Vitiligo in Children: Causes, Symptoms, Types & Treatment

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The exact causes of vitiligo in children are not known. This chronic condition causes loss of skin pigment (melanin), resulting in white patches in the skin. Hair and oral cavity may also have discoloration. These long-lasting patches can cause psychosocial issues in some children, especially teenagers. Adequate awareness and support from parents are essential to overcome low-self esteem issues (1).

A joint research conducted by scientists from the United States and France demonstrated that around 1.52% of children and 2.16% of teenagers in the US had vitiligo. However, vitiligo is not contagious and it does not spread from one person to another. The condition does not affect children’s intelligence and other skills and abilities. Read on to learn more about the causes, types, and ways to manage vitiligo in kids.

What Causes Vitiligo In Children?

Nonfunctioning or death of melanin-producing cells results in the loss of skin pigmentation in the body. Melanin is a pigment produced by cells called melanocytes. The exact cause for melanocyte dysfunction is yet to be discovered. It can be due to:

1. Heredity

Image: Shutterstock

2. Autoimmunity (the immune system destroying melanocytes)

3. Environmental factors (sunburn, stress, exposure to chemicals) (2)

Vitiligo, a skin condition, is non-contagious, which means a child cannot catch the disease from someone.

Point to consider

Vitiligo is believed to be more common in those who have a family history of psoriasisⁱChronic, long-term disease in which skin cells build up to form itchy, scaly patches , thyroid issues, Addison’s diseaseⁱA condition where the adrenal glands don’t produce enough steroid hormones resulting in muscle weakness, fatigue, and appetite loss , and type 1 diabetes (1).

What Are The Symptoms Of Vitiligo In Children?

The depigmented patches of skin are the primary symptom of vitiligo

. It can affect any area of the body, particularly the areas exposed to sun. The spots can be of different sizes. The following are the symptoms of vitiligo:

• Loss of skin pigmentation in patches
• Premature whitening or graying of hair on the head, eyebrows, eyelashes
• HypopigmentationⁱIt occurs when there is a low amount of melanin in the skin, making them lighter in comparison to unaffected parts in the oral and nasal cavity
• Changes in the color of the inner layer of the eye (retina)

What Are The Various Types Of Vitiligo?

Vitiligo is classified into two different types and three subtypes (3) (4).

1. Nonsegmental vitiligo

Nonsegmental vitiligo is the most common form and characterized by the appearance of white patches on both sides of the body. It is also known as bilateral vitiligo, vitiligo vulgaris, and generalized vitiligo.

The color changes on the skin, usually starting from hands, around eyes or mouth, and on the feet. In a few cases, it begins from areas where the skin rubs frequently. You may notice the color loss is more noticeable and spreading to more body parts over time in nonsegmental vitiligo.

2. Segmental vitiligo

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Segmental vitiligo is also called unilateral vitiligo. It usually starts at a younger age, when compared to nonsegmental vitiligo. It can involve a segment of the body, such as one leg or arm. 50% of cases are associated with color changes of hair, eyebrows, or eyelashes – a condition called poliosis (4).

Experts subtype vitiligo into three groups based on the loss of pigment on the body:

Localized: It is characterized by one or a couple of spots on the body. You might notice a loss of skin color on mucous membranes, known as mucosal vitiligo, or in areas like the face and hands, known as acrofacial vitiligo (5) (6).
Generalized: The depigmentation appears on several areas of the body.
Universal: Major parts of the original skin color become patches. It is a rare form of vitiligo.

In addition to these two types mentioned, your child may also have vitiligo which can be classified into the following clinical variants:

• Trichrome vitiligo is recognized by its appearance characterized into three sections. The affected area exhibits white spots with three distinct colors: a central zone of white depigmentation, the surrounding normal skin color, and a lighter region of skin in between, referred to as hypopigmented. This form of vitiligo indicates an active and progressive condition, necessitating prompt treatment (7).
• Quadrichrome vitiligo shows macular perifollicular (around the hair follicle) or marginal hyperpigmentation, in addition to symptoms associated with trichrome vitiligo. Notably, a fourth color (dark brown) appears in areas of perifollicular repigmentation, particularly in individuals with darker skin tones (8).

Quick fact

If there is a small isolated patch that doesn’t evolve into nonsegmental vitiligo for two years, it is known as focal vitiligo (3).

How To Diagnose Vitiligo In Infants And Children?

