Abstract
Introduction
Vitiligo is an acquired disorder characterised by progressive loss of functional melanocytes resulting in depigmented skin and hair.
Epidemiology
Its prevalence in the general population varies between 0- 2.16% worldwide with one third to one half having their onset in childhood.(1,2) Childhood vitiligo (CV), defined as disease onset before the age of 12 years, is common. In India 2% of children attending a pediatric clinic were diagnosed with vitiligo.(3) The childhood cases of vitiligo, with an age of onset less than or equal to 12 years are typically associated with more halo nevi, Koebner phenomenon, positive family history, segmental disease and personal history of atopy. Those with late onset of more than 12 years are associated with more acrofacial lesions and thyroid disease.(4) Even though disease onset in less than two years is unlikely as opposed to congenital disorders of pigmentation, the disease onset increases through the first two decades.(5) Onset before age 2 years represents 11% of pediatric-onset cases, 28% of cases start between 2 and 5 years, 40% of cases begin between 5 and 10 years, and 21% between 10 and 18 years, demonstrating that median age of onset is between 5 and 10 years of age.(6) The prevalence of vitiligo by gender is usually close to if not equal, with some studies supporting female predilection in the youngest age groups.(4) In a cohort of 268 Indian children 12 years and younger, 56.7% were girls (n = 152) and 43.3% were boys (n = 116). The breakdown of vitiligo types in a pediatric population varies by population reviewed. In a case series of 119 pediatric patients with vitiligo, 34% had generalized disease, 13% acrofacial, 3% mucosal, 29% segmental, and 21% undetermined. Lower estimates of segmental disease include 17.6% of cases in children who were 12 years or younger in an Indian cohort.(7)
References
- Krüger C, Schallreuter KU. A review of the worldwide prevalence of vitiligo in children/adolescents and adults. Int J Dermatol 2012;51:1206–12.
- Silverberg NB. The Epidemiology of Vitiligo. Curr Dermatol Rep 2015;4:36–43.
- Shrestha R, Shrestha D, Dhakal AK, Shakya A, Shah SC, Shakya H. Spectrum of pediatric dermatoses in tertiary care center in Nepal. Nepal Med Coll J 2012;14:146–8.
- Ezzedine K and Silverberg N. A Practical Approach to the Diagnosis and Treatment of Vitiligo in Children. Pediatrics 2016;138:1-12.
- Tey HL. A practical classification of childhood hypopigmentation disorders. Acta Derm Venereol 2010;90:6–11.
- Marinho FS, Cirino PV, Fernandes NC. Clinical epidemiological profile of vitiligo in children and adolescents. An Bras Dermatol 2013;88:1026–28.
- Agarwal S, Gupta S, Ojha A, Sinha R. Childhood vitiligo: clinicoepidemiologic profile of 268 children from the Kumaun region of Uttarakhand, India. Pediatr Dermatol 2013;30:348-53.
- Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: a comprehensive overview: Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. J Am Acad Dermatol 2011;65:473–91.
- Handa S, Dogra S. Epidemiology of childhood vitiligo: a study of 625 patients from North India. Pediatr Dermatol 2003;20:207–10.
- Nicolaidou E, Antoniou C, Miniati A, Lagogianni E, Matekovits A, Stratigos A, et al. Childhood- and later-onset vitiligo have diverse epidemiologic and clinical characteristics. J Am Acad Dermatol 2012;66:954–8.
- Cho S, Kang H-C, Hahm J-H. Characteristics of vitiligo in Korean children. Pediatr Dermatol 2000;17:189–93.
- Ezzedine K, Lim HW, Suzuki T, Katayama I, Hamzavi I, Lan CC et al; Vitiligo Global Issue Consensus Conference Panelists. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2012;25:E1–E13.
- Hu Z, Liu J-B, Ma S-S, Yang S, Zhan XJ. Profile of childhood vitiligo in China: an analysis of 541 patients. Pediatr Dermatol 2006;23:114–6.
- Ezzedine K, Gauthier Y, Léauté-Labrèze C, Marquez S, Bouchtnei S, Jouary T, et al. Segmental vitiligo associated with generalized vitiligo (mixed vitiligo): a retrospective case series of 19 patients. J Am Acad Dermatol 2011;65:965–71.
- Ezzedine K, Diallo A, Léauté-Labrèze C, Séneschal J, Prey S, Ballanger F, et al. Halo naevi and leukotrichia are strong predictors of the passage to mixed vitiligo in a subgroup of segmental vitiligo. Br J Dermatol 2012;166:539–44.
