What are the other Names for this Condition? (Also known as/Synonyms)

• Drug-Induced Leukoderma
• Medication-Induced Vitiligo
• Vitiligo due to Adverse Drug Reaction

What is Drug-Induced Vitiligo? (Definition/Background Information)

• Vitiligo is a common pigmentary disorder of unknown cause, in which the skin loses its melanocytes (thus termed a depigmentation disorder). Melanocytes are cells that make the brown color pigment ‘melanin’. When a patch of skin loses the pigment, it becomes white, thus making it higher prone to sunburn
• Drug-Induced Vitiligo occurs secondary to the use of certain medication, as an adverse reaction of the body to the drugs. The common medications causing the condition include immunomodulators and biologic/targeted medications (such as monoclonal antibodies)
• Stopping or discontinuing the use of such medications may decrease progression of Drug-Induced Vitiligo and/or may result in resolution of the condition. Considering adequate treatment of vitiligo and stoppage of the offending medication can help yield good outcomes

Who gets Drug-Induced Vitiligo? (Age and Sex Distribution)

• Individuals of all ages may be affected by Drug-Induced Vitiligo, although most cases are noted in elderly adults
• Both males and females are affected
• Worldwide, individuals of all racial and ethnic groups may be affected

What are the Risk Factors for Drug-Induced Vitiligo? (Predisposing Factors)

The key risk factor for Drug-Induced Vitiligo is the use of certain medications that cause the condition as a side effect. The following class of medications have been implicated:

• BRAF inhibitors such as dabrafenib and vemurafenib
• Group of cytokines called interleukins
• Interferons used for cancer therapy
• Medications used in treating metastatic melanoma such as pembrolizumab and nivolumab. Around 1 in 7 cases of Drug-Induced Vitiligo was observed due to these medications
• Topical agents such as imiquimod
• Tumor necrosis factor (TNF) inhibitors
• Tyrosine kinase inhibitors (TKIs) such as imatinib and gefitinib

Certain medications are known to cause vitiligo in rare cases, and these include:

• Anticonvulsant agents
• Antimalarial drugs such as hydroxychloroquine
• Parkinson disease medication such as levodopa
• Phenols
• Topical applications that contain diphencyprone or squaric acid

The following factors are known to contribute towards an increased risk for the condition:

• A personal or family history of vitiligo
• Genetic susceptibility to vitiligo

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Drug-Induced Vitiligo? (Etiology)

Vitiligo is an autoimmune disorder in which the body’s immune system attacks its own melanocytes. However, the exact cause of vitiligo is presently unknown. It may develop from a combination of genetic, infectious, immunologic, biochemical, and neurogenic factors.

• Drug-Induced Vitiligo develops from the use of certain medications/drugs that are administered for various health conditions. It is believed that the offending drug potentially causes an abnormal cell-mediated immune response in the body 
• In many individuals, the appearance of signs and symptoms due to the drug is observed immediately after starting the medication. The condition is also known to cover extensive areas of the body surface

What are the Signs and Symptoms of Drug-Induced Vitiligo?

The signs and symptoms of Drug-Induced Vitiligo may vary from one individual to another. It may also be mild or severe and may be related to the type and usage of the drug. The condition is known to get better after stoppage of the offending medication.

The signs and symptoms may include:

• Irregular white patches on the skin, especially on sun-exposed areas
• These lesions consists of small macules (flat discolored skin areas with distinct borders)
• The skin patches may be seen on the face, hands, and wrist
• The lesions are also noted around the body orifices such as the mouth, eyes, nostrils, genitalia, and umbilicus
• Premature graying of hair

How is Drug-Induced Vitiligo Diagnosed?

The following tests and exams may be used in the diagnosis of Drug-Induced Vitiligo:

• Complete physical examination and thorough medical history evaluation (including current and past medication use)
• Assessment of the presenting signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Drug-Induced Vitiligo?

If Drug-Induced Vitiligo is left untreated, it can result in certain complications. Some of the complications include:

• Severe skin symptoms - it is especially pronounced in dark-skinned individuals
• Worsening of the existing vitiligo
• Emotional stress from cosmetic concerns
• Recurrence/relapse of the condition
• Treatment medication side effects

How is Drug-Induced Vitiligo Treated?

Following a diagnosis of Drug-Induced Vitiligo, the treatment provided may include:

• Discontinuing the medication responsible for the side effect where possible, which may result in a cure, or in improvement of the condition
• Undertaking a treatment of vitiligo through:
  • Use of cosmetic makeup (masking of white spots in mild cases)
  • Use of sunscreens to prevent severe sun damage
  • Topical therapy using corticosteroid creams
  • Phototherapy and laser therapy
  • Skin grafting, if necessary

Follow-up care with screening and check-ups are important at regular intervals.

How can Drug-Induced Vitiligo be Prevented?

Current medical research has not established a method of preventing Drug-Induced Vitiligo. However, the following measures may be considered to help lower one’s risk for the condition:

• Drugs that cause the condition may be discontinued or alternative medication prescribed; nevertheless, this has to be decided by the healthcare expert
• If the use of certain medications places an individual at an elevated risk for this skin condition, it is advisable to check with the physician on the same
• Avoid self-medication or bringing about any changes to one’s medication dosage without consulting the healthcare provider
• Inform your physician if you are allergic to any medication

Periodic monitoring or follow-up of the condition with the healthcare provider is recommended.

What is the Prognosis of Drug-Induced Vitiligo? (Outcomes/Resolutions)

• The prognosis for Drug-Induced Vitiligo is usually good in many cases, upon discontinuation of the medication and adequate treatment of the condition
• However, the time for complete resolution may vary from one individual to another

Additional and Relevant Useful Information for Drug-Induced Vitiligo:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/