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At initial presentation, depigmented white macules were localized on the skin of the periorbital and perioral areas, neck and upper chest, hands, axillae and medial surfaces of the thighs (Figure 1A, 2, 3, 4 and B)

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Foster, R

Cross-Talk with Nitric Oxide and Autonomic Systems One hypothesized downstream linkage is that melanocortin activation in CNS circuits may stimulate nitric oxide synthase (NOS) pathways or neural NO release, which then might support peripheral or autonomic responses (vasodilation, smooth muscle tone modulation) in laboratory settings