title: Deterioration of vitiligo and new onset of halo naevi observed in two patients receiving adalimumab.
abstract: Two patients with a long-standing history of recalcitrant ankylosing spondylitis were commenced on adalimumab as monotherapy. Case 1 developed marked rapid deterioration in his previously stable vitiligo within 3 months of commencing treatment. This was attributed to anti-tumor necrosis factor (TNF) therapy, and a marked improvement was noted following withdrawal of adalimumab. Case 2 developed multiple new halo naevi over the trunk and limbs. They did not show dysplastic features and have remained unchanged despite continuation of treatment. Possible mechanisms and implications of the paradoxical occurrence of immune-mediated skin lesions seen in patients receiving anti-TNF therapies are discussed.
authors.affiliation: Department of Dermatology, University College London Hospital, London, UK. thivimaru@gmail.com
authors.forename: Thivi
authors.initials: T
authors.lastname: Maruthappu
authors.forename: Maria
authors.initials: M
authors.lastname: Leandro
authors.forename: Susie D
authors.initials: SD
authors.lastname: Morris
mesh_terms: D000068879:Adalimumab; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055882:Nevus, Halo / Q000139:chemically induced*; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*; D014820:Vitiligo / Q000139:chemically induced*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab
keywords: adalimumab; halo naevi; vitiligo