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Year : 2008  |  Volume : 74  |  Issue : 2  |  Page : 169

Vitiligo, psoriasis and imiquimod: Fitting all into the same pathway

Consultant dermatologist, Kaya Skin Clinic, Dubai, United Arab Emirates

Correspondence Address:
Bell Raj Eapen
Kaya Skin Clinic, Dubai
United Arab Emirates
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0378-6323.39717

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How to cite this article:
Eapen BR. Vitiligo, psoriasis and imiquimod: Fitting all into the same pathway. Indian J Dermatol Venereol Leprol 2008;74:169

How to cite this URL:
Eapen BR. Vitiligo, psoriasis and imiquimod: Fitting all into the same pathway. Indian J Dermatol Venereol Leprol [serial online] 2008 [cited 2020 Oct 25];74:169. Available from:


I read with interest the letter describing imiquimod-induced vitiligo-like depigmentation. [1] There are other similar case reports [2],[3] and 68 reports of pigmentary changes related to imiquimod use listed by FDA. [4] The most widely accepted theory is that imiquimod activates the cell-mediated arm of the immune system via the stimulation of multiple pro-inflammatory cytokines which up-regulates a Type-1 cell response (Th1) that unmasks an innate predilection for the development of vitiligo. [5]

The mode of action of imiquimod involves activation of Toll-like receptors (TLR) 7 and 8, which initiates a signaling cascade leading to the production of pro-inflammatory cytokines like IFN-α and TNF-α. However, TLR 7 and 8 also initiates ubiquitin-mediated proteolysis and apoptosis through the myeloid differentiation factor 88-dependent pathway as evident from the pathway map [6] hsa04620 available from KEGG. [7] In a previous letter to IJDVL , I presented the genomic evidence for ubiquitin-mediated melanocyte-specific apoptotic process in vitiligo. [8] Hence, the ubiquitin-mediated proteolysis may be important in the pathogenesis of vitiligo-like lesions following treatment with imiquimod.

A Th1 type response with increased TNF-α is vital in the pathogenesis of psoriasis. [9] Hence, it is hardly surprising that there are several reports of imiquimod-induced psoriasis. [10],[11],[12],[13] Psoriasis is a proliferative disorder while vitiligo is an apoptotic disorder. It is interesting to note that these disparate conditions converge at a fundamental pathway level.

  References Top

1.Senel E, Seckin D. Imiquimod-induced vitiligo-like depigmentation. Indian J Dermatol Venereol Leprol 2007;73: 423.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Stefanaki C, Nicolaidou E, Hadjivassiliou M, Antoniou C, Katsambas A. Imiquimod-induced vitiligo in a patient with genital warts. J Eur Acad Dermatol Venereol 2006;20:755-756.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Al-Dujaili Z, Hsu S. Imiquimod-induced vitiligo. Dermatol Online J 2007;13:10.  Back to cited text no. 3    
4.Mashiah J, Brenner S. Possible mechanisms in the induction of vitiligo-like hypopigmentation by topical imiquimod. Clin Exp Dermatol 2008;33:74-76.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Nouri K, Busso M, Machler BC. Vitiligo associated with alpha-interferon in a patient with chronic active hepatitis C. Cutis 1997;60:289-290.  Back to cited text no. 5  [PUBMED]  
6.Kawai T, Akira S. TLR signaling. Semin Immunol 2007;19:24-32.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Aoki-Kinoshita KF, Kanehisa M. Gene Annotation and Pathway Mapping in KEGG. Methods Mol Biol 2007;396:71-92.  Back to cited text no. 7  [PUBMED]  
8.Eapen BR. VIT1 gene and vitiligo. Indian J Dermatol Venereol Leprol 2004;70:184-185.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Nickoloff BJ, Nestle FO. Recent insights into the immunopathogenesis of psoriasis provide new therapeutic opportunities. J Clin Invest 2004;113:1664-1675.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Fanti PA, Dika E, Vaccari S, Miscial C, Varotti C. Generalized psoriasis induced by topical treatment of actinic keratosis with imiquimod. Int J Dermatol 2006;45:1464-1465.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]
11.Gilliet M, Conrad C, Geiges M, Cozzio A, Thurlimann W, Burg G, et al . Psoriasis triggered by toll-like receptor 7 agonist imiquimod in the presence of dermal plasmacytoid dendritic cell precursors. Arch Dermatol 2004;140:1490-1495.  Back to cited text no. 11    
12.Rajan N, Langtry JA. Generalized exacerbation of psoriasis associated with imiquimod cream treatment of superficial basal cell carcinomas. Clin Exp Dermatol 2006;31:140-141.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Wu JK, Siller G, Strutton G. Psoriasis induced by topical imiquimod. Australas J Dermatol 2004;45:47-50.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]

This article has been cited by
1 Vitiligo-like hypopigmentation associated with imiquimod treatment | [Hipopigmentación tipo vitíligo relacionada con tratamiento con imiquimod]
Monteagudo, B., Cabanillas, M., López-Mouriño, V.M., Suárez-Amor, O.
Piel. 2009; 24(9): 513
2 Hipopigmentación tipo vitíligo relacionada con tratamiento con imiquimod
Benigno Monteagudo,Miguel Cabanillas,Victor Manuel López-Mouriño,Óscar Suárez-Amor
Piel. 2009; 24(9): 513
[Pubmed] | [DOI]


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