Clinical Management With Efalizumab of a Patient with Psoriasis and Comorbid Vitiligo

Although the precise pathogenesis is not known, vitiligo appears to be an autoimmune disease involving T cell-mediated melanocyte destruction. Efalizumab, a recombinant, humanized monoclonal antibody, targets T cells, the key mediators of the immunopathogenesis of psoriasis. Although a concomitant presentation of vitiligo with psoriasis is uncommon, several cases have been reported previously in the literature. A case of a patient with vitiligo and psoriasis who was treated with efalizumab to alleviate the symptoms of psoriasis is described. Over the course of the diseases, the patient had been treated unsuccessfully with numerous therapies. The patient initiated efalizumab with a 0.7 mg/kg conditioning dose and then continued on 1 mg/kg weekly. After 2 months of efalizumab therapy, the psoriasis symptoms were reduced, and the vitiligo had visibly improved in some areas. The patient has remained on efalizumab therapy with no evidence of an exacerbation of vitiligo. The management of acute flares is also discussed. This case is illustrative of a patient with psoriasis and vitiligo who was treated successfully with efalizumab.