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Widespread vitiligo after erythroderma caused by nevirapine in a patient with AIDS.

Sir, The therapeutic options for human immunodeficiency virus (HIV) disease include several drugs, and it is now recognized that treatment with a combination of at least three drugs is the most effective. Nevirapine was the first non-nucleoside reverse transcriptase inhibitor (RTI) with a rapid and potent anti-HIV activity. It selectively inhibits the reverse transcriptase of HIV1, but not of HIV2. It has widespread tissue penetration, including the central nervous system. In addition, it has no cross-resistance or cross-reactivity with nucleoside RTIs. Nevirapine can be administered together with nucleoside RTIs and/or protease inhibitors. The most common adverse reactions to nevirapine therapy include cutaneous reactions and elevated liver enzyme concentrations. In rare cases the cutaneous reactions can be serious, including drug hypersensitivity syndrome, toxic epidermal necrolysis and Stevens-Johnson syndrome (1). Vitiligo is a common cutaneous disorder, characterized clinically by white macules on the skin that can be localized or generalized. Loss of colour can occur by two mechanisms: a defect in the synthesis or the transfer of melanin; or a partial or complete absence of melanocytes from the epidermis (2). Vitiligo has been described in association with several drugs (3, 4) as well as with viral infections (5), including HIV infection.