Vulvar vitiligo-like depigmentation and multiple halos of hypomelanosis at the trunk following treatment with imiquimod 5% cream for vulvar condylomata: casual or related events?

A 25-year-old Caucasian female with multiple genital warts involving the vulvar area was treated with imiquimod 5% cream. During follow-up the patient developed areas of hypopigmentation at the site of application of imiquimod cream and areas of hypomelanosis around multiple preexisting nevi of the trunk. At 18 months follow-up genital depigmentation persisted and halo nevi of the trunk were still present. Different mechanisms of imiquimod-induced depigmentation have been reported. Halo nevi are considered expression of an autoimmune response. In the case presented here, it might be conceivable that both vitiligo-like depigmentation at the site of application and halo of hypomelanosis around melanocytic nevi have been induced by the same immunologic mechanism elicited by topical application of imiquimod.

Segmental vitiligo after infliximab use for rheumatoid arthritis - A case report

The tumor necrosis factor alpha is a cytokine related to immune and inflammatory processes by acting on different parts of the body. It is secreted by several cell types including macrophages, lymphocytes, monocytes, neutrophils, dendritic cells, among others. Infliximab is a chimeric monoclonal antibody that specifically binds to soluble and transmembrane tumor necrosis factor alpha form blocking its action. In rheumatoid arthritis it is used because the cytokines that cause inflammation in this disease are regulated by tumor necrosis factor alpha and IL-1. We report the case of a 46-year-old patient with rheumatoid arthritis who developed segmental vitiligo after two months using infliximab. The event aims to alert to the existence of this adverse effect that can be induced with the use of this medication.

Vitiligo in a patient receiving infliximab for refractory ulcerative colitis

Infliximab is a chimerical monoclonal antibody that inhibits pro-inflammatory activity of tumour-necrosis factor alpha [TNF alpha] and it is the primary biological agent used in the treatment of moderate-to-severe ulcerative colitis [UC]. We report a case of vitiligo following infliximab administration in a patient with refractory UC. The case serves as a reminder of adverse cutaneous reactions induced by TNF alpha -antagonist therapy

Two cases of nickel dermatitis showing vitiligo-like depigmentations

The authors reviewed two patients showing "vitiligo-like depigmentations" where the skin had been in close contact with a metal spectacle frame made of nickel alloy. In spite of the hypersensitivity to nickel in both patients, they showed clinical and histologic findings indicate that the formation of "vitiligo-like depigmentation" does not result from posinflammatory hypopigmentation but from chemical hypomelanosis. We could not explain the underlying mechanisms; however, the speculation that the "vitiligo-like depigmentation" may come from the direct effect of the nickel itself, prompted us to report these cases.

Seudovitiligo por compuestos químicos: fenoles y tolueno / Vitiligolike by chemical compound: phenols and toluene

Se presentan tres pacientes con lesiones hipocrómicas, en uno de ellos francamente vitiligoides, debidas al uso de jabones que contienen fenoles y a repelente con derivado toluénico. El estudio histopatológico mostró disminución de la cantidad de melanina, con discreta reacción liquenoide epidérmica, que sugeriría un mecanismo inmunológico en la patogenia de estos cuadros. Las lesiones estaban localizadas en sitios expuestos y en un caso pudieron ser reproducidas por el fotopatch test, por lo que se presumen la existencia de un factor lumínico coadyuvante