Resolution of post-adalimumab vitiligo with secukinumab in a patient with psoriasis vulgaris

Plaque psoriasis is a chronic debilitating condition, and biologic agents that inhibit tumor necrosis factor-alpha (TNF-alpha) are widely employed in management of the condition. Notwithstanding, several paradoxical adverse reactions have been reported with TNF-alpha inhibitors, including vasculitis, vitiligo, alopecia areata, sarcoidosis and other granulomatous diseases. Herein, we report the case of a 63-year-old man who developed vitiligo while on therapy with adalimumab following failure of conventional agents for plaque psoriasis. After discontinuation of adalimumab and initiation of secukinumab, vitiligo and other psoriatic symptoms gradually resolved. After 1 year of treatment, only small plaque areas were present in the flexor site with complete remission in the extensor area along with near complete resolution of depigmented areas. In this case of possible adalimumab-induced vitiligo in a patient with plaque psoriasis, secukinumab resolved both the symptoms of psoriasis and the likely adalimumab-related vitiligo.