Abstract
Vitiligo, manifested by skin hypopigmentation, is an autoimmune disorder of the skin due to the autoimmune destruction of melanocytes. Nivolumab, which is a programmed cell death–1 receptor inhibitor, is a well-known therapy for melanoma. Nivolumab-induced vitiligo has been described in literature, explained by destruction of non-cancerous melanocytes. This is considered a favorable response, due to a correlated stronger immune response against tumor cells. The average onset of the vitiligo is reported to be 5.2 months after starting the therapy, with a maximum reported onset being 9 months. We present a 52-year-old male patient whose initial vitiligo presentation occurred a year after starting the therapy and has continued for months after concluding Nivolumab therapy.
Highlights
Vitiligo is an autoimmune disorder of the skin, marked by depigmentation of the skin, due to the autoimmune loss of melanocytes
programmed cell death–1 receptor (PD-1) ligand binds to PD-1, which leads to T-cell inactivation that allows the cancer to proliferate unchecked by the immune system
This side effect of Nivolumab has been associated with more favorable outcomes in melanoma, as it correlates to a strong immune response against tumor cells
Summary
Vitiligo is an autoimmune disorder of the skin, marked by depigmentation of the skin, due to the autoimmune loss of melanocytes. The vitiligo seen with Nivolumab has been theorized to be due to the destruction of non-cancerous melanocytes by activated T-cells. This side effect of Nivolumab has been associated with more favorable outcomes in melanoma, as it correlates to a strong immune response against tumor cells. The patient was seen for follow-up three months later, at which point he noted that the depigmented patch had continued to spread to his forehead, scalp, and left cheek (Figure 2). He reported that the right cheek became erythematous with sun exposure. Patient declined treatment with topical steroids, but has gotten low levels of ambient sun exposure and has noticed re-pigmentation of the cheek and scalp at one-year follow-up appointment
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