Treatment of Generalized Vitiligo With Anti-TNF-α Agents
April 2012 | Volume 11 | Issue 4 | Case Reports | 534 | Copyright © April 2012
Khalid M. AlGhamdi MD,a,b Huma Khurrum MD,b Alain Taïeb MD,c Khaled Ezzedine MD PhD d
a Dermatology Department,a,b Vitiligo Research Chair,a,b College of Medicine, King Saud University, Riyadh, Saudi Arabia. c Department of Dermatology and Pediatric Dermatology, Saint André and Pellegrin Hospitals, Bordeaux University Hospitals, France d Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Diseases, Centre Hospitalier Universitaire of Bordeaux, Bordeaux, France.
Abstract
Background: Although the exact pathogenesis of vitiligo is not fully understood, it appears to be an autoimmune disease. It is hypothesized
that tumor necrosis factor alpha (TNF-α) plays an important role in vitiligo. TNF-α can destroy melanocytes through the induction
of various apoptotic pathways. In addition, TNF-α can inhibit melanocyte stem cell differentiation.
Objective: To evaluate the efficacy and safety of treating vitiligo patients with anti-TNF-α agents.
Methods: A total of 6 patients were recruited. All patients had widespread non-segmental vitiligo. Biologics, including infliximab,
etanercept, and adalimumab, were given according to treatment regimens used for psoriasis. Photographs were taken at the initial
visit, every two months during the therapy and then six months after therapy completion.
Results: All patients completed the treatment; two patients were treated with infliximab, two with etanercept, and two with adalimumab.
All of the biologics were well tolerated throughout the treatment period, and none of the patients reported any significant
adverse events. Digital images were compared before, during and after treatment. Repigmentation of the vitiliginous areas was not
observed in any of the patients. Vitiligo worsened in one patient who was treated with infliximab and developed a psoriasiform rash.
However, the remaining patients did not develop any new depigmented patches during treatment or at the six-month follow-up; vitiligo
was considered stable in these five patients.
Conclusions: Although the anti-TNF-α agents were well tolerated in all six vitiligo patients, efficacy was not observed. Further evaluation
with larger studies may be required.
J Drugs Dermatol. 2012;11(4):534-539.
INTRODUCTION
The efficacy of biologics for psoriasis treatment has been
shown in several randomized clinical trials.1 However,
little is known regarding the use of these drugs for the
treatment of vitiligo. Although the exact etiology of vitiligo remains unclear, autoimmunity is currently recognized as one of
the most likely pathologic mechanisms.2 Both cellular and humoral immune responses have been implicated in the development of vitiligo, and their roles continue to be investigated. Peripheral blood and skin biopsies of patients with vitiligo show
that T-cells, mononuclear cells, various pro-inflammatory cytokines, and auto-antibodies all damage melanocytes.3
The aim of this pilot study was to evaluate the efficacy and
safety of using the anti Tumor necrosis factor-alpha (anti-TNF-α)
agents infliximab, etanercept, and adalimumab for the treatment of widespread vitiligo.
METHOD
Six patients with widespread vitiligo covering 5% or more of
the body surface area were recruited from the dermatology
clinic at King Khalid University Hospital, Riyadh, Saudi Arabia.
Two patients were treated with etanercept, two with infliximab,
and two with adalimumab. Patient data and the outcomes of
vitiligo treatment are summarized in Table 1.
All patients had unstable vitiligo (with increasing lesions within
last 6 months) and had received no treatment for vitiligo for at
least the past three months. The re-pigmentation and decrease
in lesion size were assessed at baseline, every 2 months during the therapy, and six months after therapy completion using
digital photography.
Laboratory investigations for all six patients included chest X-rays (CXR), intradermal purified protein derivative tests (PPD),
