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Hi Friends,

I was trying to figure out why Protopic works well one face patches but not on others...

First of all, in order to achieve good results with Protopic, one has to take care of the real causes mentioned exhaustively in other posts (oxidative stress, traumas/friction and psychological/emotional stress).

But how does Protopic (tacrolimus) work?

It works keeping immune system away. However, it's not enough to justify why it works really better on face patches.

Once a friend of mine had a cell transplantation surgery, the surgeon asked him to apply Protopic once a day on the treated patches.  Dr. said that it would not be to re-pigment, but to keep the pigments that had just been transplanted. He meant, to keep the immune system away from the new cells so that the transplanted melanocytes in the suspension could attach better.  We know that Tacrolimus (Protopic) is widely used in organs transplantation.

So,  I think there is an interplay between immune system and melanocyte detachment theory.  When MIA protein  detaches melanocytes,  immune system  (t-cells) comes to see what happened and eventually kill the already detached melanocytes, which are roaming around, without giving them a chance to re-attach.
I agree that MIA protein was the causative agent, but melanocytes should  re-attach if friction stops.  There are papers that support it...

Back to face patches.
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If I'm right about possible re-attachment theory,  that would explain why Protopic works well on face patches.
The face pressure cycle (different from elbow/knee/wrist/hand/foot cycles)  happens only at night (during 7-8 hours).  I mean,  when we sleep our head put a lot of pressure on the face against the pillow.  Specially on prominent bone areas.  It detaches melanocytes.  However,  this cycle happens only once a day.  So, melanocytes that are detached by MIA protein during the night, which are roaming around in the epidermis, will have the whole day (16-17 hours) to try to re-attach, as long as one applies Protopic to keep the immune system away.  Otherwise it might kill them (like transplanted cells).

Differently from face, elbow/knee/wrist/hand/foot friction cycles happen all the time, all day long.  Externally or internally by the joints.  Very intensively during the day (16-17 hours), and less intensively during the night (7-8 hours), what makes the re-attachment on these areas much more difficult, even applying Protopic.

Just sharing...