A doctor or dermatologist can diagnose the condition by visual examination of the white patches of the skin. They will use a specialized lamp called Wood’s lamp to detect paler skin. Parents may be asked about the presence of the condition in the family or if the child has a history of other autoimmune diseases.

How Is Vitiligo Treated?

The treatment of vitiligo can involve single or multiple methods. Although there is no approved permanent cure for vitiligo, the existing therapeutic options can help to improve the quality of life.

1. Topical treatment

Topical treatments are recommended for localized vitiligo. There are three main categories of drugs used in the topical treatment of vitiligo based on the site of involvement:

• Topical steroids
• Topical calcineurin inhibitors
• Topical vitamin D

Recent guidelines advise topical calcineurin inhibitors as a first-line treatment for facial and neck patches and topical corticosteroidsⁱA group of steroid hormones produced in the adrenal cortex that are used for treatments in synthetic form to reduce inflammation for other parts of the body. These have fewer side effects and can be applied two times daily. Topical vitamin D is always used in combination with topical steroids for a better prognosis.

Experts say

According to the American Academy of Dermatology, tacrolimus ointmentⁱAn immunosuppressant commonly used for the skin condition called eczema or pimecrolimus creamⁱAn immunomodulatory agent used for the treatment of a skin condition called eczema may be prescribed to children with vitiligo. They work best for head and neck patches and may be used for a longer time than corticosteroids (10).

2. Mineral complex cream

Mineral complex creams are used as adjunctive to phototherapy. These creams can help reduce oxidative pigment cell damage. Mineral complex creams may have side effects, but doctors can prescribe creams that present few complications.

3. Sun protection

Sun and UV protection should be advised for all areas of the body but is required more for areas of depigmentation or skin discoloration. You can use 2sunblock or sunscreen, hats, sunglasses, and clothing. There is a misconception that sunlight helps cure vitiligo by producing more melanin, but exposure to sunlight can cause severe sunburn due to a lack of melanin synthesis, which protects us from the harmful rays of the sun.

4. Oral vitamins supplements

According to a few studies, vitamin D and B-complex supplementation can improve outcomes in patients with vitiligo. Low-dose vitamin supplementation as a requirement is recommended in childhood. There is no evidence suggesting the effectiveness of high-dose vitamin supplementation in childhood to improve vitiligo outcomes. Follow the physician’s advice before attempting self-treatment with supplements.

5. Steroid pulse therapy

Intermittent use of supra pharmacologicalⁱRelated to more than the usual pharmacologic concentration or therapeutic dose of the drug doses of steroid is known as steroid pulse therapy that helps to reduce the side effects to an extent compared to other methods of steroid treatment

. Combination therapy with systemic steroids, topical tacrolimus, and phototherapy may aid in repigmentation. Steroid therapies can cause various side effects, including weight gain and acneiform eruptions.

6. Phototherapy

Image: Shutterstock

There are various modalities of phototherapy known to be effective in pediatric vitiligo. UVB therapy, a type of UV light therapy, is the primary choice for treatment in childhood, as it helps in the repigmentation and stabilization of the disease. Rapidly progressing vitiligo could be managed with generalized phototherapy. It may cause nausea, phototoxic reactions, and pain. Your doctor may recommend an antinuclear antibody screen before phototherapy sections.

7. Psychotherapy

Psychotherapy helps in the management of patients’ fear of disease exacerbation, poor self-esteem, low quality of life, poor social relationships, depression, and anxiety. Cognitive-behavioral therapy and hypnosis are psychotherapies aimed to improve the quality of life of vitiligo patients (9).

8. Cosmetic camouflage

The clinical appearance of the disease could be improved with a wide variety of cosmetic products such as self-tanners, clothing alterations, concealers. Makeup matched to the skin can be useful while attending events and parties. It could help improve the overall quality of life. Follow your doctor’s recommendations on choosing appropriate makeup products.

9. Surgical grafting

Image: IStock

A stable vitiligo lesion that has not shown any progression for a year can be managed with autologous graftingⁱSurgical treatment where viable tissues from pigmented donor skin to recipient vitiliginous areas . Surgical grafting is recommended for stable segmental vitiligo. It can be done using different grafting techniques ranging from punch graftingⁱSurgical treatment where a hole is punched into the skin to replace the affected tissue with a new patch of skin , split-thickness skin graftingⁱA medical procedure where skin from one site is taken to cover the surgical site in the same body , and the newer melanocyte transfer grafting. Grafting may give rise to side effects such as pain and cobblestoning effectⁱOccurs in hollow organs where longitudinal and circumferential splits of mucosa give the appearance of cobblestone .

