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Russell R, Daniel BS. A narrative review of the literature: The role of biologics and JAK inhibitors in vitiligo. Australas J Dermatol 2024. [PMID: 39087440 DOI: 10.1111/ajd.14353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/22/2024] [Accepted: 07/06/2024] [Indexed: 08/02/2024]
Abstract
Vitiligo is a chronic depigmenting disorder that significantly impacts the quality of life of patients. Though there have been significant advancements in targeted therapies in skin diseases such as psoriasis or eczema, the progress in the treatment of vitiligo has been slow, with minimal studies assessing the effect of biologics, though there has been recent evidence of the effectiveness of JAK inhibition. This paper reviews the published case reports and studies for the use of systemic targeted therapies including biologics and JAK inhibitors in vitiligo.
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Affiliation(s)
- Rhiannon Russell
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
| | - Benjamin S Daniel
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Perez-Bootello J, Cova-Martin R, Naharro-Rodriguez J, Segurado-Miravalles G. Vitiligo: Pathogenesis and New and Emerging Treatments. Int J Mol Sci 2023; 24:17306. [PMID: 38139134 PMCID: PMC10743634 DOI: 10.3390/ijms242417306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Vitiligo is a complex disease with a multifactorial nature and a high impact on the quality of life of patients. Although there are multiple therapeutic alternatives, there is currently no fully effective treatment for this disease. In the current era, multiple drugs are being developed for the treatment of autoimmune diseases. This review assesses the available evidence on the pathogenesis of vitiligo, and a comprehensive review of treatments available for vitiligo now and in the near future is provided. This qualitative analysis spans 116 articles. We reviewed the mechanism of action, efficacy and safety data of phototherapy, afamelanotide, cyclosporine, phosphodiesterase 4 inhibitors, trichloroacetic acid, basic fibroblast growth factor, tumor necrosis factor (TNF) inhibitors, secukinumab, pseudocatalase and janus kinase (JAK) inhibitors. At the moment, there is no clearly outstanding option or fully satisfactory treatment for vitiligo, so it is necessary to keep up the development of new drugs as well as the publication of long-term effectiveness and safety data for existing treatments.
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Xie B, Zhu Y, Shen Y, Xu W, Song X. Treatment update for vitiligo based on autoimmune inhibition and melanocyte protection. Expert Opin Ther Targets 2023; 27:189-206. [PMID: 36947026 DOI: 10.1080/14728222.2023.2193329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION The treatment of vitiligo remains challenging due to the complexity of its pathogenesis, influenced by genetic factors, oxidative stress and abnormal cell adhesion that collectively impact melanocyte survival and trigger immune system attacks, resulting in melanocyte death. Melanocytes in vitiligo are believed to exhibit genetic susceptibility and defects in cellular mechanisms, such as defects in autophagy, that reduce their ability to resist oxidative stress, leading to increased expression of the pro-inflammatory protein HSP70. The low expression of adhesion molecules, such as DDR1 and E-cadherin, accelerates melanocyte damage and antigen exposure. Consequently, autoimmune attacks centered on IFN-γ-CXCR9/10-CXCR3-CD8+ T cells are initiated, causing vitiligo. AREAS COVERED This review discusses the latest knowledge on the pathogenesis of vitiligo and potential therapeutic targets from the perspective of suppressing autoimmune attacks and activating melanocytes functions. EXPERT OPINION Vitiligo is one of the most challenging dermatological diseases due to its complex pathogenesis with diverse therapeutic targets. Immune suppression, such as corticosteroids and emerging JAK inhibitors, has proven effective in disease progression. However, during the early stages of the disease, it is also important to optimize therapeutic strategies to activate melanocytes for alleviating oxidative stress and improving treatment outcomes.
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Affiliation(s)
- Bo Xie
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine; West Lake Ave 38, Hangzhou, 310009, People's Republic of China
| | - Yuqi Zhu
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine; West Lake Ave 38, Hangzhou, 310009, People's Republic of China
- Zhejiang Chinese Medical University; Binwen Rd 548, Hangzhou, 310053, People's Republic of China
| | - Yuqing Shen
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine; West Lake Ave 38, Hangzhou, 310009, People's Republic of China
- Zhejiang Chinese Medical University; Binwen Rd 548, Hangzhou, 310053, People's Republic of China
| | - Wen Xu
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine; West Lake Ave 38, Hangzhou, 310009, People's Republic of China
- Zhejiang University School of Medicine; Yuhangtang Rd 866, Hangzhou, 310058, People's Republic of China
| | - Xiuzu Song
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine; West Lake Ave 38, Hangzhou, 310009, People's Republic of China
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Lee H, Cowan TL, Daniel BS, Murrell DF. A review of JAK and IL-23 inhibitors to treat vitiligo. Australas J Dermatol 2023; 64:204-212. [PMID: 36810815 DOI: 10.1111/ajd.14001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Abstract
Vitiligo is an autoimmune skin disorder resulting in the depigmentation of skin characterised by patches of varying sizes and shapes. A common disorder of pigmentation that affects 0.5%-2% of the global population. Despite its well-understood autoimmune pathogenesis, the targets for effective cytokine intervention remain unclear. Current first-line treatments include oral or topical corticosteroids, calcineurin inhibitors and phototherapy. These treatments are limited, have varying efficacies, and are associated with significant adverse events or can be time-consuming. Therefore, biologics should be explored as a potential treatment for vitiligo. There are currently limited data for the use of JAK and IL-23 inhibitors for vitiligo. A total of 25 studies were identified in the review. There is promising evidence regarding the use of JAK and IL-23 inhibitors for the treatment of vitiligo.
