title: Vitiligo-like lesions occurring in patients receiving anti-programmed cell death-1 therapies are clinically and biologically distinct from vitiligo.
abstract: BACKGROUND
  The use of anti-programmed cell death (PD)-1 therapies in metastatic tumors is associated with cutaneous side effects including vitiligo-like lesions.
  
  
  OBJECTIVE
  We sought to characterize clinically and biologically vitiligo-like lesions occurring in patients receiving anti-PD-1 therapies by studying a case series of 8 patients with metastatic tumors and 30 control subjects with vitiligo.
  
  
  METHODS
  Eight patients receiving anti-PD-1 therapies with features of vitiligo-like lesions seen in our department were recruited. Clinical features and photographs were analyzed. For some patients, skin and blood samples were obtained. Results were compared with the vitiligo group.
  
  
  RESULTS
  All patients developed lesions localized on photoexposed areas with a specific depigmentation pattern consisting of multiple flecked lesions without Koebner phenomenon. In contrast to vitiligo, patients receiving anti-PD-1 therapies who developed vitiligo-like lesions did not report any personal or family histories of vitiligo, thyroiditis, or other autoimmune disorders. Analysis of blood and skin samples revealed increased C-X-C motif ligand 10 levels in serum of patients developing vitiligo-like lesions, associated with skin infiltration of CD8 T-cells expressing C-X-C motif receptor 3 and producing elevated levels of interferon-γ and tumor necrosis factor-alfa.
  
  
  CONCLUSIONS
  This cross-sectional study concerned a single center.
  
  
  CONCLUSIONS
  Clinical and biological patterns of vitiligo-like lesions occurring in patients receiving anti-PD-1 therapies differ from vitiligo, suggesting a different mechanism.
authors.affiliation: Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France.
authors.forename: Maiana
authors.initials: M
authors.lastname: Larsabal
authors.affiliation: Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Marti
authors.affiliation: Institut National de la Santé Et de la Recherche Médicale (INSERM) U1035, Biothérapies de Maladies Génétiques, Inflammatoires et Cancers (BMGIC), Immuno-dermatology ATIP-AVENIR, University of Bordeaux, Bordeaux, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Jacquemin
authors.affiliation: Institut National de la Santé Et de la Recherche Médicale (INSERM) U1035, Biothérapies de Maladies Génétiques, Inflammatoires et Cancers (BMGIC), Immuno-dermatology ATIP-AVENIR, University of Bordeaux, Bordeaux, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rambert
authors.affiliation: Institut National de la Santé Et de la Recherche Médicale (INSERM) U1035, Biothérapies de Maladies Génétiques, Inflammatoires et Cancers (BMGIC), Immuno-dermatology ATIP-AVENIR, University of Bordeaux, Bordeaux, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Thiolat
authors.affiliation: Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France.
authors.forename: Léa
authors.initials: L
authors.lastname: Dousset
authors.affiliation: Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France; Institut National de la Santé Et de la Recherche Médicale (INSERM) U1035, Biothérapies de Maladies Génétiques, Inflammatoires et Cancers (BMGIC), Immuno-dermatology ATIP-AVENIR, University of Bordeaux, Bordeaux, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Taieb
authors.affiliation: Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Dutriaux
authors.affiliation: Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France.
authors.forename: Sorilla
authors.initials: S
authors.lastname: Prey
authors.affiliation: Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France; Institut National de la Santé Et de la Recherche Médicale (INSERM) U1035, Biothérapies de Maladies Génétiques, Inflammatoires et Cancers (BMGIC), Immuno-dermatology ATIP-AVENIR, University of Bordeaux, Bordeaux, France.
authors.forename: Katia
authors.initials: K
authors.lastname: Boniface
authors.affiliation: Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France; Institut National de la Santé Et de la Recherche Médicale (INSERM) U1035, Biothérapies de Maladies Génétiques, Inflammatoires et Cancers (BMGIC), Immuno-dermatology ATIP-AVENIR, University of Bordeaux, Bordeaux, France. Electronic address: julien.seneschal@chu-bordeaux.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Seneschal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects; D018414:CD8-Positive T-Lymphocytes; D016022:Case-Control Studies; D054357:Chemokine CXCL10 / Q000097:blood*; D003875:Drug Eruptions / Q000209:etiology / Q000378:metabolism* / Q000473:pathology*; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D000077594:Nivolumab; D010781:Photography; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors; D011446:Prospective Studies; D054367:Receptors, CXCR3 / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014820:Vitiligo / Q000235:genetics / Q000378:metabolism* / Q000473:pathology*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; C114753:CXCL10 protein, human; C515187:CXCR3 protein, human; D054357:Chemokine CXCL10; C105992:PDCD1 protein, human; D061026:Programmed Cell Death 1 Receptor; D054367:Receptors, CXCR3; D014409:Tumor Necrosis Factor-alpha; D000077594:Nivolumab; D007371:Interferon-gamma; C582435:pembrolizumab
keywords: anti-programmed cell death–1 therapy; nivolumab; pembrolizumab; vitiligo; vitiligo-like lesions