Dupilumab Linked to Increased Risk of Vitiligo in Atopic Dermatitis Patients, Though Absolute Risk Remains Low
A retrospective cohort analysis suggests that atopic dermatitis (AD) patients treated with dupilumab may have an increased risk of developing vitiligo, although the overall absolute risk remains low.
“Dupilumab has emerged as a revolutionary therapy for moderate-to-severe AD,” the investigators noted, while acknowledging that “cases of both new-onset vitiligo and resolution of pre-existing vitiligo after dupilumab treatment have been reported.”
Using the TriNetX US Collaborative Network, researchers conducted a propensity score–matched cohort study comparing adults with AD treated with dupilumab to those receiving other systemic therapies, including corticosteroids, methotrexate, azathioprine, mycophenolate mofetil, and cyclosporine. Patients with prior vitiligo were excluded, and the primary outcome was new-onset vitiligo within 3 years of treatment initiation.
After matching, 27,723 patients were included in the dupilumab cohort and 27,868 in the control cohort. Vitiligo incidence was 0.206% in the dupilumab group compared with 0.104% in controls. This corresponded to an absolute risk difference of 0.102% and a relative risk of 1.976 (95% CI, 1.264–3.089), with a hazard ratio of 2.297 (95% CI, 1.467–3.595), indicating a statistically significant increase in risk.
Despite this relative increase, the overall event rate remained low, suggesting that vitiligo represents a rare adverse event in this setting.
“AD patients treated with dupilumab were more likely to develop vitiligo after treatment initiation,” the authors concluded. “The absolute risk difference was small, indicating this as a rare adverse event.”
“Given the psychosocial burden of vitiligo, clinicians should still be aware of this potential outcome when counseling patients and monitoring during therapy,” the authors added.
These findings highlight the importance of patient counseling and monitoring for pigmentary changes, while reinforcing the overall favorable benefit-risk profile of dupilumab in AD.
Reference
Choudhury S, Lee M. Examining the risk of vitiligo in atopic dermatitis patients treated with dupilumab. Presented at: American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, Colorado.