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Affiliation(s)
- Henry Lee
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy L Cowan
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
| | - Benjamin S Daniel
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
| | - Dédée F Murrell
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
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Feng Y, Lu Y. Advances in vitiligo: Update on therapeutic targets. Front Immunol 2022; 13:986918. [PMID: 36119071 PMCID: PMC9471423 DOI: 10.3389/fimmu.2022.986918] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
Vitiligo, whose treatment remains a serious concern and challenge, is an autoimmune skin disease characterized by patches of depigmentation. The increasing application of molecular-targeted therapy in skin diseases, such as psoriasis and systemic lupus erythematosus, has dramatically improved their condition. Besides, there is a favorable effect of repigmentation in the treatment of the above diseases combined with vitiligo, implying that molecular-targeted therapy may also have utility in vitiligo treatment. Recently, the role of cytokine and signaling pathways in vitiligo pathogenesis are increasingly recognized. Thus, investigations are underway targeting the molecules described above. In this paper, we present a synopsis of current practices in vitiligo treatment and introduce the improvement in identifying new molecular targets and applying molecular-targeted therapies, including those under development in vitiligo treatment, providing valuable insight into establishing further precision medicine for vitiligo patients.
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Raimondo A, Guglielmi G, Marino C, Ligrone L, Lembo S. Hair whitening in a patient with psoriasis on adalimumab reversed after switching to ixekizumab. JAAD Case Rep 2021; 11:51-53. [PMID: 33912637 PMCID: PMC8063687 DOI: 10.1016/j.jdcr.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Annunziata Raimondo
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Salerno, Italy
| | - Giulia Guglielmi
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Salerno, Italy
| | - Carlo Marino
- Dermatology Unit, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Scuola Medica Salernitana, Salerno, Italy
| | - Luigi Ligrone
- Dermatology Unit, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Scuola Medica Salernitana, Salerno, Italy
| | - Serena Lembo
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Salerno, Italy
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Tumor necrosis factor (TNF)-α- 308 G/A gene polymorphism (rs1800629) in Egyptian patients with alopecia areata and vitiligo, a laboratory and in silico analysis. PLoS One 2020; 15:e0240221. [PMID: 33370782 PMCID: PMC7769607 DOI: 10.1371/journal.pone.0240221] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose & methods Several single-nucleotide polymorphisms (SNPs) in the promoter region of the TNF-α gene can cause variations in the gene regulatory sites and act as risk factors for some autoimmune disorders as alopecia areata (AA) and vitiligo. This study aimed to detect the serum TNF-α (sTNF) level (by ELISA) and the rs1800629 (by real-time PCR) among AA and vitiligo Egyptian patients and to determine their relation with disease duration and severity. In silico analysis of this SNP to study the molecular regulation of the mutant genotypes was also done. Results In AA patients, no risk was associated with the mutant genotypes vs. the normal genotype, or with A allele vs. G allele. The risk of vitiligo was significantly higher with the G/A and A/A genotypes compared with HCs (p = 0.011). Similarly, a significantly increased risk was noted in patients with A allele vs. G allele (p<0.0001). In AA and vitiligo patients, a significant increase in sTNF-α levels was noted in the mutant G/A genotypes vs. the normal G/G genotype (p<0.0001) and in the A allele vs the G allele (p<0.0001). According to the in silico analysis, this SNP could mainly affect the SP1 transcription factor binding site with subsequent effect on TNF-α expression. Conclusion According to results of the laboratory and the in silico study, the mutant TNF-α (308) genotypes were risk factors that conferred susceptibility to vitiligo among Egyptian patients but had no effect on the susceptibility to AA.
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Jaouad N, Ben Abdelghani K, Sellami M, Khadiri F, Amine B, Elbinoune I, Fazaa A, Laatar A, Bahiri R. Vitiligo and anti-tumor necrosis factors: Cases report. Therapie 2020; 76:504-507. [PMID: 33323190 DOI: 10.1016/j.therap.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/20/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Nada Jaouad
- Service of Rheumatology A, El Ayachi Hospital, University Mohamed V Rabat, 11150 Salé, Morocco.
