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Heat, derived from procedures such as laser hair removal or pulsed light, can damage the skin and trigger depigmentation.77,78 On the other hand, smoking, with its detrimental effects on skin health and the immune system, can exacerbate the disease.79 Furthermore, numerous drugs, including some immunomodulators and biological agents, can induce or worsen vitiligo.8083 Moreover, viral infections, such as HCV, HIV, varicella-zoster virus (VZV), and COVID-19, and exposure to allergens suchas dust mites, have been associated with vitiligo outbreaks.8486 Finally, psychological stress is a known factor that can aggravate the condition, possibly due to its impact on the immune system.87 However, there are no studies that prove a direct association between vitiligo and pollution, specific diets, or alcohol consumption.8890 Environmental triggers of vitiligo.7686,8891 TKI: tyrosine kinase inhibitors