Vitiligo is a skin condition that causes patches of skin to lose their natural pigment, resulting in white or light-coloured spots. While it affects individuals of all ages, vitiligo in children can be particularly challenging for both the child and their parents. Parents may face unique challenges when it comes to understanding vitiligo, as the condition can impact a child’s self-esteem, social interactions, and mental well-being.

Causes of Vitiligo in Children

Vitiligo in children is caused by a combination of genetic, autoimmune, and environmental factors. Here are the main causes:

• Genetics: A family history of vitiligo or autoimmune diseases can increase the likelihood of a child developing vitiligo. Specific genes may predispose children to the condition, although not every child with a family history will develop it.
• Autoimmune Response: This disease is often considered an autoimmune disorder, where the body’s immune system mistakenly attacks and destroys the cells responsible for producing pigment in the skin commonly known melanocytes. This leads to the loss of skin colour and the development of white patches.
• Environmental Triggers: Certain environmental factors can trigger the onset of vitiligo in children. These triggers may include emotional stress, skin trauma (such as cuts, sunburns, or wounds), or exposure to certain chemicals. In some cases, infections or viruses may also play a role in triggering vitiligo.
• Vitamin Deficiencies: Some research suggests that deficiencies in essential vitamins, such as vitamin B12, folate, and vitamin D, may contribute to the development of vitiligo. These deficiencies can weaken the body’s immune system and make it more susceptible to autoimmune conditions like vitiligo.

Symptoms of Vitiligo in Children

The primary symptom of vitiligo in children is the development of white or light-coloured patches of skin. These patches occur due to the loss of pigment in the affected areas. Other symptoms may include:

• The most noticeable symptom is the appearance of flat, irregularly shaped white patches on the skin. These patches can appear anywhere on the body but are most commonly found on the face, hands, arms, and areas exposed to the sun. Over time, these patches may spread.
• In many cases, the patches of vitiligo are symmetrical, appearing on both sides of the body in the same areas. For example, a patch on the right hand may appear in the same place on the left hand.
• In some cases, vitiligo can affect the hair on the scalp or other parts of the body. This results in grey or white hair in the areas where the skin has lost pigment.
• Vitiligo may cause the skin around the eyes, mouth, and other mucous membranes to lose colour, which may be noticeable.
• Areas of depigmented skin are more sensitive to the sun and may burn more easily than surrounding skin. These areas do not tan because they lack melanin, which protects the skin from UV damage.
• While not common, some children may experience mild itching or a slight discomfort around the affected areas of the skin.

Since vitiligo does not cause pain or other physical health problems, the main concern for children with the condition is often cosmetic and psychological. The visible changes in skin colour can sometimes lead to self-esteem issues, especially in children who may face teasing or bullying due to their appearance.

Can Childhood Vitiligo Go Away?

Childhood vitiligo can improve or disappear on its own, but outcomes are unpredictable. Symptoms can vary greatly between children, with some experiencing pigment return and others worsening symptoms.

Spontaneous Regimentation

In some children, vitiligo may naturally improve over time, with the skin slowly regaining its normal colour in the affected areas. However, this is not always guaranteed, and it can take months or even years for any changes to become noticeable.

Chronic Condition

For many children, vitiligo is a chronic condition that may continue for years or even for life. The patches of depigmentation may spread to other parts of the body, and new patches may appear.

Treatment Impact

While childhood vitiligo may not go away on its own, various treatments – such as topical medications, light therapy (phototherapy), and in some cases, surgical options—can help manage the condition and even restore pigment to the skin.

Unpredictable Progression

Vitiligo is unpredictable, meaning it can improve, stabilise, or worsen over time without any clear reason. Some children may experience only small patches of vitiligo that remain stable, while others may have more widespread changes.

Diagnosing Vitiligo in Children

Diagnosing vitiligo in children involves a clinical evaluation by a healthcare provider and specialised tests to confirm the condition.

Medical History and Physical Examination

To diagnose vitiligo, your dermatologist will first take a medical history and conduct a physical examination. They will ask about the child’s symptoms, family history of vitiligo or other skin conditions, and any potential triggers like trauma or stress. During the physical exam, the dermatologist will closely inspect the child’s skin for white or light-coloured patches to confirm the diagnosis.

Wood’s Lamp Examination

A Wood’s lamp is an ultraviolet (UV) light used to examine the skin. When the affected areas of the skin are exposed to the Wood’s lamp, the depigmented patches will often appear more clearly under the UV light. This can help differentiate vitiligo from other skin conditions that may cause similar discolouration, such as fungal infections or leukoderma (skin lightening due to scarring).

Skin Biopsy

In some cases, a skin biopsy may be performed to confirm the diagnosis. This involves removing a small sample of skin from one of the white patches and examining it under a microscope. The biopsy can help confirm that the melanocytes (pigment-producing cells) are absent or damaged, which is characteristic of vitiligo. However, this is not always necessary and is typically reserved for more complex cases.