10. Depigmentation

The remaining skin color is removed using depigmenting agents. This method is an option for widespread vitiligo when other treatments failed to give positive outcomes. These agents could be used for nine months or more. It may cause redness, swelling, itching, and dry skin. It is permanent, and you will be sensitive to sunlight.

11. Micropigmentation

Your doctor can implant pigment into your skin using special instruments. It’s most effective for patches on and around lips, especially for people with darker complexions. Treatment may trigger the development of other spots of vitiligo, and it is challenging to find implants matching skin color (10) (11) (12) (13).

There have been some emerging treatments for vitiligo lately. Ruxolitinib, a topical Janus Kinase (JAK) inhibitor, has recently been approved for treating vitiligo in adults, but its efficacy in children is yet to be determined (14). Other promising treatments for vitiligo include platelet-rich plasma (PRP) therapy and cellular therapies like melanocyte transplantation (15) (16).

How To Manage The Psychological Impact Of Vitiligo On Children?

Vitiligo might make children conscious and affect their self-esteem. It may lead to emotional distress, anxiety, and social stigmatization. However, there are ways to reinforce confidence and improve the quality of life for a child with vitiligo (17). The following tips are helpful to deal with the psychological impacts of vitiligo:

• Never focus on vitiligo. Appreciate your child for their achievements and let them know it has nothing to do with skin color.

• Never put pressure on your child to hide the patches.

• Make them feel your unconditional love and acceptance. Let your child understand and explain what vitiligo is to their peers.

• Encourage your child to participate in games, trips, and other social events.

Image: IStock

• Consult psychologist if you notice your child is depressed or anxious due to vitiligo

There is no specific and approved treatment of vitiligo promising complete cure. Family and social support is the best way to help children have a healthy life without any psychological impact.

Snigdha Johri, an artist, shares on her blog how the psychological impact of vitiligo affected her childhood. She says, “It came into my life when I was about 5… Coming from a small town in Northern India, I grew up listening to many superstitious theories around it… Very soon, I had realized that having vitiligo did not just make me uncomfortable but also the people I came in contact with, it was and is still a socially stigmatized issue. The stares and questions from strangers and acquaintances and some awkward visits to relatives, family friends when my presence created a moral dilemma about whether I can touch or use certain things as some believed it to be a communicable disease are a few unpleasant episodes of my life that I still remember (some of them still continue to happen). Time went by, and as vitiligo was spreading to different parts of my body, it was crippling my mind with insecurities about my future and led to some bad decisions and poor choices, though when I look back today, it seems all those experiences shaped up who I am as a person, somehow they turned out to be not so bad after all, as they made me more sensitive yet strong and resilient (ⅰ).’’

Infographic: Vitiligo And Other Autoimmune Conditions

Autoimmunity, or the destruction of melanocytes by the immune system, is one of the reasons behind vitiligo. Thus, it is not uncommon for it to exist with other autoimmune conditions or for children with vitiligo to have the risk of other autoimmune diseases. The following infographic presents a list of autoimmune conditions associated with vitiligo.

Illustration: Momjunction Design Team

Illustration: Vitiligo in Children: Causes Symptoms Types & Treatment

Image: Stable Diffusion/MomJunction Design Team

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Dr. Nikolina Zdraveska is a pediatrician, educator and a researcher, with around 15 years in the field. Currently, she is working at University Children Hospital in Skopje, Macedonia. Dr. Zdraveska has received her medical degree from the Medical Faculty of Skopje in her native Macedonia and completed Residency Training at University Children’s Hospital in Skopje.

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  Dr. Pierrette Mimi Poinsett is a licensed pediatrician and a health advocate with 19 years of experience. She completed her doctor of medicine from the University of Chicago Pritzker School of Medicine and is currently practicing as a medical consultant in California.
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  Dr. Leah Alexander is a board-certified pediatrician who provides medical care in an outpatient setting in Fair Lawn, New Jersey. She has also been working as a pediatrician with Medical Doctors Associates at Pediatricare Associates, New Jersey, since 2005. Dr. Alexander holds a bachelor's degree in Health Science from Kalamazoo College and a Doctor of Medicine degree from Michigan State University.

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