Treatment of generalized vitiligo with anti-TNF-α Agents

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-?) plays an important role in vitiligo. TNF-? can destroy melanocytes through the induction of various apoptotic pathways. In addition, TNF-? can inhibit melanocyte stem cell differentiation.

Objective: To evaluate the efficacy and safety of treating vitiligo patients with anti-TNF-? 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-? agents were well tolerated in all six vitiligo patients, efficacy was not observed. Further evaluation with larger studies may be required.