Vitiligo in Children

Vitiligo is a disease in which patients lose color (otherwise known as pigment) on certain areas of their skin. This loss of pigment leads to light or white patches of skin on various parts of the body that may get bigger or spread over time. Vitiligo affects 1 percent of the population, it can run in families, and half of vitiligo patients develop the condition in childhood or adolescence.

Vitiligo can be “localized,” affecting only one part of the body, or it can be “generalized,” involving skin all over the body. One specific subtype of vitiligo, called segmental vitiligo, affects skin limited to one part of the body and is more common in children than in adults. Physical injury to the skin (for example, rubbing or friction) can cause vitiligo to spread — this is called the “Koebner phenomenon.”

Patients may develop light or white areas on any part of the body ranging in size from tiny spots to large patches. These skin changes may affect a small area or nearly the entire body. The locations most often affected are the face, hands, neck, elbows, knees, body folds (such as groin and underarms), and genital region.

There may be areas of white hair on the head or body, as well. Often, the body parts that are affected will be symmetric.

Vitiligo is an autoimmune disease, which is a condition in which the body’s immune system attacks itself. In vitiligo, the immune system destroys the cells in the skin that produce its color. Vitiligo runs in families and is partially genetic — however, not everyone who has a relative with vitiligo will develop the disease.

Patients with vitiligo are more likely to have other autoimmune conditions such as thyroid disease or alopecia areata. Patients who are younger at time of diagnosis are more likely to have a family history of vitiligo. Vitiligo in childhood is associated with eczema, as well.

Vitiligo can usually be diagnosed based on a doctor’s skin exam alone, without the need for any blood tests or a skin biopsy. Shining a special light, called a “Wood lamp,” on the vitiligo spots can help diagnose the condition.

Treatment options for vitiligo include:

• Creams and ointments that affect the immune system, such as topical steroids, calcineurin inhibitors, and Janus kinase inhibitors
• Narrow-band ultraviolet B (nbUVB), a light-based therapy that can be performed a few times per week at the doctor’s office or at home with a portable machine
• Oral steroids, to stop worsening disease in cases where vitiligo is spreading rapidly
• “Depigmentation” with a substance called 20% monobenzyl ether of hydroquinone in patients with very widespread vitiligo, to remove the remaining color in areas with normal skin
• Surgery, such as grafting of skin from one part of the body to another
• Camouflage, using certain makeups and coverups

Treatment success varies, and it can take months to see results. Oftentimes, combining multiple treatment options can work the best. Children are more likely to respond to treatments than adults.

Vitiligo on the face is more likely to improve than vitiligo on the hands, wrists, and feet. When the color returns to the skin, it usually does so in freckle-like spots within the vitiligo patches. Of note, patients with vitiligo may experience psychological stress, depression, or anxiety, and would benefit from psychosocial support and resources.

At Boston Children’s Hospital, we start by treating vitiligo with topical therapies, such as:

• Steroids
• Calcineurin inhibitors
• Janus kinase inhibitors

If treating vitiligo with creams and ointments alone is insufficient, we consider other options, including phototherapy and oral medications that affect the immune system. We work with families to make a joint decision based on the risks and benefits of the various treatment options and their unique treatment goals.