| | - Kawther Ben Abdelghani
- Mongi Slim Hospital, Faculty of medicine, University of Tunis EL Manar, 2046 Tunis, Tunisia
| | - Meriem Sellami
- Mongi Slim Hospital, Faculty of medicine, University of Tunis EL Manar, 2046 Tunis, Tunisia
| | - Fadoua Khadiri
- Poison Control and Pharmacovigilance Center, 10100 Rabat, Morocco
| | - Bouchra Amine
- Service of Rheumatology A, El Ayachi Hospital, University Mohamed V Rabat, 11150 Salé, Morocco
| | - Imane Elbinoune
- Service of Rheumatology A, El Ayachi Hospital, University Mohamed V Rabat, 11150 Salé, Morocco
| | - Alia Fazaa
- Mongi Slim Hospital, Faculty of medicine, University of Tunis EL Manar, 2046 Tunis, Tunisia
| | - Ahmed Laatar
- Mongi Slim Hospital, Faculty of medicine, University of Tunis EL Manar, 2046 Tunis, Tunisia
| | - Rachid Bahiri
- Service of Rheumatology A, El Ayachi Hospital, University Mohamed V Rabat, 11150 Salé, Morocco
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Rajendiran KS, Rajappa M, Chandrashekar L, Thappa DM, Devaraju P. Association Analysis of Tumor Necrosis Factor Alpha Promoter Polymorphisms and Vitiligo Susceptibility in South Indian Tamils. Dermatology 2020; 236:554-564. [PMID: 32074604 DOI: 10.1159/000505544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022] Open
Abstract
Tumor necrosis factor alpha (TNF-α) has been associated with the pathogenesis of several autoimmune diseases. Also, various studies in different ethnics showed an association between TNF-α gene polymorphisms and susceptibility to vitiligo. The paucity of genetic data led us to undertake this study to evaluate the association of five TNF-α SNPs (rs1799964, rs1800630, rs1799724, rs1800629, and rs361525) with the development of vitiligo in South Indian Tamils. A total of 264 vitiligo patients and 264 healthy controls were recruited and TNF-α genotyping was performed using amplification-refractory mutation system polymerase chain reaction and TaqMan allele discrimination assay. Circulatory TNF-α levels were measured by enzyme-linked immunosorbent assay. We observed that a single polymorphic allele A in the promoter region -308 (rs1800629) conferred significant risk to develop vitiligo (p = 0.0002, OR = 1.70, 95% CI = 1.28-2.25), whereas the other polymorphisms failed to contribute to disease risk (p > 0.05). From the constructed haplotypes, TCCAG was found to be a significant risk factor for vitiligo (p < 0.05). Also, a strong linkage disequilibrium was observed between the following SNPs: (1) rs1799964 and rs1800629 (2) rs1800630 and rs1799724 (D' = 0.90). Analysis of the influence of genotype on phenotypes revealed that the A allele of rs361525 was a risk factor for vitiligo in females (p = 0.04, OR = 0.45, 95% CI = 0.21-0.95), whilst the rs1800629 allele conferred protection against early disease onset (p < 0.05). A statistically significant difference in plasma TNF-α levels was found between cases and controls (p < 0.05). The TNF-α -308A allele and TCCAG haplotype were identified as genetic risk factors for vitiligo susceptibility in South Indian Tamils.
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Affiliation(s)
- Kalai Selvi Rajendiran
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Medha Rajappa
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Laxmisha Chandrashekar
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India,
| | - Devinder Mohan Thappa
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Panneer Devaraju
- Unit of Microbiology and Molecular Biology, Indian Council of Medical Research-Vector Control Research Centre, Puducherry, India
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Singh M, Kotnis A, Jadeja SD, Mondal A, Mansuri MS, Begum R. Cytokines: the yin and yang of vitiligo pathogenesis. Expert Rev Clin Immunol 2018; 15:177-188. [DOI: 10.1080/1744666x.2019.1550358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mala Singh
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, India
| | - Ashwin Kotnis
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, India
| | - Shahnawaz D. Jadeja
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, India
| | - Anushree Mondal
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, India
| | - Mohmmad S. Mansuri
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, India
| | - Rasheedunnisa Begum
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, India
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Increased Risk of Vitiligo Following Anti-Tumor Necrosis Factor Therapy: A 10-Year Population-Based Cohort Study. J Invest Dermatol 2018; 138:768-774. [DOI: 10.1016/j.jid.2017.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/07/2017] [Accepted: 11/14/2017] [Indexed: 11/20/2022]
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Wan J, Lin F, Zhang W, Xu A, DeGiorgis J, Lu H, Wan Y. Novel approaches to vitiligo treatment via modulation of mTOR and NF-κB pathways in human skin melanocytes. Int J Biol Sci 2017; 13:391-400. [PMID: 28367103 PMCID: PMC5370446 DOI: 10.7150/ijbs.17318] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/09/2017] [Indexed: 01/18/2023] Open
Abstract
Vitiligo is a skin depigmentation disorder with an increasing prevalence. Among recognized mechanisms is the oxidative stress that affects melanocytes which are responsible for skin pigmentation. Studies have shown that high concentration of hydrogen peroxide, or H2O2, induces apoptotic activities. Few studies have been done with lower doses of H2O2. Using human skin melanocytes, we investigated the effect of moderate concentration of H2O2 on melanocyte dendrites. Confocal data show that H2O2 at 250 µM induces loss of dendrites, as indicated by cytoskeletal proteins. α-melanocyte stimulating hormone or α-MSH pretreatment protects against H2O2-induced loss of dendrites, while α-MSH alone enhances dendrites. PI3K/AKT inhibitor LY294002 and mTORC1 inhibitor Rapamycin inhibit α-MSH-induced dendrites. In this study, we also investigated the effect of TNFα on cultured human skin melanocytes, since TNFα plays important roles in vitiligo. Confocal data demonstrate that TNFα induces NFκB activation. Western blot analysis shows that TNFα induces IκB phosphorylation and degradation. Interestingly, α-MSH does not have any effect of TNFα-induced IκB degradation and NF-κB activation. α-MSH, however, activates mTORC1 pathway. TNFα induces p38 but not AMPKα activation. Collectively, our data suggest that modulation of mTOR and NF-κB pathways may be a novel approach for better clinical management of vitiligo.
