Can prescription drugs cause vitiligo?

Last Updated on 22nd September 2022 by Caroline Haye

Medications linked to pigment loss

Before I launch into the subject of whether some prescription drugs cause vitiligo, I’d like to state, for the record, that I am the sort of person who only ever takes medication as a last resort. I always prefer to get some fresh air and exercise or a massage to cure a headache instead of swallowing a pill. And I would rather eat my way to better health than get a doctor’s prescription. I accept that there are times when drugs or surgery are the only option. But I can’t help thinking it is safer and kinder to nudge the body gently back into balance naturally, wherever possible, rather than whacking it with a pharmaceutical or surgical blunt instrument.

This opinion is based on a mixture of intuition and bitter experience. For some reason, I only have to look at a tablet with an unpronounceable chemical name and I either break out in a rash or I develop a killer case of constipation. I am not denying that there are some marvellous drugs around today, including many of course that save lives and alleviate suffering. But I am only too aware that they all carry a risk of unwanted side-effects of one sort or another. So, as someone with a history of vitiligo, the subject I want to explore here is whether pigment loss is ever a potential side effect of medication.

The quick answer is yes

The quick answer to this questions is yes. A number of prescription drugs can cause vitiligo. And, although pigment loss is a relatively uncommon pharmaceutical side-effect, it is significant for those of us who already have a history of this. So it is worth being aware that some drugs do pose an increased risk in our case. Discussing this risk with our doctor, in the event that we are ever prescribed one of them, would enable us to make an informed decision. And the chances are that an alternative medicine might be available that would be a safer choice… My point being that, unless we bring the topic up ourselves, our doctor is unlikely to raise it.

Most of the medications that carry a known risk of skin de-pigmentation (a.k.a. drug-induced leukoderma) fall into the following categories. (Which, of course, is not to say that all drugs in these categories pose the same risk.)

Immune-modulating, targeted and biologic medicines.

Many of these drugs, like certain interleukins and interferons, are used to treat cancers. Others, like infliximab and adalimumab are for treating inflammatory conditions of the skin (e.g. psoriasis), joints (e.g. arthritis) or gastrointestinal tract (e.g. coeliac and Crohn’s diseases). But they are not limited to prescription drugs. They also include some over-the-counter items like imiquimod cream, which is a treatment for genital warts.

Anti-convulsant and anti-psychotic drugs

In particular, a class of tranquilliser called benzodiazepines that doctors often prescribe to treat either anxiety or seizures, includes a number of drugs that may cause de-pigmentation. One example is carbamazepine, a medication for epilepsy, neuropathic pain and schizophrenia, among other conditions. A case of drug-induced vitiligo is documented in this report of a patient who lost pigment while taking carbamazepine.

Anti-malaria medication

As far as I can tell from my searches, the only anti-malaria drug known to induce vitiligo is chloroquine. But the reason I have singled this out for a special mention is because I can remember taking an anti-malarial before a trip to Africa (almost 30 years ago now) and feeling quite ill afterwards. I don’t remember if it was chloroquine or not. But I do know that my vitiligo spread rapidly around that time, which makes me wonder with hindsight if there may have been a connection. (Apparently though, doctors do not prescribe chloroquine so often nowadays, as it is not very effective against plasmodium falciparum, the most common and dangerous type of malaria parasite.)

PPIs (Proton Pump Inhibitors)

Doctors prescribe PPIs to combat heartburn and acid reflux symptoms, which work by inhibiting the secretion of gastric acid. Unfortunately for us, it seems they also inhibit melanin production, as this article explains. (You may also be interested in reading about the knock-on effects of low stomach acid on nutritional absorption, including “leaky gut” syndrome and autoimmune conditions, on my Vitiligo and Low Stomach Acid page.)

Beta blockers

Beta blockers are a class of drug that is widely used to lower blood pressure, treat angina and reduce the risk of heart attack. And, as such, they save lives. However, if you find yourself a borderline candidate for this type of medication or your doctor can recommend an acceptable alternative, you may want to take into account the fact that there are a number of possible side effects of taking beta blockers that affect the skin, including aggravating vitiligo.

Antibiotics

Ampicillin is a penicillin-type drug for treating a variety of common, and less common, infections. These can include anything from ear and bladder infections or food poisoning to endocarditis (a bacterial infection of the heart valves and lining). If, like me, you are allergic to penicillin, you will want to avoid this medication in any case. But, either way, you should bear in mind that research (albeit only on mice at this stage) has demonstrated that this antibiotic induces vitiligo.

This research, in line with several other recent studies, indicates that an imbalance in gut bacteria (such as occurs with antibiotic treatment) is a trigger for vitiligo. But not enough data exists yet to show exactly what the ideal vitiligo-friendly gut microbiome looks like (i.e. how many different species of bacteria and in what ratio). It is a new and complex area of research, so it will probably be some time before anyone knows what other antibiotics, besides ampicillin, may cause de-pigmentation. Reason tells me that all antibiotics interfere with the balance of bacteria in the gut. So, I only ever take them in dire emergencies. And I always follow a course of antibiotics with a course of broad-spectrum probiotics to try to restore a healthier balance.

So, which individual prescription drugs cause vitiligo?

The following list of possible vitiligo-inducing medications is as accurate and comprehensive as I could make it. But it is bound to be incomplete because information on the subject is relatively hard to come by and to collate.

I have included as many of the individual medications and their trade names as I could. This is to make it easier to check, at a glance, on any you may be taking… In which case, you then have the option to talk to your doctor about any vitiligo-related concerns you may have.

PLEASE NOTE: I’m sure I don’t need to stress how important it is to talk through all decisions about discontinuing or changing prescription medicines with your doctor… But I will stress it anyway because many of the conditions these drugs treat are life-threatening. It goes without saying that playing amateur pharmacist is absolutely not a good idea. So, please use this information responsibly.

List of vitiligo-inducing drugs

• Infliximab (brand names include Remicade, Inflectra, Renflexis and Avsola)
• Etanercept (brand names include Enbrel, Erelzi and Eticovo)
• Adalimumab (brand name Humira)
• Imatinib (brand names include Gleevac and Glivec)
• Dasatinib (brand name Sprycel)
• Pazopanib (brand name Votrient)
• Sunitinib (brand name Sutent)
• Gefitinib (brand name Iressa)
• Pembrolizumab (a.k.a. lambrolizumab; brand name Keytruda)
• Nivolumab (brand name Opdivo)
• Vemurafenib (brand name Zelboraf)
• Dabrafenib (brand name Tafinlar)
• Tolcapone (brand name Tasmar)
• Levodopa (brand names include Sinemet and Madopar)
• Dopamine (brand names include Intropin, Dopastat and Revimine)
• Proton pump inhibitors (PPIs)
• Fluphenazine (brand names include Modecate, Moditen and Prolixin) 
• Carbamazepine (brand name Tegretol)
• Valproic acid (a.k.a. valproate; brand names include Depakote, Convulex, Syonell and Belvo)
• Clonazepam (brand name Klonopin)
• Phenytoin (brand name Dilantin)
• Insulin lispro (brand names include Humalog, Liprolog and Admelog)
• Chloroquine
• Ganciclovir (brand names include Cytovene, Cymevene and Vitrasert)
• Clofazimine
• Ampicillin (brand names include Omnipen, Ampi, Penglobe and Principen)

(If you found this article useful, you may also want to check out my blog on chemically-induced vitiligo.)

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