Drug-associated vitiligo: A systematic review of therapies, clinical patterns and mechanisms.
Immune checkpoint inhibitors were the most common drug class linked to vitiligo.
Drug-associated vitiligo: A systematic review of therapies, clinical patterns and mechanisms.
Vitiligo is an acquired depigmenting disorder resulting from melanocyte loss.
To systematically review reported cases of drug-associated vitiligo, identify implicated therapies, characterise clinical features and evaluate proposed pathogenic mechanisms.
A systematic review was conducted according to PRISMA guidelines and a prospectively registered protocol (PROSPERO: CRD42025648719).
immune checkpoint inhibitors were the leading drug class behind vitiligo cases
The most commonly reported agents were imiquimod 5% cream (n=30), nivolumab (n=30), diphenylcyclopropenone (n=18), pembrolizumab (n=17), interferon-α (n=17) and ribociclib (n=16).
Vitiligo most commonly involved the upper extremities (n=127), face (n=119) and trunk (n=101).
Among 256 cases with reported latency, vitiligo most frequently developed between 3 and 6 months following treatment initiation (66/256, 25.8%), although distinct temporal patterns were observed between therapeutic classes.
Drug-associated vitiligo represents a heterogeneous spectrum of disorders spanning multiple therapeutic classes.
While recurrent clinical patterns and biologically plausible mechanisms support a contributory role for several drug classes, causality remains uncertain for many reported associations.
Recognition of characteristic clinical and temporal patterns may improve patient counselling, inform treatment decisions and guide future pharmacovigilance and mechanistic research.