Alghamdi Khalid M, Khurrum Huma, Taieb Alain, Ezzedine Khaled
Dermatology Department, Vitiligo Research Chair,College of Medicine, King Saud UniversityRiyadh, Saudi Arabia.
J Drugs Dermatol. 2012 Apr;11(4):534-9.
Although the exact pathogenesis of vitiligo is not fully understood, it appears to be an autoimmune disease. It is hypothesized that tumor necrosis factor alpha (TNF-?) plays an important role in vitiligo. TNF-? can destroy melanocytes through the induction of various apoptotic pathways. In addition, TNF-? can inhibit melanocyte stem cell differentiation.
To evaluate the efficacy and safety of treating vitiligo patients with anti-TNF-? agents.
A total of 6 patients were recruited. All patients had widespread non-segmental vitiligo. Biologics, including infliximab, etanercept, and adalimumab, were given according to treatment regimens used for psoriasis. Photographs were taken at the initial visit, every two months during the therapy and then six months after therapy completion.
All patients completed the treatment; two patients were treated with infliximab, two with etanercept, and two with adalimumab. All of the biologics were well tolerated throughout the treatment period, and none of the patients reported any significant adverse events. Digital images were compared before, during and after treatment. Repigmentation of the vitiliginous areas was not observed in any of the patients. Vitiligo worsened in one patient who was treated with infliximab and developed a psoriasiform rash. However, the remaining patients did not develop any new depigmented patches during treatment or at the six-month follow-up; vitiligo was considered stable in these five patients.
Although the anti-TNF-? agents were well tolerated in all six vitiligo patients, efficacy was not observed. Further evaluation with larger studies may be required.
尽管白癜风的确切发病机制尚未完全明确，但它似乎是一种自身免疫性疾病。据推测，肿瘤坏死因子α（TNF-α）在白癜风中起重要作用。TNF-α可通过诱导各种凋亡途径破坏黑素细胞。此外，TNF-α可抑制黑素细胞干细胞分化。
评估使用抗TNF-α药物治疗白癜风患者的疗效和安全性。
共招募了6名患者。所有患者均患有广泛的非节段性白癜风。根据用于治疗银屑病的方案给予生物制剂，包括英夫利昔单抗、依那西普和阿达木单抗。在初次就诊时、治疗期间每两个月以及治疗完成后六个月拍摄照片。
所有患者均完成治疗；2例患者接受英夫利昔单抗治疗，2例接受依那西普治疗，2例接受阿达木单抗治疗。在整个治疗期间，所有生物制剂的耐受性良好，没有患者报告任何严重不良事件。对治疗前、治疗期间和治疗后的数字图像进行了比较。所有患者均未观察到白癜风区域的色素再生。1例接受英夫利昔单抗治疗的患者出现银屑病样皮疹，白癜风病情加重。然而，其余患者在治疗期间或六个月随访时均未出现任何新的色素脱失斑；这5例患者的白癜风病情被认为稳定。
尽管6例白癜风患者对抗TNF-α药物的耐受性良好，但未观察到疗效。可能需要进行更大规模的研究进一步评估。
