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. Objectives 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. Conclusion 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.