Blood Tests

Usually, no specific blood tests are used to diagnose vitiligo directly. But the doctor may order blood tests to rule out other autoimmune conditions that could be associated with vitiligo, such as thyroid disease, pernicious anaemia, or diabetes. These tests can help check for any underlying autoimmune disorders that might be contributing to the condition.

Differential Diagnosis

Several other conditions can cause skin discolouration in children, so the doctor may consider differential diagnoses to rule out other possible causes. These conditions may include:

• Tinea versicolor (a fungal infection)
• Pityriasis alba (a common condition with light patches, often on the face)
• Leukoderma (skin depigmentation due to trauma or scarring)

Psychological Evaluation

Since vitiligo can affect a child’s self-esteem and social interactions, especially if the patches are visible, some healthcare providers may recommend a psychological evaluation to assess the emotional impact of the condition. This is especially important for children who may feel self-conscious or face bullying.

Vitiligo in Children Treatment

There is no cure for vitiligo, but vitiligo treatment can help manage it and improve skin appearance. Parents should consult a dermatologist for guidance on the best treatment options for their child.

Topical Corticosteroids

Corticosteroids are commonly prescribed to help reduce inflammation and stimulate the regimentation of skin cells. In some cases, the use of these creams can help restore pigment in the affected areas.

Light Therapy (Phototherapy)

Narrowband ultraviolet B (UVB) phototherapy is one of the most effective treatments for vitiligo. This treatment involves exposing the skin to controlled doses of UV light, which can stimulate the melanocytes to produce pigment. Phototherapy is typically done in a dermatology clinic, and it may require several sessions over weeks or months.

Topical Calcineurin Inhibitors

These creams, such as tacrolimus and pimecrolimus, are sometimes used as an alternative to corticosteroids. They help reduce inflammation and may help re-pigment the skin without the potential side effects of steroids.

Depigmentation

In cases where vitiligo has spread extensively across the body, a dermatologist may recommend depigmentation therapy. This involves lightening the remaining pigmented skin to match the colour of the vitiligo-affected areas. This approach is generally considered for adults but may be considered in certain paediatric cases.

Skin Grafting and Micropigmentation

In some cases, particularly when vitiligo is limited to small areas, a dermatologist may recommend skin grafting or micro-pigmentation (tattooing) to restore the appearance of the skin. These procedures are less common for children but may be considered in severe cases.

Herbal and Natural Remedies

Some parents may explore natural remedies for treating vitiligo. While there is limited scientific evidence to support their effectiveness, certain herbs, such as ginkgo biloba, are thought to help restore pigment in some cases. However, these treatments should always be used under the guidance of a healthcare professional.

Prevention and Early Intervention for Vitiligo in Children

To prevent or minimise the risk of vitiligo, take steps to manage the condition early on and support both the physical and emotional well-being of children affected by it.

Sun Protection

Excessive sun exposure can harm melanocytes and make depigmented patches worse. Sunburn can also trigger flare-ups of vitiligo. To protect your child:

• Use sunscreen with at least SPF 30 on exposed skin.
• Ensure they wear wide-brimmed hats and protective clothing outdoors.
• Limit time in the sun, especially from 10 AM to 4 PM.

Healthy Lifestyle

By maintaining a balanced diet and good overall health, you can strengthen your child’s immune system and reduce oxidative stress, which is linked to vitiligo progression.

Healthy habits to encourage include consuming antioxidant-rich foods such as berries and spinach, ensuring adequate intake of vitamin D, vitamin C, zinc, and copper, staying hydrated by drinking plenty of water and promoting regular exercise and sufficient sleep to reduce stress and support immunity.

Minimise Stress

Stress can exacerbate vitiligo, so it’s important to reduce stress levels. Strategies include teaching relaxation techniques, creating a positive home environment, and engaging in enjoyable activities.

Avoid Skin Trauma and Irritants

Children with vitiligo may develop new patches of skin discolouration in response to trauma known as the Koebner response. To prevent trauma, use gentle skincare products, avoid harsh chemicals, have your child wear protective gear during sports or outdoor activities, and teach them to be cautious with sharp objects and rough surfaces.

The Bottom Line

Vitiligo in children, while challenging, does not have to overshadow their lives. With the right understanding, timely treatment, and emotional support, children can thrive and embrace their uniqueness. Staying informed about vitiligo and accessing available resources can empower both the child and the family to navigate this journey with resilience and positivity.

Sources:

• https://www.myvitiligoteam.com/resources/treating-vitiligo-in-children-your-guide
• https://www.verywellhealth.com/vitiligo-in-children-causes-symptoms-treatment
• https://kidshealth.org/en/parents/vitiligo
• https://dermnetnz.org/topics/vitiligo
• https://vitiligosociety.org/vitiligo-treatments/
• https://www.childrenshospital.org/treatments/vitiligo
• https://www.niams.nih.gov/health-topics/vitiligo/diagnosis-treatment-and-steps-to-take