Vitiligo in Child
See also in: External and Internal Eye,AnogenitalAlerts and Notices
Synopsis
While the exact etiology is not known, many consider vitiligo to be an autoimmune disease in which the melanocyte is targeted. Genetic predisposition and trauma are other risk factors for vitiligo development. Other autoimmune diseases are observed more frequently in patients with vitiligo, including diabetes mellitus type 1, pernicious anemia, Hashimoto thyroiditis, Graves disease, Addison disease, and alopecia areata.
The segmental form of the disease, which presents as an asymmetric, frequently dermatomal, depigmented band, disproportionally affects children. This form of the disease is less likely to be associated with coexisting autoimmune phenomena.
Vitiligo has been associated with ocular (eg, uveitis) and cochlear abnormalities.
Codes
ICD10CM:L80 – Vitiligo
SNOMEDCT:
56727007 – Vitiligo
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Depigmented macules or patches:- Albinism, piebaldism, and other genetic disorders – Begin in infancy.
- Patients with Waardenburg syndrome may also present with heterochromia irides, deafness, limb defects, or Hirschsprung disease in addition to congenital pigmentary abnormalities.
- Medication-induced or chemical-induced leukoderma – Look for history of chemical use and/or topical corticosteroids.
- Lichen sclerosus – Look for sclerotic white plaques, often in the genital area; can be severely pruritic. Lichen sclerosus can be depigmented but also has epidermal changes (atrophy, fissures, petechiae).
- Onchocerciasis – Shins are common site of involvement. Suspect if patient is coming from endemic area (Africa, Central or South America).
- Tinea versicolor – Potassium hydroxide (KOH) positive. Mild scale noted; often seen in the shoulders, upper trunk.
- Pityriasis alba – Typically affects the cheeks of atopic individuals; presents with hypopigmented, not depigmented, macules with ill-defined borders.
- Post-inflammatory hypopigmentation
- Idiopathic guttate hypomelanosis – Characteristic pattern and shape of lesions different from vitiligo, including well-demarcated, 0.4- to 0.7-mm macules that do not coalesce, are symmetric, and involve the extensor forearms and shins; the face is rarely involved.
- Morphea – Look for sclerotic plaques.
- Hypopigmented macules, also known as ash leaf spots, are typically the first cutaneous finding observed in patients with tuberous sclerosis. Wood's lamp examination reveals hypopigmentation, not depigmentation. Lesions do not favor the face or areas of trauma, as may occur in vitiligo.
- Nevus depigmentosus are hypopigmented, usually present at birth, and usually do not extend or regress over time.
- Hypomelanosis of Ito presents as whorled areas of hypopigmentation following Blaschko lines.
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Management Pearls
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Therapy
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Drug Reaction Data
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.Subscription Required
References
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Last Reviewed:07/26/2017
Last Updated:07/16/2019
Last Updated:07/16/2019
Patient Information for Vitiligo in Child
Overview
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.
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.
Vitiligo in Child
See also in: External and Internal Eye,Anogenital