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Summary  Tumour necrosis factor ( TNF )‐α, a proinflammatory cytokine central to many autoimmune diseases, has been implicated in the depigmentation process in vitiligo. We review its role in vitiligo by exploring its pro‐ and anti‐inflammatory properties and examine the effects of blocking its actions with  TNF ‐α antagonist therapeutics in reports available in the literature. We found that  TNF ‐α inhibition halts disease progression in patients with progressive vitiligo but that, paradoxically, treatment can be associated with  de novo  vitiligo development in some patients when used for other autoimmune conditions, particularly when using adalimumab and infliximab. These studies reinforce the importance of stating appropriate outcomes measures, as most pilot trials propose to measure repigmentation, whereas halting depigmentation is commonly overlooked as a measure of success. We conclude that  TNF ‐α inhibition has proven useful for patients with progressive vitiligo, where  TNF ‐α inhibition is able to quash cytotoxic T‐cell‐mediated melanocyte destruction. However, a lingering concern for initiating  de novo  disease will likely prevent more widespread application of  TNF  inhibitors to treat vitiligo.

Tumour necrosis factor‐α inhibition can stabilize disease in progressive vitiligo