Dupilumab-Associated Vitiligo Is Rare but Requires Early Recognition, finds study
Dupilumab can rarely trigger new-onset vitiligo, even after the medication has been discontinued, possibly due to activation of the Th1/interferon-γ pathway following IL-4 receptor blockade. Topical corticosteroids appear to be associated with better repigmentation outcomes, whereas stopping dupilumab alone may not reverse depigmentation. Clinicians should monitor for new skin depigmentation, especially in patients with underlying immune dysregulation, as early diagnosis and prompt topical corticosteroid treatment may improve prognosis.
Vitiligo is a rare adverse event associated with dupilumab. This study aims to describe a case of new-onset vitiligo following dupilumab treatment in a Chinese patient and to systematically review the literature to characterize its clinical features.
A retrospective case analysis was conducted on a 70-year-old male patient who developed vitiligo as a result of dupilumab treatment. Comprehensive clinical, imaging, laboratory, and treatment data were meticulously documented. A systematic literature review revealed a total of 20 cases of dupilumab-induced vitiligo, which were categorized into two subgroups: improved (n = 13) and nonimproved (n = 7), based on treatment outcomes. The clinical characteristics of these subgroups were compared using appropriate statistical tests.
The patient developed depigmented patches accompanied by gray hair 4 months after the initiation of dupilumab, with no repigmentation observed despite ongoing treatment. Among the 20 pooled cases, the majority of patients received dupilumab for the treatment of atopic dermatitis (17/20, 85.00%). The onset of vitiligo typically occurred within 3 months of dupilumab initiation (11/18, 61.11%). Most patients presented with new-onset vitiligo (13/17, 76.47%), and more than half (13/20, 65.00%) exhibited clinical improvement in vitiligo symptoms. Subgroup analysis indicated that the use of topical corticosteroids (p = 0.017) was significantly associated with favorable outcomes.
Dupilumab rarely induces new-onset vitiligo, even after drug discontinuation, potentially through the activation of the Th1/IFN-γ pathway following IL-4R blockade. The use of topical corticosteroids may be associated with more favorable outcomes in patients with dupilumab-induced vitiligo, whereas discontinuing dupilumab might not ensure repigmentation. Clinicians should closely monitor for depigmentation in patients treated with dupilumab, particularly in those with immune dysregulation, as early recognition and the application of topical corticosteroids may improve prognosis.
Reference:
X. Pu, S. Ju, and Y. Yu, “ New-Onset Vitiligo During Dupilumab Treatment: A Clinical Observation and Literature Review,” The Clinical Respiratory Journal 20, no. 7 (2026): e70200, https://doi.org/10.1111/crj.70200.
Keywords:
Dupilumab, Associated, Vitiligo, Rare, Requires, Early Recognition, X. Pu, S. Ju, and Y. Yu
