Ribociclib-Induced Vitiligo: A Case Report with Histological, Dermatoscopic, Confocal Microscopy, and LC-OCT Findings Along with a Narrative Literature Review.
4 affiliations
- 1Department of Radiological, Oncological and Pathological Science, Sapienza University of Rome, Rome, Italy.
- 2Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Science, University of La Sapienza, Rome, Italy.
- 3Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
- 4IDI-IRCCS Istituto Dermopatico dell'Immacolata, Rome, Italy.
Abstract
Introduction
CDK4/6 inhibitors have revolutionized the therapeutic management of metastatic estrogen receptor-positive (ER+), HER2-negative breast cancer (BC) by increasing treatment efficacy while maintaining a favorable safety profile. An exceedingly rare adverse event associated with these agents is the development of vitiligo-like skin depigmentation.Objectives
This study aimed to characterize a case of ribociclib-induced vitiligo and investigate its underlying pathogenic mechanisms, with particular focus on vitiligo onset. We report the case of a 60-year-old postmenopausal female with metastatic, hormone-sensitive BC who experienced a durable partial remission during treatment with ribociclib in combination with aromatase inhibitors. During therapy, the patient developed hypopigmented lesions on her upper limbs 34 months after initiation of ribociclib, preceded by pruritus and erythema.Methods
Reflectance confocal microscopy (RCM) optical coherence tomography (OCT), and histopathological examination were used.Result
RCM and OCT proved valuable for real-time assessment and monitoring of skin changes, thereby informing clinical decisions regarding the management of skin toxicity. The presence of an inflammatory infiltrate, comprising lymphocytes and hyper-reflective inflammatory cells, suggests that inhibition of the CDK4/6 pathway may enhance antitumor activity beyond cell cycle arrest by modulating the immune response and promoting immune-mediated tumor control.Conclusions
The observed alterations in melanocyte regression could represent evidence of systemic immune activation and autoimmunity influencing melanocyte viability. These mechanisms may have significant implications for improving patient prognosis.
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BibTeX
@article{mezi2026ribociclibinduced,
title = {{Ribociclib-Induced Vitiligo: A Case Report with Histological, Dermatoscopic, Confocal Microscopy, and LC-OCT Findings Along with a Narrative Literature Review.}},
author = {Silvia Mezi and Flavia Persechino and Andrea Ascione and Antonella Chiavassa and Adele Artemi and Camilla Capasso and Simone Amato and Alessia Paganelli and Giovanni Pellacani},
journal = {Dermatology practical \& conceptual},
year = {2026},
month = jul,
doi = {10.5826/dpc.1603a6849},
url = {https://europepmc.org/article/MED/42858444},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Ribociclib-Induced Vitiligo: A Case Report with Histological, Dermatoscopic, Confocal Microscopy, and LC-OCT Findings Along with a Narrative Literature Review.
AU - Silvia Mezi
AU - Flavia Persechino
AU - Andrea Ascione
AU - Antonella Chiavassa
AU - Adele Artemi
AU - Camilla Capasso
AU - Simone Amato
AU - Alessia Paganelli
AU - Giovanni Pellacani
PY - 2026
DA - 2026/07/31
JO - Dermatology practical & conceptual
DO - 10.5826/dpc.1603a6849
UR - https://europepmc.org/article/MED/42858444
AB - Introduction CDK4/6 inhibitors have revolutionized the therapeutic management of metastatic estrogen receptor-positive (ER+), HER2-negative breast cancer (BC) by increasing treatment efficacy while maintaining a favorable safety profile. An exceedingly rare adverse event associated with these agents is the development of vitiligo-like skin depigmentation.Objectives This study aimed to characterize a case of ribociclib-induced vitiligo and investigate its underlying pathogenic mechanisms, with particular focus on vitiligo onset. We report the case of a 60-year-old postmenopausal female with metastatic, hormone-sensitive BC who experienced a durable partial remission during treatment with ribociclib in combination with aromatase inhibitors. During therapy, the patient developed hypopigmented lesions on her upper limbs 34 months after initiation of ribociclib, preceded by pruritus and erythema.Methods Reflectance confocal microscopy (RCM) optical coherence tomography (OCT), and histopathological examination were used.Result RCM and OCT proved valuable for real-time assessment and monitoring of skin changes, thereby informing clinical decisions regarding the management of skin toxicity. The presence of an inflammatory infiltrate, comprising lymphocytes and hyper-reflective inflammatory cells, suggests that inhibition of the CDK4/6 pathway may enhance antitumor activity beyond cell cycle arrest by modulating the immune response and promoting immune-mediated tumor control.Conclusions The observed alterations in melanocyte regression could represent evidence of systemic immune activation and autoimmunity influencing melanocyte viability. These mechanisms may have significant implications for improving patient prognosis.
SN - 2160-9381
ER -