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Affiliation(s)
- Jerry Wan
- Department of Biology, Providence College, Providence, RI 02918, USA
| | - Fuquan Lin
- Department of Dermatology, the 3 rd Hospital of Hangzhou, Hangzhou 310000, Zhejiang Province, China
| | - Wei Zhang
- Department of Dermatology, Guiyang Medical University, Guizhou 550004, China
| | - Aie Xu
- Department of Dermatology, the 3 rd Hospital of Hangzhou, Hangzhou 310000, Zhejiang Province, China
| | - Joseph DeGiorgis
- Department of Biology, Providence College, Providence, RI 02918, USA
| | - Hongguang Lu
- Department of Dermatology, Guiyang Medical University, Guizhou 550004, China
| | - Yinsheng Wan
- Department of Biology, Providence College, Providence, RI 02918, USA
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Toussirot É, Aubin F. Paradoxical reactions under TNF-α blocking agents and other biological agents given for chronic immune-mediated diseases: an analytical and comprehensive overview. RMD Open 2016; 2:e000239. [PMID: 27493788 PMCID: PMC4964220 DOI: 10.1136/rmdopen-2015-000239] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/24/2016] [Accepted: 04/28/2016] [Indexed: 12/26/2022] Open
Abstract
Paradoxical adverse events (PAEs) have been reported during biological treatment for chronic immune-mediated diseases. PAEs are defined as the occurrence during biological agent therapy of a pathological condition that usually responds to this class of drug. A wide range of PAEs have been reported including dermatological, intestinal and ophthalmic conditions, mainly with antitumour necrosis factor α (TNF-α) agents. True PAEs include psoriasis, Crohn's disease and hidradenitis suppurativa. Other PAEs may be qualified as borderline and include uveitis, scleritis, sarcoidosis and other granulomatous diseases (granuloma annulare, interstitial granulomatous dermatitis), vasculitis, vitiligo and alopecia areata. Proposed hypotheses to explain these PAEs include an imbalance in cytokine production, the differential immunological properties between the monoclonal antibodies and TNF-α soluble receptor, an unopposed type I interferon production and a shift towards a Th1/Th2 profile. Data from registries suggest that the risk for paradoxical psoriasis is low and non-significant. We discuss management of these PAEs, which depends on the type and severity of the adverse events, pre-existing treated conditions and the possibility of alternative therapeutic options for the underlying disease. Paradoxical adverse events are not restricted to anti-TNF-α agents and close surveillance of new available biological drugs (anti-interleukin-17/23, anti-integrin) is warranted in order to detect the occurrence of new or as yet undescribed events.
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Affiliation(s)
- Éric Toussirot
- Clinical Investigation Center in Biotherapy, INSERM CIC-1431, University Hospital of Besançon, Besançon, France
- FHU INCREASE, University Hospital of Besançon, Besançon, France
- Department of Rheumatology, University Hospital of Besançon, Besançon, France
- Department of Therapeutics and UPRES EA 4266: “Pathogenic agents and Inflammation”, University of Franche-Comté, Besancon, France
| | - François Aubin
- Department of Dermatology, University Hospital of Besançon, Besançon, France
- University of Franche-Comté, Besançon, France
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Méry-Bossard L, Bagny K, Chaby G, Khemis A, Maccari F, Marotte H, Perrot JL, Reguiai Z, Sigal ML, Avenel-Audran M, Boyé T, Grasland A, Gillard J, Jullien D, Toussirot E. New-onset vitiligo and progression of pre-existing vitiligo during treatment with biological agents in chronic inflammatory diseases. J Eur Acad Dermatol Venereol 2016; 31:181-186. [PMID: 27291924 DOI: 10.1111/jdv.13759] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/06/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The development of vitiligo during treatment with biological agents is an unusual event and only a few isolated cases have been reported. OBJECTIVES To describe the clinical characteristics and evolution of patients developing new-onset vitiligo following initiation of a biological agent for chronic inflammatory disease; and also to report the clinical course of pre-existing vitiligo under biological therapy. METHODS This nationwide multicentre, retrospective study, carried out between July 2013 and January 2015, describes the characteristics of a large series of 18 patients (psoriasis N = 8, inflammatory rheumatic diseases N = 8, ulcerative colitis N = 1, uveitis N = 1) who developed new-onset vitiligo while receiving a biological agent. RESULTS TNFα inhibitors were the most common biological agent involved (13/18) while anti-IL-12/23 and anti-IL-17 agents or abatacept were less common (4/18 and 1/18 respectively). Mean duration of biological agent exposure before vitiligo onset was 13.9 ± 16.5 months. Outcome was favourable for most patients (15/17) while maintaining the biological agent. Data were also collected for 18 patients (psoriasis N = 5, inflammatory rheumatic diseases N = 10, inflammatory bowel diseases N = 2, SAPHO N = 1) who had pre-existing vitiligo when treatment with a biological agent started (TNFα inhibitors N = 15, ustekinumab N = 1, rituximab N = 1, tocilizumab N = 1). Vitiligo progressed in seven patients and was stable or improved in eight cases. CONCLUSION Vitiligo may thus emerge and/or progress during treatment with various biological agents, mainly TNFα inhibitors and could be a new paradoxical skin reaction. De novo vitiligo displays a favourable outcome when maintaining the biological agent, whereas the prognosis seems worse in cases of pre-existing vitiligo.
