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Acral vitiligo (AV) is resistant to treatment There are many factors help in developing this resistance. Low density of pilosebaceous follicles, melanocyte, melanocyte stem cell reservoirs, baseline epidermal stem cell factor from which the melanocytes could migrate, lower stem cell factor (SCF), c-kit, MHCII expression as well as lower density of Langerhans cells (LC), and high rate of koebnerization are playing roles in resistance of acral lesions
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