Nguyen Julie K, Schlichte Megan J, Jogi Reena, Alikhan Mujahed, Patel Anisha B
Department of Dermatology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX.
Dermatol Online J. 2020 Mar 15;26(3):13030/qt1hk2x4j5.
With recent advancements in the understanding of vitiligo pathogenesis, Janus kinase (JAK) inhibitors have emerged as a promising new treatment modality, but their effects remain incompletely elucidated. Tofacitinib, an oral JAK 1/3 inhibitor approved for the treatment of rheumatoid arthritis, has previously been shown to induce significant re-pigmentation in vitiligo. However, as with other novel targeted therapies, cutaneous adverse effects have been observed. We report a 36-year-old woman with a history of rheumatoid arthritis, refractory to multiple pharmacotherapies, who was initiated on tofacitinib and subsequently developed progressive depigmented patches consistent with new-onset vitiligo. Although definitive causation cannot be established in this case without additional studies, it is important to note that many targeted therapies have the potential to induce paradoxical effects, that is, the occurrence or exacerbation of pathologic conditions that have been shown to respond to these medications. Paradoxical findings with other targeted therapies include the occurrence of melanoma during treatment with BRAF inhibitors, keratoacanthomas with PD-1 inhibitors, vitiligo and psoriasis with TNF-alpha inhibitors, and hidradenitis suppurativa with various biologic agents. Although JAK inhibitors hold therapeutic promise in the treatment of inflammatory skin disorders, further research is warranted to more fully comprehend their effects.
随着近期对白癜风发病机制认识的进展，Janus激酶（JAK）抑制剂已成为一种有前景的新治疗方式，但其效果仍未完全阐明。托法替布是一种已获批用于治疗类风湿关节炎的口服JAK 1/3抑制剂，此前已显示其可在白癜风患者中诱导显著的色素重新沉着。然而，与其他新型靶向疗法一样，也观察到了皮肤不良反应。我们报告了一名36岁有类风湿关节炎病史的女性，她对多种药物治疗均耐药，开始使用托法替布治疗后，随后出现了与新发白癜风一致的进行性色素脱失斑。尽管在没有进一步研究的情况下，本病例无法确定明确的因果关系，但需要注意的是，许多靶向疗法都有可能引发矛盾效应，即已证明对这些药物有反应的病理状况的发生或加重。其他靶向疗法的矛盾发现包括使用BRAF抑制剂治疗期间发生黑色素瘤、使用PD-1抑制剂出现角化棘皮瘤、使用TNF-α抑制剂出现白癜风和银屑病，以及使用各种生物制剂出现化脓性汗腺炎。尽管JAK抑制剂在治疗炎症性皮肤病方面具有治疗前景，但仍需要进一步研究以更全面地了解其作用。
