TNF-α antagonists have offered benefit in patients withprogressing vitiligo

Vitiligo is a cutaneous disease presenting with a loss of epidermalmelanocytes. Vitiligo is a multifactorial disease, but autoimmunity plays atleast some role in every type of vitiligo. T cell-mediated autoimmunity playsa prominent role in disease progression, as skin-infiltrating cytotoxic Tlymphocytes are reactive with melanocytes. Tumor necrosis factor (TNF)-α,also known as cachectic, is a proinflammatory cytokine central to manyautoimmune diseases. TNF- α potentially plays both harmful and protectiveroles in vitiligo, by activating the cytotoxic T cells that are detrimental tomelanocytes, and stimulating Tregs, respectively. Tregs are responsible forimmune homeostasis. They suppress the activity of autoreactive T cells thatescape clonal deletion in the thymus, such as those reactive againstmelanocytes in vitiligo. We found that TNF- α inhibition, via the use of TNF-α antagonists, halts disease progression and even can promote repigmentationin patients with progressive vitiligo but that, paradoxically, treatment can beassociated with de novo vitiligo development in some patients when used forother autoimmune conditions, particularly when using adalimumab andinfliximab. etanercept should be considered the preferred anti-TNF- α agentto employ in patients at risk for developing vitiligo, in order to mitigate therisk of this adverse event during therapy for other conditions. Indeed, theresults for TNF- α inhibition in the treatment of progressive vitiligo inpatients without other autoimmune conditions are very promising.

کلیدواژه ها:

Vitiligo ، Autoimmunity ، TNF- α