Drug Induced Vitiligo

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Drug-induced vitiligo has similar characteristics to non-induced vitiligo and is likely due to a similar autoimmune factor.
This type of vitiligo is also called drug-induced leukoderma.

What is Vitiligo?

It is a common condition that has as its main symptom the loss of pigmentation, in which melanocytes are destroyed by an autoimmune process.

The loss of melanocyte cells, which are responsible for producing melanin, results in the appearance of white spots.
They gradually increase in a slow way, without any change in the texture of the skin.

One of the complications due to the presence of white spots is the possibility of sunburn in the areas where vitiligo is present.

What is drug induced vitiligo?

In some cases, people can develop vitiligo due to the use of drugs.
Drug-induced leukoderma is the result of drugs that modify the immune system, including immunomodulators, biologics, and therapies used for cancer.

Vitiligo can also be induced by topical exposure to substances such as monobenzone.

Some targeted therapies for lymphoma and leukemia or drugs that treat anti-inflammatory diseases such as rheumatoid arthritis or psoriasis are among the drugs that can cause vitiligo.

Causes

Drug-induced leukoderma is usually caused by immunomodulating, biologic, or targeted drugs. These medicines include:

  • Carcinoma drugs
  • Cytokine and interferon-based drugs
  • Tumor necrosis factor inhibitors
  • The programmed death receptor inhibitors, pembrolizumab and nivolumab, used in metastatic melanoma (15% of treated patients develop vitiligo)
  • Tyrosine kinase inhibitors

There have also been rare reports of drug-induced leukoderma caused by:

  • Topical diphenciprone and squaric acid
  • Anticonvulsants
  • Levodopa
  • Antimalarials such as hydroxychloroquine
  • other drugs

The causes of drug-induced leukoderma are still uncertain, and autoimmune, neural, and cytotoxic theories currently exist in relation to this.

Risk factors

Risk factors for drug-induced vitiligo include:

  • Genetic factors
  • Ethnicity. All races are concerned
  • Sex. Men and women are equally affected
  • Age. Drug-induced leukoderma tends to affect older patients than those seen with non-drug-induced vitiligo.
  • Other autoimmune diseases. Individuals with drug-induced leukoderma can also develop other autoimmune disorders, most notably Addison’s disease, autoimmune thyroid disease, diabetes mellitus, pernicious anemia, and alopecia areata.
  • A previous history of vitiligo can also make a patient more vulnerable to an extension of drug-induced pigment loss.

Like other types of vitiligo, genetic factors can make some people more prone to developing drug-induced vitiligo.

Features drug induced vitiligo

The characteristics of drug-induced vitiligo are similar to non-induced vitiligo, with the exception that it tends to have both a rapid onset and an extension.

Drug-induced leukoderma manifests as flat, depigmented patches of skin with irregular but defined edges.

The areas of the body most affected are:

  • face
  • elbows
  • knees
  • back of hands
  • genitals

Vitiligo is most visible in people with dark skin and often causes emotional distress, embarrassment, and reduces quality of life.

Treatments

Treatment begins with the discontinuation of the responsible drug.
Possible options for treating drug-induced vitiligo include:

  • Cosmetic camouflage and sunscreen
  • Phototherapy
  • Excimer laser therapy
  • Topical corticosteroids and calcineurin inhibitors
  • Skin grafts taken from normally pigmented areas.

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