- Neri I, Russo T, Piccolo V, Patrizi A. Mixed vitiligo in childhood: a study on 13 Italian patients. J Eur Acad Dermatol Venereol 2013;27:e140–1.
- Ezzedine K, Mahé A, Van Geel N, Cardot-Leccia N, Gauthier Y, Descamps V, et al. Hypochromic vitiligo: delineation of a new entity. Br J Dermatol 2015;172:716–21.
- Nicolaidou E, Mastraftsin S, Tzanetakou V, Rigopoulos D. Chilhood vitiligo. Am J Clin Dermatol 2019;1-12.
- Cohen BE, Mu EW, Orlow SJ. Comparison of childhood vitiligo presenting with or without associated halo nevi. Pediatr Dermatol 2016;33:44–8.
- Patrizi A, Bentivogli M, Raone B, Dondi A, Tabanelli M, Neri I. Association of halo nevus/i and vitiligo in childhood: a retrospective observational study. J Eur Acad Dermatol Venereol 2013;27:e148–52.
- Silverberg NB. Pediatric vitiligo. Pediatr Clin N Am 2014;61:347–66.
- Laberge G, Mailloux CM, Gowan K, Holland P, Bennett DC, Fain PR, et al. Early disease onset and increased risk of other autoimmune diseases in familial generalized vitiligo. Pigment Cell Res 2005;18:300–5.
- Iacovelli P, Sinagra JL, Vidolin AP, Marenda S, Capitanio B, Leone G, et al. Relevance of thyroiditis and of other autoimmune diseases in children with vitiligo. Dermatology 2005;210:26–30.
- Kartal D, Borlu M, Ҫinar SL, Kesikoğlu A and Utaş Thyroid abnormalities in paediatric patients with vitiligo: retrospective study. Postepy Dermatol Alergol 2016;33:232–4.
- Kakourou T, Kanaka-Gantenbein C, Papadopoulou A, Kaloumenou E, Chrousos GP. Increased prevalence of chronic autoimmune (Hashimoto’s) thyroiditis in children and adolescents with vitiligo. J Am Acad Dermatol 2005;53:220–3.
- Ezzedine K, Diallo A, Léauté-Labrèze C, Seneschal J, Boniface K, Cario-André M, et al. Pre- vs. Postpubertal onset of vitiligo: multivariate analysis indicates atopic diathesis association in pre-pubertal onset vitiligo. Br J Dermatol 2012;167:490–5.
- Bilgiç O, Bilgiç A, Akiş HK, Eskioğlu F, Kiliç EZ. Depression, anxiety and health related quality of life in children and adolescents with vitiligo. Clin Exp Dermatol 2011;36:360–5.
- Silverberg JI, Silverberg NB. Quality of life impairment in children and adolescents with vitiligo. Pediatr Dermatol 2014;31:309–18.
- Catucci Boza J, Giongo N, Machado P, Horn R, Fabbrin A, Cestari T. Quality of life impairment in children and adults with vitiligo: a cross-sectional study based on dermatology-specific and disease-specific quality of life instruments. Dermatology 2016;232:619–25.
- Amer AA, Mchepange UO, Gao XH, Hong Y, QI R, Wu Y, et al. Hidden victims of childhood vitiligo: impact on parents’ mental health and quality of life. Acta Derm Venereol 2015;95:322–5.
- Manzoni AP, Weber MB, Nagatomi AR, Pereira RL, Townsend RZ, Cestari TF. Assessing depression and anxiety in the caregivers of pediatric patients with chronic skin disorders. An Bras Dermatol 2013;88:894–9.
- Van Geel N, Speeckaert M, Chevolet I, De Schepper S, Lapeere H, Boone B, et al. Hypomelanoses in children. J Cutan Aesthet Surg 2013;6:65–72.
- Taieb A, Alomar A, Bӧhm M, Dell'anna ML, De Pase A, Eleftheriadou V, et al. Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol 2013;168:5–19.
- Zabetian S, Jacobson J, Lim HW, Eide MJ, Huggins RH. Quality of life in a vitiligo support group. J Drugs Dermatol 2017;16:344–50.
- Ho N, Pope E, Weinstein M, Greenberg S, Webster C, Krafchik BR, et al. A double-blind, randomized, placebo-controlled trial of topical tacrolimus 0.1% vs. Clobetasol propionate 0.05% in childhood vitiligo. Br J Dermatol 2011;165:626–32.
- Kӧse O, Arca E, Kurumlu Z. Mometasone cream versus pimecrolimus cream for the treatment of childhood localized vitiligo. J Dermatolog Treat 2010;21:133–9.
