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Vitiligo in Child
See also in: External and Internal Eye,Anogenital
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Vitiligo in Child

See also in: External and Internal Eye,Anogenital
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Contributors: Sarah N. Robinson MD, Vivian Wong MD, PhD, Susan Burgin MD
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Synopsis

Vitiligo is a relatively common disorder affecting melanocytes, resulting in depigmented, white patches of the skin. Vitiligo typically arises symmetrically in areas of frequent trauma, particularly on the face, upper chest, hands, elbows, knees, axillae, and perineum. Prevalence is estimated to be between 0.5%-1%. Vitiligo often presents in childhood or young adulthood, with roughly half of cases beginning before the age of 20.

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).
Hypopigmented macules or patches:
  • 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.

Best Tests

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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.

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References

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Last Reviewed: 07/27/2017
Last Updated: 07/17/2019
Copyright © 2019 VisualDx®. All rights reserved.
Vitiligo in Child
See also in: External and Internal Eye,Anogenital
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Vitiligo : Dorsum of hand, Face, Fingers, Hair color change, Scattered few, Symmetric extremities, Widespread, Depigmented macules/patches
Clinical image of Vitiligo
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