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Affiliation(s)
- L Méry-Bossard
- Département de dermatologie, CH François Quesnay, Mantes-la-Jolie, France
| | - K Bagny
- Département de médecine interne et dermatologie, CHU Felix Guyon, Saint-Denis, France
| | - G Chaby
- Département de dermatologie, CHU Amiens Picardie Site Nord, Amiens, France
| | - A Khemis
- Département de dermatologie, CHU Archet 2, Nice, France
| | - F Maccari
- Département de dermatologie, HIA Bégin, Saint-Mandé, France
| | - H Marotte
- Département de rhumatologie, CHU Saint-Etienne Hôpital Nord, Saint Etienne, France
| | - J L Perrot
- Département de dermatologie, CHU Saint Etienne Hôpital Nord, Saint-Etienne, France
| | - Z Reguiai
- Département de dermatologie, CHU Reims, Reims, France
| | - M L Sigal
- Département de dermatologie, CH Victor Dupouy, Argenteuil, France
| | | | - T Boyé
- Département de dermatologie, HIA Sainte-Anne, Toulon, France
| | - A Grasland
- Département de médecine interne, AP-HP Hôpital Louis Mourier, Colombes, France
| | - J Gillard
- Département de rhumatologie, CHT Jura Sud, Lons le Saulnier, France
| | - D Jullien
- Département de Dermatologie, CHU Edouard Herriot, Lyon, France
| | - E Toussirot
- Centre d'investigation clinique biothérapie INSERM CIC-1431, FHU INCREASE, Rhumatologie, CHRU, Besançon, France
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Jung JM, Lee YJ, Won CH, Chang SE, Lee MW, Choi JH, Moon KC. Development of Vitiligo during Treatment with Adalimumab: A Plausible or Paradoxical Response? Ann Dermatol 2015; 27:620-1. [PMID: 26512182 PMCID: PMC4622902 DOI: 10.5021/ad.2015.27.5.620] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/06/2014] [Accepted: 11/12/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ye Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Chan Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Webb KC, Tung R, Winterfield LS, Gottlieb AB, Eby JM, Henning SW, Le Poole IC. Tumour necrosis factor-α inhibition can stabilize disease in progressive vitiligo. Br J Dermatol 2015; 173:641-50. [PMID: 26149498 PMCID: PMC4583813 DOI: 10.1111/bjd.14016] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 12/21/2022]
Abstract
Tumour necrosis factor (TNF)-α, a proinflammatory cytokine central to many autoimmune diseases, has been implicated in the depigmentation process in vitiligo. We review its role in vitiligo by exploring its pro- and anti-inflammatory properties and examine the effects of blocking its actions with TNF-α antagonist therapeutics in reports available in the literature. We found that TNF-α inhibition halts disease progression in patients with progressive vitiligo but that, paradoxically, treatment can be associated with de novo vitiligo development in some patients when used for other autoimmune conditions, particularly when using adalimumab and infliximab. These studies reinforce the importance of stating appropriate outcomes measures, as most pilot trials propose to measure repigmentation, whereas halting depigmentation is commonly overlooked as a measure of success. We conclude that TNF-α inhibition has proven useful for patients with progressive vitiligo, where TNF-α inhibition is able to quash cytotoxic T-cell-mediated melanocyte destruction. However, a lingering concern for initiating de novo disease will likely prevent more widespread application of TNF inhibitors to treat vitiligo.
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Affiliation(s)
- K C Webb
- Department of Dermatology, Loyola University Stritch School of Medicine, 2160 South First Ave, Maywood, IL, U.S.A
| | - R Tung
- Department of Dermatology, Loyola University Stritch School of Medicine, 2160 South First Ave, Maywood, IL, U.S.A
| | - L S Winterfield
- Department of Dermatology, Loyola University Stritch School of Medicine, 2160 South First Ave, Maywood, IL, U.S.A
| | - A B Gottlieb
- Department of Dermatology, Tufts University Medical Center, Boston, MA, U.S.A
| | - J M Eby
- Oncology Research Institute, Loyola University Chicago, IL, U.S.A
| | - S W Henning
- Oncology Research Institute, Loyola University Chicago, IL, U.S.A
| | - I C Le Poole
- Departments of Pathology, Microbiology and Immunology, Loyola University Stritch School of Medicine, 2160 South First Ave, Maywood, IL, U.S.A
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Evaluation of the Efficacy of Topical Tetracycline in Enhancing the Effect of Narrow Band UVB against Vitiligo: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial. ISRN DERMATOLOGY 2014; 2014:472546. [PMID: 24665368 PMCID: PMC3934486 DOI: 10.1155/2014/472546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 12/24/2013] [Indexed: 01/03/2023]
Abstract
Background. Vitiligo is a pigmentary disorder characterized by depigmented macules due to absence of melanocytes. Increased levels of tumor necrosis factor alpha and interleukin-1 in the epidermis of lesions may play a role in keratinocyte apoptosis and less production of melanogenic cytokines. Tetracyclines reduce production of tumor necrosis factor alpha and interleukin-1. Objective. To evaluate the effect of topical tetracycline on vitiligo patients on phototherapy. Methods. Thirty cases of generalized stable vitiligo were chosen randomly and pigmentation of two assigned lesions on right and left sides (same size and location) was determined by vitiligo area severity index, and medication and placebo were randomly assigned to be applied twice daily on either right or left side, respectively. Images were taken of the lesions at the end of the 4th, 8th, and 12th weeks and pigmentations were compared to baseline using aforementioned index. The patients also took narrow band ultraviolet B two to three times a week. Results. Mean pigmentation, based on vitiligo area severity index, changed significantly from 90.1667 to 86.6667 (P = 0.026) and on placebo side from 89.6667 to 86.8333 (P = 0.026). There was no significant difference between medication and placebo sides in terms of pigmentation (P = 0.566). Conclusions. No significant difference in improving repigmentation between medication and placebo sides was seen.
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18
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Allam M, Riad H. Concise review of recent studies in vitiligo. Qatar Med J 2013; 2013:1-19. [PMID: 25003059 PMCID: PMC4080492 DOI: 10.5339/qmj.2013.10] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 10/20/2013] [Indexed: 12/12/2022] Open
Abstract
Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. Etiological hypotheses of vitiligo include genetic, immunological, neurohormonal, cytotoxic, biochemical, oxidative stress and newer theories of melanocytorrhagy and decreased melanocytes survival. There are several types of vitiligo which are usually diagnosed clinically and by using a Wood's lamp; also vitiligo may be associated with autoimmune diseases, audiological and ophthalmological findings or it can be a part of polyendocrinopathy syndromes. Several interventions are available for the treatment for vitiligo to stop disease progression and/or to attain repigmentation or even depigmentation. In this article, we will present an overall view of current standing of vitiligo research work especially in the etiological factors most notably the genetic components, also, types and associations and various and newer treatment modalities.
