- Best Results4-12 months
- Treatment Recovery0 days
- Procedure Time2-10 minutes
- Skin SpecialistDavin Lim
- Duration of ResultsVariable
- Back to Work0 days
- Cost0-$ (Medicare)
Vitiligo In Children
Vitiligo is common in childhood. The prognosis is better in children compared to adults, as most cases re-pigment after prescribed therapy. The exception is segmental vitiligo. This subset may be rapidly progressive initially, however will stabilise within 6-8 months.
FactsFacts on Vitiligo in Children
- Most white patches in children are not due to vitiligo
- Common conditions include pityriasis alba & post inflammatory hypopigmentation
- The highest peak ranges from 4 to 8 years of age
- Segmental vitiligo accounts for 20% of vitiligo cases in children
- Segmental disease is often recalcitrant to topicals & phototherapy
- Autoimmune disorders are more commonly associated in this age group
How does vitiligo differ in children compared to adult vitiligo?
Children have more segmental forms of vitiligo as well as higher incidence of halo moles. A family history of autoimmune disorders is commonly noted in children. The good news is that children respond better to treatment compared to adults, except for segmental vitiligo.
What are the common causes of white patches in children?
The majority of white patches in children are not due to vitiligo. By far the most common cause is pityriasis alba. This presents as white areas on the face. It is mainly seen in darker skin children as the contrast in skin colour makes it more obvious.
Other causes of skin lightening include post inflammatory hypopigmentation. Dermatitis, eczema, pityriasis versicolor & pityriasis rosea are common causes. A dermatologist can tell the difference between these common conditions.
What are safe treatments for vitiligo in children?
Children with vitiligo will generally have a better prognosis than adults. The algorithm of treatment is similar to adults. Based upon recent guidelines-
Narrowband phototherapy: should be started early. Generally, patients over the age of 6-7 are candidates. 20-30 sessions are required to see results. Segmental vitiligo does not usually respond.
Topicals include steroid creams, PGE2 analogues, vitamin D, pimecrolimus & tacrolimus. Tacrolimus concentration is usually lower in children than in adults; 0.03 compared to 0.1%.
How successful are dermatological treatments for childhood vitiligo?
Most cases of generalized vitiligo are responsive to treatment with response rates of greater than 85%. Exceptions include acral & segmental vitiligo.
The combination of topical CS, tacrolimus & phototherapy is the mainstay of management.
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What is segmental vitiligo?
This form of vitiligo is uncommon (but more common in children). Segmental vitiligo subtype is seen in 20% of childhood cases. Compared to normal vitiligo, segmental disease –
- Presents as a single white patch in 90%.
- Border often irregular. Does not cross the midline. Often dermatomal.
- Affects young people.
- Stable after the first six months to one year.
- Rapid onset then stable.
What is the prognosis of segmental vitiligo?
There is good news & bad news. The good news is that even though segmental disease is of rapid onset, it stops expanding after 6 months. The bad news is that the hair follicle is often white. This is important because vitiligo spots with white hair usually don’t respond very well to treatment. That’s because the melanocyte stem cells, which can make more of the pigment-making cells, live in the hair follicles, but are most likely destroyed if the hair has become affected by vitiligo, turning white.
This form of vitiligo is stable, and hence patients are good candidates for surgical intervention including ReCell or split graft transfers of melanocytes. I do not advise treatment until the teenage years or beyond.
Can diet & supplementation help?
Yes. These can be useful adjunctive therapy. In summary, a diet low in acidic foods can help. Very rarely vitiligo can be associated with gluten insensitivity. In the context of supplementation, a multivitamin containing vitamin B, C, E, & D can be considered.
Herbal supplementation including green tea & ginkgo biloba can reduce oxidative stress on pigment cells. Results are conflicting, however given the low cost & benign nature of dietary supplements, it can be considered as adjunctive therapy. More on this website.
What is phototherapy for vitiligo?
This is a medically prescribed method to re-pigment white patches due to vitiligo. Narrowband phototherapy delivers calibrated doses of ultraviolet B via a photobooth.
Treatments are painless, quick, effective (in most cases) & covered under Medicare.
This wavelength of light is 311 nm. Phototherapy refines the normal spectrum of UV from the sun, filtering all the harmful rays. This procedure is safe in children.
- Phototherapy involves 2-3 sessions per week
- 20 sessions are required to notice changes
- Therapy takes between 1-7 minutes
- Phototherapy is under Medicare with no out of pocket expenses to the patient
How many sessions are required?
Typically, a minimum of 20 sessions are required. Each session takes 1-7 minutes to perform. A typical course consists of 2-3 visits per week. I evaluate patients after 20-30 sessions.
Is phototherapy safe?
Yes. Studies over 30 years have demonstrated the safety of narrowband phototherapy. Eye protection is used in all children during the procedure.
This subset of vitiligo carries a good prognosis, unless it is segmental disease. For DIY solutions, start with simple vitamins & supplements such as ginkgo biloba. You can source pseudocatalase creams online. Add natural phototherapy, but don’t burn your kid. Home treatments are not as effective as prescribed phototherapy.
For home treatments, I do not endorse stabbing your child with microneedling devices. It will cause trauma to children (unless you are Asian, as most Asiatic kids are hardened by trauma anyway). Let’s be sensible now. If you live in a remote area & cannot have access to phototherapy, you can discuss options with your dermatologist. Some may prescribe psoralen creams which are activated by natural light.
How do I treat segmental vitiligo?
Firstly, one needs to confirm the diagnosis. Most cases can be diagnosed on history & examination. The absence of white hairs carries a poor prognosis in the context of topicals, lasers, microneedling & light therapy. The great news is that it is stable.
Options to treat include follicular unit transfer, punch grafting, split grafts & melanocyte transfer with ReCell. Once re-pigmentation has been achieved, results are usually lifelong. Relapse is unlikely to occur. Note: I combine phototherapy post melanocyte transfer to improve re-pigmentation rates. The final result is usually 12-18 months post-surgery.
Davin’s Viewpoint on Treating Vitiligo in Children
Many cases of white patches in children are due to other causes including pityriasis alba & post inflammatory hypopigmentation. The latter is frequently seen in contact, irritant & allergic reactions, psoriasis & other inflammatory skin conditions.
Unusual cases of white patches include ash leaf spots of tuber sclerosis (usually withs associated angiofibromas), achromic nevus & naevus depigmentosus. As always, an accurate diagnosis is essential as this dictates both prognosis & treatment.
Childhood vitiligo has a very similar algorithm as adults. Namely the use of CS, tacrolimus & prostaglandin analogies coupled with phototherapy gives the best outcomes. It is important to give patients a good indication of prognosis. Segmental vitiligo is usually resistant to narrowband & creams. The good news is that it is stable & non-progressive.
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