Use of anti-tumor necrosis factor agents: a possible therapy for vitiligo

Vitiligo is a depigmenting skin disorder resulting from the loss of melanocytes in the epidermis. Although the exact aetiology of vitiligo has not yet been established, the abnormal immune responses have been frequently observed in vitiligo patients. Moreover, some vitiligo patients show higher lesion levels of tumor necrosis factor (TNF)-alpha. TNF-alpha is an important pleiotropic cytokine that exerts potent pro-inflammatory effects. There is growing evidence that TNF-alpha plays an important role in the pathomechanism process of some autoimmunity diseases, including ankylosing spondylitis (AS). Treated with anti-TNF agents infliximab, with the improvement of AS, a patient's vitiligo lesions also faded out. Therefore, we hypothesized that TNF-alpha play an important role in vitiligo. On the one hand, TNF-alpha destroys melanocytes through induction of various apoptotic pathways. On the other hand, TNF-alpha inhibits melanocyte stem cells differentiation. Anti-TNF therapy may be an effective treatment for vitiligo.