TNF-alpha inhibition can stabilize disease in progressive vitiligo Journal Article


Authors: Webb, K. C.; Tung, R; Winterfield, L. S.; Gottlieb, A. B.; Eby, J. M.; Henning, S. W.; Le Poole, I. C.
Article Title: TNF-alpha inhibition can stabilize disease in progressive vitiligo
Abstract: TNF-alpha, a proinflammatory cytokine central to many autoimmune diseases, has been implicated in the depigmentation process in vitiligo. We reviewed its role in vitiligo by exploring its pro- and anti-inflammatory properties and examined the effects of blocking its actions with TNF-alpha antagonist therapeutics in reports available in the literature. We found that TNF-alpha 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 to treat other autoimmune conditions, particularly when using adalimumab and infliximab. These studies reinforce the importance of stating appropriate outcomes measures as most pilot trials proposed to measure repigmentation, whereas halting depigmentation was commonly overlooked as a measure of success. We conclude that TNF inhibition was useful for patients with progressive vitiligo, where TNF-alpha inhibition is able to quash cytotoxic T cell-mediated melanocyte destruction. However, a lingering concern for initiating de novo disease will likely prevent a more widespread application of TNF inhibitors to treat vitiligo. This article is protected by copyright. All rights reserved.
Journal Title: The British journal of dermatology
Volume: 173
Issue: 3
ISSN: 1365-2133; 0007-0963
Publisher: Unknown  
Date Published: 2015
Start Page: 641
End Page: 650
Language: ENG
DOI/URL:
Notes: LR: 20150709; CI: This article is protected by copyright. All rights reserved.; JID: 0004041; 2015/01/29 [received]; 2015/05/26 [revised]; 2015/06/29 [accepted]; aheadofprint