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Affiliation(s)
- Mohamed Allam
- Dermatology Department, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Riad
- Dermatology Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
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19
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Camara-Lemarroy CR, Salas-Alanis JC. The role of tumor necrosis factor-α in the pathogenesis of vitiligo. Am J Clin Dermatol 2013; 14:343-50. [PMID: 23912226 DOI: 10.1007/s40257-013-0039-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Vitiligo is an acquired immune disorder of the skin characterized by the presence of white depigmented macules. Its immunopathogenesis is not completely understood, but inflammatory alterations in the skin microenvironment, and particularly increased expression of the cytokine tumor necrosis factor-α (TNFα), are thought to be essential regulators of melanocyte dysfunction and death. In this article we review the evidence that implicates TNFα in the pathogenesis of vitiligo, including studies on serum and tissue levels of TNFα, TNFα gene polymorphisms, in vitro studies, and therapeutic trials using TNFα inhibitors. TNFα emerges as a complex mediator with apparently conflicting roles in vitiligo.
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Affiliation(s)
- Carlos R Camara-Lemarroy
- Departamento de Medicina Interna, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL, 64700, Mexico,
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20
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Maruthappu T, Leandro M, Morris SD. Deterioration of vitiligo and new onset of halo naevi observed in two patients receiving adalimumab. Dermatol Ther 2013; 26:370-2. [DOI: 10.1111/dth.12002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thivi Maruthappu
- Department of Dermatology; University College London Hospital; London; UK
| | - Maria Leandro
- Department of Dermatology; University College London Hospital; London; UK
| | - Susie D. Morris
- Department of Dermatology; University College London Hospital; London; UK
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21
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Abstract
There is a limited number of options in vitiligo treatment, with the disease frequently refractory to all existing treatment modalities. This warrants development of novel and improving existing vitiligo treatments as well as finding predicting factors to improve treatment outcome through appropriate selection and the most efficient application of a treatment. These issues are addressed in clinical studies aiming to evaluate safety and efficiency of novel treatments, improvements and modifications introduced to existing treatments, and to define predictors of treatment efficiency and their limitations. Here, results of recent (since year 2009) clinical studies in vitiligo field are overviewed, with the emphasis on their contribution to improved vitiligo management.
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22
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Nguyen TV, Cowen EW, Leslie KS. Autoinflammation: From monogenic syndromes to common skin diseases. J Am Acad Dermatol 2013; 68:834-53. [PMID: 23453357 DOI: 10.1016/j.jaad.2012.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 10/05/2012] [Accepted: 11/01/2012] [Indexed: 11/26/2022]
Abstract
Autoinflammation is characterized by aberrant regulation of the innate immune system and often manifests as periodic fevers and systemic inflammation involving multiple organs, including the skin. Mutations leading to abnormal behavior or activity of the interleukin 1 beta (IL-1ß)-processing inflammasome complex have been found in several rare autoinflammatory syndromes, for which anticytokine therapy such as IL-1 or tumor necrosis factor-alfa inhibition may be effective. It is becoming clear that features of autoinflammation also affect common dermatoses, some of which were previously thought to be solely autoimmune in origin (eg, vitiligo, systemic lupus erythematosus). Recognizing the pathogenetic role of autoinflammation can open up new avenues for the targeted treatment of complex, inflammatory dermatoses.
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Affiliation(s)
- Tien V Nguyen
- Department of Dermatology, University of California, San Francisco, California 94143, USA
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23
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Laddha NC, Dwivedi M, Begum R. Increased Tumor Necrosis Factor (TNF)-α and its promoter polymorphisms correlate with disease progression and higher susceptibility towards vitiligo. PLoS One 2012; 7:e52298. [PMID: 23284977 PMCID: PMC3527546 DOI: 10.1371/journal.pone.0052298] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 11/12/2012] [Indexed: 02/07/2023] Open
Abstract
Tumor Necrosis Factor (TNF)-α, is a paracrine inhibitor of melanocytes, which plays a critical role in the pathogenesis of several autoimmune diseases including vitiligo, as abnormal immune responses have frequently been observed in vitiligo patients. Moreover, vitiligo patients show higher lesion levels of TNF-α. Genetic polymorphisms in the promoter region of TNF-α are involved in the regulation of its expression. The present study explores TNF-α promoter polymorphisms and correlates them with TNF-α transcript and protein levels in vitiligo patients and controls of Gujarat along with its effect on disease onset and progression. PCR-RFLP technique was used for genotyping of these polymorphisms in 977 vitiligo patients and 990 controls. TNF-α transcript and protein levels were measured by Real time PCR and ELISA respectively. The genotype and allele frequencies for the investigated polymorphisms were significantly associated with vitiligo patients. The study revealed significant increase in TNF-α transcript and protein levels in vitiligo patients compared to controls. In particular, haplotypes: AATCC, AACCT, AGTCT, GATCT, GATCC and AGCCT were found to increase the TNF-α levels in vitiligo patients. Analysis of TNF-α levels based on the gender and disease progression suggests that female patients and patients with active vitiligo had higher levels of TNF-α. Also, the TNF-α levels were high in patients with generalized vitiligo as compared to localized vitiligo. Age of onset analysis of the disease suggests that the haplotypes: AACAT, AACCT, AATCC and AATCT had a profound effect in the early onset of the disease. Moreover, the analysis suggests that female patients had an early onset of vitiligo. Overall, our results suggest that TNF-α promoter polymorphisms may be genetic risk factors for susceptibility and progression of the disease. The up-regulation of TNF-α transcript and protein levels in individuals with susceptible haplotypes advocates the crucial role of TNF-α in autoimmune pathogenesis of vitiligo.
