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Alteration of genetic factors involved in immune responses and melanogenesis along with environmental factors are central to disease manifestation

Liu X, Zhao T, Wang L, Yang Z, Luo C, Li M, et al

Increased BDI-II scores resulted from items related to mental and physical fatigue (tiredness/fatigue, loss of energy, items referring to cognitive symptoms such as concentration difficulties) apart from one patient, who had a higher score across most items, while still not meeting the criteria for depression

Tacrolimus and pimecrolimus are prescription creams that reduce inflammation without the rebound effects of steroids