Vitiligo is an acquired, pigmentary disorder characterized by loss of melanocytes. While vitiligo can appear at any time from shortly after birth into adulthood, it frequently begins in childhood. Onset during infancy is rare. Vitiligo in the infant can present as a focal macule or patch, in a segmental distribution appearing in a dermatome, or as vitiligo vulgaris. Vitiligo vulgaris has the findings of symmetrically scattered, slowly enlarging depigmented patches on the face (particularly periorificial distribution), trunk, hands, axillae, groin, upper and lower limbs, and body folds.
The natural course of the disease is slowly progressive and may have long periods of quiescence. Most treatment options should be reserved for after infancy.
Codes
ICD10CM: L80 – Vitiligo
SNOMEDCT: 56727007 – Vitiligo
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Differential Diagnosis & Pitfalls
Note that albinism (look for abnormal eye color), piebaldism (localized), and other genetic disorders appear more frequently in infancy and have other associated cutaneous findings in addition to a positive family history.
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Vitiligo is a condition caused by the immune system turning against itself (an autoimmune disease). Immune cells of the body attack the color-producing (pigment-producing) cells in the skin, which leads to the formation of white (depigmented) patches that are often much larger than a thumbnail. In darker skin colors, the contrast between the normal pigmented skin and depigmented areas is greater than in lighter skin colors.
It may be seen with other autoimmune diseases, such as thyroid disease, alopecia areata, diabetes mellitus, Addison disease, and myasthenia gravis.
The way that vitiligo progresses varies greatly; it may remain in the area where it started (localized) or it may become more widespread.
Who’s At Risk
Vitiligo may start at any age but usually begins between the ages of 2 and 40. All races / ethnicities may be affected. Despite a common belief, vitiligo is not more common in Black individuals; however, the contrast between affected and normal skin is more obvious and potentially more cosmetically bothersome in individuals with darker skin.
Signs & Symptoms
Vitiligo may affect areas prone to chronic minor injury, such as the fingers, knuckles, and elbows. It may also affect the face, upper chest, hands, underarms, and groin. It may be widespread, affecting both sides of the body (generalized); it may affect only one side of the body (segmental); or it may affect only one localized area (focal).
Sharply defined white patches are seen. If the affected area contains hair, the hair may turn white.
Sometimes halo nevi can be seen, which is a mole surrounded by a circular white patch, resembling a halo.
Self-Care Guidelines
It is important to protect your child's skin from the sun, particularly the affected areas:
Avoid exposure to midday sun (10 AM to 3 PM).
Wear a broad-spectrum, high sun protection factor (SPF higher than 30) sunscreen.
Wear protective clothing and hats.
Dermablend or Covermark cosmetic cover-up makeups can hide the white patches.
When to Seek Medical Care
It is not necessary to treat vitiligo, but see your child's doctor for evaluation if it becomes bothersome or if it is progressing.
Treatments
The doctor may recommend:
Topical steroid creams or ointments to help restore skin color. Use these with caution because of the risk of tissue damage (atrophy) with prolonged use, particularly on the face and skin fold areas.
Topical nonsteroid medications, such as ruxolitinib (Opzelura) cream (age 12 and older), tacrolimus (Protopic) ointment, and pimecrolimus (Elidel) cream.
Ultraviolet (UV) light therapy or laser therapy.
Superficial skin grafts, especially in hard-to-treat (recalcitrant) locations, such as over joints.
Patient Information for Vitiligo in Infant/Neonate