- Rodrigues M, Ezzedine K, Hamzavi I, et al. Current and emerging treatments for vitiligo. J Am Acad Dermatol 2017;77:17–29.
- Dang YP, Li Q, Shi F, Yuan XY, Liu W. Effect of topical calcineurin inhibitors as monotherapy or combined with phototherapy for vitiligo treatment: a meta-analysis. Dermatol Ther 2016;29:126–33.
- Kanwar AJ, Dogra S. Narrow-band UVB for the treatment of generalized vitiligo in children. Clin Exp Dermatol 2005;30:332–6.
- Rodrigues M. Skin cancer risk (nonmela-noma skin cancers/melanoma) in vitiligo patients. Dermatol Clin 2017;35:129–34.
- Wu W, the 23andMe Research Team, Amos CI, et al. Inverse relationship between vitiligo-related genes and skin cancer. J Invest Dermatol 2018;138:2072–5.
- Dayal S, Sahu P, Gupta N. Treatment of childhood vitiligo using tacrolimus ointment with narrowband ultraviolet B phototherapy. Pediatr Dermatol 2016;33:646–51.
- Siegfried EC, Jaworski JC, Hebert A. Topical calcineurin inhibitors and lymphoma risk: evidence update with implication for daily practice. Am J Clin Dermatol 2013;14:163–78.
- Cho S, Zheng Z, Park YK, Roh MR. The 308-nm excimer laser: a promising device for the treatment of childhood vitiligo. Photodermatol Photoimmunol Photomed 2011;27:24–9.
- Koh MJ, Mok ZR, Chong WS. Phototherapy for the treatment of vitiligo in Asian children. Pediatr Dermatol 2015;32:192–7.
- Hui-Lan Y, Xiao-Yan H, Jian-Yong F, Zong-Rong L. Combination of 308- nm excimer laser with topical pimecrolimus for the treatment of childhood vitiligo. Pediatr Dermatol 2009;26:354–6.
- Hu JJ, Xu AE, Wu XG, Sun XC, Luo XY. Small-sized lesions of childhood vitiligo treated by autologous epidermal grafting. J Dermatolog Treat 2012;23:219–23.
- Sahni K, Parsad D, Kanwar AJ. Noncultured epidermal suspension transplantation for the treatment of stable vitiligo in children and adolescents. Clin Exp Dermatol 2011;36:607–12.
- Mulekar SV, Al Eisa A, Delvi MB, Al Issa A, Al Saeed AH. Childhood vitiligo: a long-term study of localized vitiligo treated by noncultured cellular grafting. Pediatr Dermatol 2010;27:132–6.
- Yao L, Li SS, Zhong SX, Song Y, Hu DN, Guo JW. Successful treatment of vitiligo on the axilla in a 5-year-old child by cultured-melanocyte transplantation. J Eur Acad Dermatol Venereol 2012;26:658–60.
- Wu XG, Xu AE. Successful treatment of vitiligo on the scalp of a 9-year-old girl using autologous cultured pure melanocyte transplantation. Pediatr Dermatol 2017;34:e22–3.
- Awad SS, Abdel Aziz RT, Mohammed SS. Management of resistant halo nevi. J Cosmet Laser Ther 2018;9:1–4.
- Wang K, Wang Z, Huang W. Resolution of vitiligo following excision of halo congenital melanocytic nevus: a rare case report. Dermatol Ther 2016;29:145–7.
- Workman M, Sawan K, El Amm C. Resolution and recurrence of vitiligo following excision of congenital melanocytic nevus. Pediatr Dermatol 2013;30:e166–8.
- Majid I, Imran S. Relapse after methylprednisolone oral minipulse therapy in childhood vitiligo: a 12-month follow-up study. Indian J Dermatol 2013;58:113–6.
- Schallreuter KU, Krüger C, Würfel BA, Panske A, Wood JM. From basic research to the bedside: efficacy of topical treatment with pseudocatalase PC-KUS in 71 children with vitiligo. Int J Dermatol 2008;47:743–53.
- Grimes PE, Nashawati R. Depigmentation therapies for vitiligo. Dermatol Clin 2017;35:219–27.
- Cralglow BG, King BA. Tofacitinib citrate for the treatment of vitiligo: a pathogenesis-directed therapy. JAMA Dermatol 2015;151:1110–2.
- Rothstein B, Joshipura D, Saralya A, Abdat R1, Ashkar H1, Turkowski Y, et al. Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib. J Am Acad Dermatol 2017;76:1054–60.
Corresponding Author
Himang Jharaik
Obstetrics & Gynaecology Deptt, Civil Hospital Theog, District Shimla 171201. Himachal Pradesh, India