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: Vitiligo is non-contagious, which means a child cannot catch the disease from someone.
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
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.
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.
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
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
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).
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 (10). 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.
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.
