Vitiligo with Progressive Repigmentation during Secukinumab Treatment in a Patient with Psoriatic Arthritis: A Case Report

Abstract

The proposed role of interleukin (IL)-17 in vitiligo pathogenesis, as well as the possible action of anti-IL-17A drugs on vitiligo, are not fully understood. The appearance of vitiligo as a paradoxical effect of treatment with anti-tumor necrosis factor-α drugs is an event well known in the literature, but is rarely described with anti-IL-17A drugs. In this case report, we describe a 42-year-old woman who developed new-onset vitiligo with repigmentation during successful secukinumab therapy for psoriatic arthritis. After 1 year of secukinumab therapy, vitiligo affecting >85% of the skin was evident on clinical and dermatoscopic examination, together with small, repigmented lesions. In depigmented lesions, reflectance confocal microscopy (RCM) showed disappearance of the bright dermal papillary rings normally seen at the dermo-epidermal junction. In repigmented lesions, activated dendritic melanocytes were observed on RCM. The patient continued to receive secukinumab, and continued to experience a slow and progressive repigmentation. Our case shows that anti-IL-17A biological agents for chronic inflammatory diseases may be associated with the development of new-onset vitiligo that improves over time with ongoing therapy. Therefore, physicians should be aware of the possibility of this rare paradoxical skin reaction in patients receiving secukinumab, and that it may not be necessary to discontinue secukinumab to achieve repigmentation.

Anti-IL-17A antibody-associated de novo vitiligo: Case report and review of literature

“…However, IL-17A inhibitor was rarely reported. Table 1 shows a summary of the published cases of IL-17 inhibitor-associated vitiligo in the literature ( 2 – 4 , 8 ). There has been primarily reported cases in association with secukinumab ( 2 , 4 ), one case with ixekizumab ( 3 ), and no case with brodalumab.…”

A Case of Psoriasis After Narrow Band UVB (NBUVB) Phototherapy for Vitiligo Treatment

“…Giordano et al reported vitiligo with during secukinumab treatment in a psoriasis patient (Giordano et al, 2021). Goodwin et al reported the development of vitiligo patches over psoriasis lesions in a patient undergoing NB-UVB treatment for psoriasis (Goodwin et al, 2001).…”

The delicate relation between melanocytes and skin immunity: A game of hide and seek

“…Other biologics have also occasionally been associated with the development of vitiligo. Both cases of de novo vitiligo as repigmentation have been reported using IL‐17 inhibitors and IL‐12/23 inhibitors (Anthony et al, 2020; Giordano et al, 2021; Marasca et al, 2021; Speeckaert et al, 2019). A pilot trial using secukinumab did not find a stabilizing effect of IL‐17 inhibition in progressive vitiligo patients (Speeckaert et al, 2019).…”