aDepartment of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, KoreabDepartment of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
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To the Editor: Vitiligo remains a major challenge in dermatology because there is no definitive cure.1 The autoimmune nature of vitiligo has been described,2 and the involvement of T cells in pathogenesis of vitiligo has also been shown in previous reports.3 While the therapeutic potential of immunosuppressants has often been raised, their role has not been well examined.We conducted a nationwide, population-based, retrospective cohort study to investigate the risk of vitiligo in organ transplant recipients (OTRs) using Korean National Health Insurance claims database (diagnoses according to the International Classification of Diseases, 10th revision [ICD-10] code) from 2009 until 2013. We identified all OTRs with kidney (Z94.0), liver (Z94.4), heart (Z94.1), lung (Z94.2), and both heart and lung (Z94.3) transplant status, who underwent organ transplantation before 2009 and survived through 2013. OTRs who had been diagnosed with vitiligo (L80) at least once in 2009 and 2010 were excluded, to rule out preexisting vitiligo. Three controls were randomly selected for each OTR by frequency matching for age and sex among those who had not received a diagnosis of vitiligo and organ transplant status in 2009 and 2010.The outcome of interest was the 3-year risk of vitiligo, defined by a documented principal diagnosis of vitiligo (L80) ≥5 times between 2011 and 2013 to minimize misclassification errors. Univariate and multivariate logistic regression analyses were sequentially performed to assess the risks of vitiligo in the OTR group compared to the control group.A total of 14,712 OTRs and 44,136 matched controls were enrolled. Vitiligo developed in 0.05% of OTRs between 2011 and 2013, and showed a significant decreased risk (odds ratio 0.305 [95% confidence interval 0.148–0.630]) compared with controls (0.20%; Table I). The most frequently used immunosuppressants in OTRs were tacrolimus (60.36%), mycophenolate mofetil (53.81%), and cyclosporine (42.44%; Table II).Our results may be attributed to the use of immunosuppressants in OTRs, and we speculate that the immunosuppressants could be effective in halting the spread of vitiligo as well. Although corticosteroids are the most commonly used systemic drugs for patients with spreading vitiligo, adverse effects restrict the long-term use of corticosteroids. Until now, a few case series showed conflicting results of the use of immunosuppressants other than corticosteroids for treatment of vitiligo.4,5There are a few limitations in our study. First, the detailed information of individuals that may influence the results was not assessed, such as medications other than the immunosuppressive agents, lifestyle factors, original disease that indicated transplantation, personal/family history of vitiligo or autoimmune diseases, donor–recipient mismatch, and medical history of the donor. Second, the associations of individual drugs with vitiligo risk were not determined.In conclusion, we demonstrated the association of organ transplant status with a reduced risk of vitiligo. Although our observations do not address the effectiveness of immunosuppressants, the use of immunosuppressants might be considered to manage patients with vitiligo after reviewing the risk and benefits. Additional studies are needed.JungMinBaeMD, PhDKwangHyunChoiMDJinYoungChoiMDMiriKimMD, PhDGyungMoonKimMD, PhDDongSooYuMD, PhDYoungBokLeeMD, PhDaDepartment of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, KoreabDepartment of Dermatology, Veterans Health Service Medical Center, Seoul, Korea*Reprint requests: Young Bok Lee, MD, PhD, Department of Dermatology, Uijeongbu St.