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Triggering Factors Against a genetically predisposed background, certain triggering events can precipitate the onset or worsening of vitiligo: Intense emotional stress (grief, separation, psychological shock) particularly frequent Skin trauma : phenomenon of Koebner (appearance of spots on friction areas, cuts, burns, tattoos) Severe sunburn Pregnancy, childbirth, menopause (hormonal fluctuations) Viral or bacterial infections Certain medications (rare cases of induction by interferons, cancer immunotherapies) Key takeaway: vitiligo is never "the patient's fault"

In their study the GSG-Index was found to be elevated in those with NAFLD, more elevated in NAFLD plus obesity, and highly correlated to liver enzymes

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B-S C, Zeng Z, Mu H, Wang Z, McQueen T, Protopopova M, Cortes J, Marszalek J, S-B P, Davis RE, Thornton DE, Andreeff M , Konopleva M