Vitiligo In Children

  • Best Results4-12 months
  • Treatment Recovery0 days
  • Procedure Time2-10 minutes
  • Skin SpecialistDavin Lim
  • Duration of ResultsVariable
  • AnaestheticNA
  • 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.

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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