New-onset vitiligo and progression of pre-existing vitiligo during treatment with biological agents in chronic inflammatory diseases.
BACKGROUND
The development of vitiligo during treatment with biological agents is an unusual event and only a few isolated cases have been reported.


OBJECTIVE
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.


CONCLUSIONS
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.
Département de dermatologie, CH François Quesnay, Mantes-la-Jolie, France.
L
L
Méry-Bossard
Département de médecine interne et dermatologie, CHU Felix Guyon, Saint-Denis, France.
K
K
Bagny
Département de dermatologie, CHU Amiens Picardie Site Nord, Amiens, France.
G
G
Chaby
Département de dermatologie, CHU Archet 2, Nice, France.
A
A
Khemis
Département de dermatologie, HIA Bégin, Saint-Mandé, France.
F
F
Maccari
Département de rhumatologie, CHU Saint-Etienne Hôpital Nord, Saint Etienne, France.
H
H
Marotte
Département de dermatologie, CHU Saint Etienne Hôpital Nord, Saint-Etienne, France.
J L
JL
Perrot
Département de dermatologie, CHU Reims, Reims, France.
Z
Z
Reguiai
Département de dermatologie, CH Victor Dupouy, Argenteuil, France.
M L
ML
Sigal
Département de dermatologie, CHU Angers, Angers, France.
M
M
Avenel-Audran
Département de dermatologie, HIA Sainte-Anne, Toulon, France.
T
T
Boyé
Département de médecine interne, AP-HP Hôpital Louis Mourier, Colombes, France.
A
A
Grasland
Département de rhumatologie, CHT Jura Sud, Lons le Saulnier, France.
J
J
Gillard
Département de Dermatologie, CHU Edouard Herriot, Lyon, France.
D
D
Jullien
Centre d'investigation clinique biothérapie INSERM CIC-1431, FHU INCREASE, Rhumatologie, CHRU, Besançon, France.
E
E
Toussirot
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014820:Vitiligo / Q000473:pathology*; D055815:Young Adult