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Affiliation(s)
- Naresh C. Laddha
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
| | - Mitesh Dwivedi
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
| | - Rasheedunnisa Begum
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
- * E-mail:
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Colucci R, Lotti T, Moretti S. Vitiligo: an update on current pharmacotherapy and future directions. Expert Opin Pharmacother 2012; 13:1885-99. [PMID: 22835073 DOI: 10.1517/14656566.2012.712113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Vitiligo is a common pigmentary skin disorder, characterized by the appearance of white macules on the skin, mucosal or hair. Treatment is often a tough challenge and involves a wide range of therapies. AREAS COVERED This review focuses on available first- and second-line pharmacological treatments for vitiligo. In particular, the mechanisms of action, the main indications, the efficacy and the most important side effects are reviewed. Moreover, a brief discussion is provided, regarding other nonpharmacological treatments, such as phototherapy and surgical options, due to their importance and successful outcomes in vitiligo treatment. Finally, a concise overview regarding the future directions in vitiligo therapy is presented. EXPERT OPINION The promising outcomes reported here demonstrate that it is possible to achieve a satisfactory and often stable repigmentation of vitiligo lesions. Topical corticosteroids, calcineurin inhibitors, phototherapy and photochemotherapy represent the first-line therapeutic options, due to their safety and efficacy, whereas vitamin D analogues, targeted phototherapy, oral corticosteroids and surgery should be used as second-line therapies. Other therapies, such as antioxidants, can be used in association with other therapeutic options, whereas depigmenting agents should be used only in cases of extensive vitiligo, recalcitrant to other treatments.
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Affiliation(s)
- Roberta Colucci
- University of Florence, Section of Clinical, Preventive and Oncologic Dermatology, Department of Critical Care Medicine and Surgery, Florence, Italy.
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25
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Vitiligo: a comprehensive overview Part II: treatment options and approach to treatment. J Am Acad Dermatol 2011; 65:493-514. [PMID: 21839316 DOI: 10.1016/j.jaad.2010.10.043] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/17/2010] [Accepted: 10/01/2010] [Indexed: 02/04/2023]
Abstract
Vitiligo is a common skin disorder that results in depigmentation. With the appropriate management, many patients can minimize disease progression, attain repigmentation, and achieve cosmetically pleasing results. There are numerous medical and surgical treatments aimed at repigmentation; therapies for depigmentation are available for patients with recalcitrant or advanced disease. The use of cosmetics at all stages of treatment may be vital to the patient's quality of life. Understanding all the available options helps choose the appropriate treatment plan and tailor it to your patient. Part II of this two-part series on vitiligo discusses the indications for, evidence behind, and adverse effects associated with many of the therapies used for vitiligo. Both conventional medical and surgical options are discussed in addition to several alternative and promising new therapies.
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AlGhamdi KM, Khurrum H, Rikabi A. Worsening of Vitiligo and Onset of New Psoriasiform Dermatitis following Treatment with Infliximab. J Cutan Med Surg 2011; 15:280-4. [DOI: 10.2310/7750.2011.10068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Vitiligo is a depigmentation disorder caused by melanocyte destruction that possibly results from an autoimmune mechanism. Psoriasis is an immune-mediated, chronic, inflammatory dermatosis. Although tumor necrosis factor α antagonists (anti-TNF-α), such as infliximab, are effective in treating psoriasis, many cases reported in the literature indicate that psoriasis might also be induced by treatment with infliximab. Some studies also suggest that TNF-α antagonists might be an effective treatment for vitiligo because the disorder is characterized by increased levels of TNF-α, indicating that it might play a role in the pathogenesis of this disease. Objective: We report a case of psoriasiform dermatitis with vacuolar interface reaction that occurred after infliximab therapy in a patient with vitiligo. Method: A 17-year-old male patient with vitiligo vulgaris was treated with an intravenous infusion of 5 mg/kg of infliximab at 0, 2, and 6 weeks and then once every 6 weeks over a span of 6 months. The patient was monitored both clinically and with laboratory investigations. He had no personal or family history of psoriasis. He tolerated the treatment well, without side effects. However, he developed a biopsy-proven psoriasiform lesion for the first time 4 months after he completed his sixth dose of infliximab. His vitiligo also worsened. Conclusion: This case report shows that infliximab given for vitiligo did not improve the disorder and that the vitiligo actually progressed. Moreover, psoriasiform lesions developed after this therapy. Further studies are needed to identify the effects of infliximab in patients with vitiligo.
