**10. Vitiligo**

Vitiligo is one of the other rare skin disorders that can occur with anti-TNF-alpha treatment. The role of anti-TNF-alpha inhibition in the development of vitiligo is complex and controversial. As with other paradoxical immune-mediated reactions, there are case studies where vitiligo has been significantly improved in anti-TNF-alpha therapy in vitiligo patients. The therapeutic effect of anti-TNF-alpha treatment on vitiligo is believed to be blocking the physiological effect of TNF-alpha on melanogenesis. According to the literature, TNF-alpha reduces tyrosinase levels. The melanocytic effect of TNF-alpha on vitiligo has also been demonstrated [49].
