye, cosmetics, and cleaning products, all allergens that also cause allergic contact dermatitis by contact hypersensitivity (CHS). Identification of provoking factors and therefore risk factors for vitiligo are important in preventing disease progression, although they are often not recognised due to unawareness of patients. Therefore, patients should be educated how to avoid these known risk factors.


  1. 1.
    Jeon IK, Park CJ, Lee MH, et al. A multicenter collaborative study by the Korean Society of Vitiligo about patients’ occupations and the provoking factors of vitiligo. Ann Dermatol. 2014;26:349–56.CrossRefGoogle Scholar
  2. 2.
    Vrijman C, Hosseinpour D, Bakker JG, et al. Provoking factors, including chemicals, in Dutch patients with vitiligo. Br J Dermatol. 2013;168:1003–11.CrossRefGoogle Scholar
  3. 3.
    Ahn YS, Kim MG. Occupational skin diseases in Korea. J Korean Med Sci. 2010;25:S46–52.CrossRefGoogle Scholar
  4. 4.
    Boissy RE, Manga P. On the etiology of contact/occupational vitiligo. Pigment Cell Res. 2004;17:208–14.CrossRefGoogle Scholar
  5. 5.
    Ghosh S. Chemical leukoderma: what’s new on etiopathological and clinical aspects? Ind J Dermatol. 2010;55:255–8.CrossRefGoogle Scholar
  6. 6.
    Ezzedine K, Lim H, Suzuki T, et al. Revised classification/nomenclature of vitiligo and related issues: The Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res. 2012;25(3):E1–E13.CrossRefGoogle Scholar
  7. 7.
    van den Boorn JG, Picavet DI, van Swieten PF, et al. Skin-depigmenting agent monobenzone induces potent T-cell autoimmunity toward pigmented cells by tyrosinase haptenation and melanosome autophagy. J Invest Dermatol. 2011;131:1240–51.CrossRefGoogle Scholar
  8. 8.
    Toosi S, Orlow SJ, Manga P. Vitiligo-inducing phenols activate the unfolded protein response in melanocytes resulting in upregulation of IL6 and IL8. J Invest Dermatol. 2012;132:2601–9.CrossRefGoogle Scholar
  9. 9.
    Yang F, Sarangarajan R, Le Poole IC, et al. The cytotoxicity and apoptosis induced by 4-tertiary butylphenol in human melanocytes are independent of tyrosinase activity. J Invest Dermatol. 2000;114:157–64.CrossRefGoogle Scholar
  10. 10.
    Lerner AB. On the etiology of vitiligo and gray hair. Am J Med. 1971;51:141–7.CrossRefGoogle Scholar
  11. 11.
    Webb KC, Eby JM, Hariharan V, et al. Enhanced bleaching treatment: opportunities for immune-assisted melanocyte suicide in vitiligo. Exp Dermatol. 2014;23:529–33.CrossRefGoogle Scholar
  12. 12.
    Ebner H, Helletzgruber M, Hofer R, et al. Vitiligo from p-tert. butylphenol; a contribution to the problem of the internal manifestations of this occupational disease. Occup Environ Dermat. 1979;27:99–104.Google Scholar
  13. 13.
    Budde J, Stary A. Skin and systemic disease caused by occupational contact with p-tert-butylphenol. Occup Environ Dermat. 1988;36:17–9.Google Scholar
  14. 14.
    Bajaj AK, Gupta SC, Chatterjee AK. Contact depigmentation from free para-tertiary-butylphenol in bindi adhesive. Contact Dermatitis. 1990;22:99–102.CrossRefGoogle Scholar
  15. 15.
    Manga P, Sheyn D, Yang F, et al. A role for tyrosinase-related protein 1 in 4-tert-butylphenol-induced toxicity in melanocytes: implications for vitiligo. Am J Pathol. 2006;169:1652–62.CrossRefGoogle Scholar
  16. 16.
    Yang F, Boissy RE. Effects of 4-tertiary butylphenol on the tyrosinase activity in human melanocytes. Pigment Cell Res. 1999;12:237–45.CrossRefGoogle Scholar
  17. 17.
    Hariharan V, Klarquist J, Reust MJ, et al. Monobenzyl ether of hydroquinone and 4-tertiary butyl phenol activate markedly different physiological responses in melanocytes: relevance to skin depigmentation. J Invest Dermatol. 2010;130:211–20.CrossRefGoogle Scholar
  18. 18.
    Kroll TM, Bommiasamy H, Boissy RE, et al. 4-Tertiary butyl phenol exposure sensitizes human melanocytes to dendritic cell-mediated killing: relevance to vitiligo. J Invest Dermatol. 2005;124:798–806.CrossRefGoogle Scholar
  19. 19.
    Mosenson JA, Eby JM, Hernandez C, et al. A central role for inducible heat-shock protein 70 in autoimmune vitiligo. Exp Dermatol. 2013;22:566–9.CrossRefGoogle Scholar
  20. 20.
    van den Boorn JG, Konijnenberg D, Dellemijn TA, et al. Autoimmune destruction of skin melanocytes by perilesional T cells from vitiligo patients. J Invest Dermatol. 2009;129:2220–32.CrossRefGoogle Scholar
  21. 21.
    Ghosh S, Mukhopadhyay S. Chemical leucoderma: a clinico-aetiological study of 864 cases in the perspective of a developing country. Br J Dermatol. 2009;160:40–7.CrossRefGoogle Scholar
  22. 22.
    Lecart S, Boulay V, Raison-Peyron N, et al. Phenotypic characterization of human CD4+ regulatory T cells obtained from cutaneous dinitrochlorobenzene-induced delayed type hypersensitivity reactions. J Invest Dermatol. 2001;117:318–25.CrossRefGoogle Scholar
  23. 23.
    Ezzedine K, Eleftheriadou V, Whitton M, et al. Vitiligo. Lancet. 2015;386:74–84.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of DermatologyZiekenhuisgroep TwenteHengeloNetherlands

Personalised recommendations