Vitiligo in Children: Causes, Symptoms, Types & Treatment

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IN THIS ARTICLE

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).

Vitiligo is not a contagious disease, which 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
Vitiligo in children could be hereditary

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  1. Autoimmunity (the immune system destroying melanocytes)
  1. Environmental factors (sunburn, stress, exposure to chemicals) (2)

Vitiligo 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 psoriasis, thyroid issues, Addison’s disease, 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
  • Hypopigmentation 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

Universal vitiligo in children

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Segmental vitiligo is also called unilateral vitiligo. It usually starts at an 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.
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.

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 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 can help limit the area involvement if <20% of body surface area is affected. 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 corticosteroids for other parts of the body. It has fewer side effects and 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 ointment or pimecrolimus cream 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 (6).

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 protection should be advised for all areas of the body but is required more for areas of depigmentation. You can use sunblock 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 lack of melanin, which protects us from 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 suprapharmacological 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

Phototherapy for vitiligo in children

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There are various modalities of phototherapy known to be effective in pediatric vitiligo. UVB therapy is the primary choice for the treatment in the childhood, as it helps in 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 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 (5).

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

Surgical grafting is recommended for stable segmental vitiligo

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A stable vitiligo lesion that has not shown any progression for a year can be managed with autologous grafting. Surgical grafting is recommended for stable segmental vitiligo. It can be done using different grafting techniques ranging from punch grafting, split-thickness skin grafting, and the newer melanocyte transfer grafting. Grafting may give rise to side effects such as pain and cobblestoning effect.

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 (6) (7) (8) (9) (10).

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 (11). The following tips are helpful to deal with the psychological impacts of vitiligo:

  • Never focus on the 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.
Encourage your child with vitiligo to participate in games

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  • 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.

Frequently Asked Questions

When do kids get vitiligo?

Although vitiligo is uncommon in very young children, it is most commonly seen in individuals after the age of 10 (12). If you notice the symptoms, take them to the doctor for a diagnosis.

What are the early stages of vitiligo?

Vitiligo initially appears as a pale white patch on a particular region of the skin, which might gradually turn completely white (13). Some may even observe graying or whitening of the hair.

Can vitiligo be cured in the early stages?

There is no medication to stop the progression of vitiligo. Therefore, treatments are usually directed to restore pigmentation or eliminate remnant color (12).

The exact cause of vitiligo is unknown, and the disease is characterized by patches on the skin, hair, or the oral cavity. The appearance may take a hit on children’s self-esteem and confidence while growing up. The condition may result from genetic factors, environmental factors, or autoimmune conditions. Some children may completely recover from vitiligo, while it may remain the same for others. There is no proven treatment for vitiligo though certain medications can help control the spread and improve the quality of life.

Infographic: Teach Your Children More About Vitiligo

It is important that a child is well-informed about a condition they have. It is equally crucial for their peers and parents to be informed and educated about the same. Use the infographic below to learn and communicate such important aspects of vitiligo.

importance of gross motor skills and developmental milestones [infographic]
Illustration: MomJunction Design Team

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
1. Vitiligo; National Institute of Arthritis and Musculoskeletal and Skin Diseases
2. John E. Harris, Speaking of Vitiligo; UMASS. Medical School
3. Flauberto de Sousa Marinho et al., Clinical epidemiological profile of vitiligo in children and adolescents; National Center for Biotechnology Information
4. K. Ezzedine et al., Revised classification/nomenclature of vitiligo and related issues; National Center for Biotechnology Information
5. Cadmus SD et al., Therapeutic interventions to lessen the psychosocial effect of vitiligo in children: A review; National Center for Biotechnology Information
6. Vitiligo: Diagnosis And Treatment; American Academy of Dermatology
7. Whitton ME et al., Interventions for vitiligo; National Center for Biotechnology Information
8. Bishnoi A and Parsad D, Clinical and Molecular Aspects of Vitiligo Treatments; National Center for Biotechnology Information
9. Thomas B. Fitzpatrick, Vitiligo Treatments; American Vitiligo Research Foundation
10. Van Driessche F and Silverberg N, Current Management of Pediatric Vitiligo; National Center for Biotechnology Information
11. Papadopoulos L et al., Coping with the disfiguring effects of vitiligo: a preliminary investigation into the effects of cognitive-behavioural therapy; National Center for Biotechnology Information
12. Papadopoulos L et al., Vitiligo; Cleveland Clinic.
13. Papadopoulos L et al., Vitiligo; National Health Service (NHS)
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Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made...
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Dr. Nikolina Zdraveska

(PhD, MD )
Dr. Nikolina Zdraveska is a pediatrician, educator and a researcher, working at University Children Hospital in Skopje, Macedonia. She 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. She is attending physician at the Department of Neonatology for ten years and is Assistant Professor at...
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