title: Worsening of vitiligo and onset of new psoriasiform dermatitis following treatment with infliximab.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology and Pathology, King Saud University, Riyadh, Saudi Arabia. kmgderm@yahoo.com
authors.forename: Khalid M
authors.initials: KM
authors.lastname: Alghamdi
authors.forename: Huma
authors.initials: H
authors.lastname: Khurrum
authors.forename: Ammar
authors.initials: A
authors.lastname: Rikabi
mesh_terms: D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018450:Disease Progression; D003875:Drug Eruptions / Q000209:etiology*; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D008297:Male; D014820:Vitiligo / Q000188:drug therapy*
chemical_list: D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D000069285:Infliximab