Vitiligo-like lesions occurring in patients receiving anti-programmed cell death–1 therapies are clinically and biologically distinct from vitiligo

Pigmentary changes in patients treated with targeted anticancer agents: A systematic review and meta-analysis

“…Finally, vitiligo-like lesions that occur during treatment with selective PD-1 inhibitors, such as pembrolizumab and nivolumab, have been reported in up to 25% of patients and may be associated with a clinical benefit [60]. A recent study suggests a unique clinical phenotype and pathophysiological pathway that implicates a CD8 T-cell immune response distinct from spontaneously occurring vitiligo [61]. …”

Atezolizumab‐associated vitiligo‐like leukoderma in a patient with transitional cell carcinoma

“…This dichotomy has been challenged, however, both by case reports and by a study demonstrating that the two conditions cannot be distinguished by blinded assessment . More recently, a study of vitiligo‐like lesions occurring in patients on anti‐PD‐1 therapy described a photo‐accentuated depigmentation pattern consisting of multiple flecked lesions without Koebner phenomenon . Our patient's presentation, however, resembled that of classical vitiligo, despite treatment with anti‐PD‐L1 therapy.…”

“…This case calls into question whether immunotherapy‐related vitiligo‐like depigmentation occurs more frequently during the treatment of nonmelanoma malignancies than is suggested by the number of reports in the literature. In addition, this case has implications regarding the spectrum of presenting features of vitiligo‐like lesions, which have been previously characterized as flecked macules with a photo‐accentuated distribution . As the list of indications for immune checkpoint inhibitors continues to expand, it will be increasingly important to study the incidence, pathomechanism, and prognostic significance of this irAE.…”

Programmed cell death protein 1 and vitiligo

“…Nevertheless, some authors considered melanoma‐associated vitiligo a distinct entity from vitiligo. Larsabal et al reported that vitiligo‐like lesions induced by PD‐1 inhibitors are distinct from vitiligo not only because they show higher serum CXCL10 concentration and a higher number of IFN‐γ producing CXCR3 + CD8 + T cells in lesional skin compared with vitiligo but also, they did not associate with Koebner phenomenon, which is frequently observed in active vitiligo. As IFN‐γ producing CXCR3 + CD8 + T cell number and CXCL10 also have been reported to correlate with disease activity of vitiligo, the disease mechanism of vitiligo‐like lesions induced by PD‐1 inhibitors is very similar to active vitiligo.…”