Vitiligo in children

Half of all vitiligo patients have an onset before the age of 20, and children comprise 25% of all vitiligo patients. “If this disorder begins in childhood, it is often associated with profound emotional trauma. Affected children often have longstanding social adjustment issues,” said Prof. Pearl Grimes (Vitiligo & Pigmentation Institute of Southern California, USA) [1].

Most bothersome sites are the face and legs. If the disease starts early, it has a greater severity. Vitiligo is seen more frequent in children with atopic dermatitis [2]. Ezzedine et al. (2014) identify 2 clinical subtypes of vitiligo: those with early onset disease (<12 years) are characterised by a family history of vitiligo, a family history of premature greying, and halo nevi; those with late onset disease (>12 years) often have acrofacial localisation [3]. Research has shown that cosmetic camouflage leads to a significant improvement in quality of life in children with vitiligo [4].

Compared with adults, comorbidity with regard to autoimmune disease is lower in children, but multiple studies have documented an increased frequency of thyroid disorders [5-7]. “I strongly recommend that you get a thyroid panel if this is the only lab you do,” said Prof. Grimes. In children, there is a higher incidence of segmental vitiligo (see Figure). “Treatment goal is to stabilise and improve quality of life. Fortunately, excellent therapeutic outcomes are often achieved in children,” said Prof. Grimes. To treat vitiligo successfully, a multi-modality approach is warranted: It is important to decrease the oxidative stress and the aberrant immune response, and to stimulate melanocyte regrowth and proliferation. Oral corticosteroids (prednisone 5-10 mg daily) are necessary to stabilise vitiligo. Narrowband UVB phototherapy is an effective method to stimulate repigmentation: in a retrospective study, a repigmentation rate of >75% was achieved in 45.4% of cases [8]. In general, children show enhanced repigmentation compared with adult patients. In addition, “vitamin D is a powerful antioxidant and is often deficient in patients with vitiligo, especially when they get older. Therefore, we should also always check vitamin D levels in our patients,” recommended Prof. Grimes.

Figure: Distribution of the clinical types of vitiligo differs between children and adults [1]



Figure kindly provided by Dr Grimes.

1. Grimes PE. Session S002, AAD Annual Meeting, 1-5 March 2019, Washington DC, USA.
2. Ezzedine K et al. Br J Dermatol 2012;167:490-5.
3. Ezzedine K et al. Pigment Cell Melanoma Res 2014:27:134-9.
4. Salsberg JM et al. J Cutan Med Surg 2016;20:211-5.
5. Kartal D et al. Postepy Dermatol Alergol 2016;33:232-234
6. Kroon MW et al. Horm Res Paediatr 2013;79:137-44.
7. Afar T, Isleten F. Indian J Endocrinol Metab 2013:17:1096-9.
8. Yazici S et al. Turk J Med Sci 2017;47:381-4.



Posted on 19 April, 201923 February, 2021