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Affiliation(s)
- Khalid M. AlGhamdi
- From the Departments of Dermatology and Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Huma Khurrum
- From the Departments of Dermatology and Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ammar Rikabi
- From the Departments of Dermatology and Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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27
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Kim NH, Torchia D, Rouhani P, Roberts B, Romanelli P. Tumor necrosis factor-α in vitiligo: direct correlation between tissue levels and clinical parameters. Cutan Ocul Toxicol 2011; 30:225-7. [PMID: 21388239 DOI: 10.3109/15569527.2011.560913] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Experimental evidences have shown that tumor necrosis factor (TNF)-α may play a role in the pathogenesis of nonsegmental vitiligo, and successful cases of vitiligo treated with TNF-α inhibitors have been recently reported. MATERIALS AND METHODS Two cases of refractory generalized vitiligo, which showed high tissue levels of TNF-α, were commenced anti-TNF-α antibody etanercept 50 mg weekly. A retrospective study, considering chart review and immunohistochemical staining for TNF-α, was then carried out on eight additional patients affected by untreated vitiligo. RESULTS Etanercept achieved improvement of vitiligo in two patients at 6-month follow-up. Five out of eight specimens showed a strong cytoplasmic staining for TNF-α. Considering all 10 cases, patients with a strong TNF-α staining were characterized by a higher vitiligo disease activity score than patients with a weak staining. DISCUSSION These findings, albeit limited in significance by the low number of cases and the retrospective nature of the study, confirm a probable role of TNF-α in the pathogenesis of vitiligo. The intensity of TNF-α staining in vitiligo lesions may be worth to be further studied as a biomarker for potentially successful anti-TNF-α treatment of nonsegmental vitiligo in cases refractory to conventional treatment.
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Affiliation(s)
- Nancy H Kim
- University of Miami Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, Miami, FL 33125, USA
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28
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Balato N, Di Costanzo L, Balato A, Patruno C, Scalvenzi M, Ayala F. Psoriasis and melanocytic naevi: does the first confer a protective role against melanocyte progression to naevi? Br J Dermatol 2011; 164:1262-70. [DOI: 10.1111/j.1365-2133.2011.10271.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Posada C, Flórez A, Batalla A, Alcázar JJ, Carpio D. Vitiligo during Treatment of Crohn's Disease with Adalimumab: Adverse Effect or Co-Occurrence? Case Rep Dermatol 2011; 3:28-31. [PMID: 21931575 PMCID: PMC3175360 DOI: 10.1159/000324619] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Adalimumab is a fully human monoclonal anti-tumor necrosis factor-a agent that is approved for the treatment of Crohn's disease. It has a good safety profile, injection site reactions being the most common adverse effect. We report a case of a 54-year-old woman with a 30-year history of Crohn's disease who developed achromic patches on the trunk and upper extremities after initiating treatment with adalimumab. Cutaneous biopsy confirmed diagnosis of vitiligo and laboratory testing ruled out thyroid disease. Concomitant occurrence of vitiligo and inflammatory bowel disease, although rare, has been described. A common autoimmune basis could explain this fact. Moreover, multiple cutaneous adverse effects have been described in the literature secondary to biologic treatments, including vitiligo. In this report, we discuss the possibility of vitiligo as secondary to adalimumab treatment or as an association between both diseases.
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Affiliation(s)
- Celia Posada
- Service of Dermatology, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
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30
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Campanati A, Giuliodori K, Ganzetti G, Liberati G, Offidani AM. A patient with psoriasis and vitiligo treated with etanercept. Am J Clin Dermatol 2010; 11 Suppl 1:46-8. [PMID: 20586509 DOI: 10.2165/1153424-s0-000000000-00000] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psoriasis is a chronic, immune-mediated, inflammatory dermatosis whose aetiopathogenesis remains unclear, although tumour necrosis factor alpha (TNFalpha) appears to play a crucial role. The biological potential of TNFalpha inhibitors, such as etanercept, which reduce the inflammatory cascade, has radically changed the therapeutic management of patients with psoriasis and other immunomediated inflammatory diseases, associated with TNFalpha. The pathogenesis of the selective destruction of melanocytes in vitiligo is not fully understood, although there is growing evidence that several T helper type 1 cytokines, particularly TNFalpha, may be involved in the depigmentation process. A patient is described who presented with both psoriasis and vitiligo, and was treated with etanercept. After 24 weeks of therapy, the patient's psoriasis had improved markedly and the patient noted a mild improvement of vitiligo, with a reduction in macules and repigmentation in the scapular region.
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Affiliation(s)
- Anna Campanati
- Dermatological Clinic, Department of Biostatistics and Medical Information Technology Polytechnic Marche University, Via Conca 71, Ancona, Italy.
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Sockolov ME, Alikhan A, Zargari O. Non-psoriatic dermatologic uses of monoclonal antibody therapy. J DERMATOL TREAT 2009; 20:319-27. [DOI: 10.3109/09546630902936778] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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32
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Lv Y, Li Q, Wang L, Gao T. Use of anti-tumor necrosis factor agents: a possible therapy for vitiligo. Med Hypotheses 2009; 72:546-7. [PMID: 19201101 DOI: 10.1016/j.mehy.2008.12.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 12/05/2008] [Accepted: 12/10/2008] [Indexed: 10/21/2022]
Abstract
Vitiligo is a depigmenting skin disorder resulting from the loss of melanocytes in the epidermis. Although the exact aetiology of vitiligo has not yet been established, the abnormal immune responses have been frequently observed in vitiligo patients. Moreover, some vitiligo patients show higher lesion levels of tumor necrosis factor (TNF)-alpha. TNF-alpha is an important pleiotropic cytokine that exerts potent pro-inflammatory effects. There is growing evidence that TNF-alpha plays an important role in the pathomechanism process of some autoimmunity diseases, including ankylosing spondylitis (AS). Treated with anti-TNF agents infliximab, with the improvement of AS, a patient's vitiligo lesions also faded out. Therefore, we hypothesized that TNF-alpha play an important role in vitiligo. On the one hand, TNF-alpha destroys melanocytes through induction of various apoptotic pathways. On the other hand, TNF-alpha inhibits melanocyte stem cells differentiation. Anti-TNF therapy may be an effective treatment for vitiligo.
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Affiliation(s)
- Yajie Lv
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China
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