Vitiligo
Introduction
Vitiligo (vi-tuh-lai-gow) is an autoimmune condition where patches of skin and sometimes hair, lose their colour. It occurs due to a loss of our pigment producing cells in the skin known as melanocytes.
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Acral vitiligo on a child's hand and ankle
Who gets it?
Vitiligo affects 1 in 100 people and occurs equally in both boys and girls. This condition may start at any age, although it is most common in those aged 10-30 years old. Children who have family members that are affected by vitiligo or any other autoimmune condition, may be at a higher risk for developing vitiligo.
What causes it?
Vitiligo is caused by a loss of melanocytes within the skin. Melanocytes are pigment-making cells in the skin that are responsible for the skin and hair colour, and so their absence means that pigment cannot be made to give our skin its normal colour. The loss of melanocytes are believed to be a result of immune cells targeting these pigment-making cells and destroying them.
Children who have vitiligo may be at a higher risk of other immune-related conditions such as diabetes, thyroid disease and rheumatoid arthritis.
What does it look and feel like?
Looks like..
Your child may get new flat, white patches of skin that are lighter than their normal skin colour.
The patches can develop anywhere on the body but commonly in areas such as the face, hands, elbows, body folds, chest, abdomen or groin region.
They may have the same area of skin on both sides of the body being affected (symmetrical).
There may be white coloured hairs within patches of white skin.
There may be white skin around brown moles.
Existing white patches on your child's skin may grow.
You may notice new white patches developing in areas where your child has been sunburnt.
There may be white patches that occur in areas of physical trauma.
Blotches of brown or normal skin colour may develop inside white patches - this a sign of repigmentation.
Feels like...
Your child is usually well.
There is no itch or skin pain.
What tests might be needed?
Usually your child's GP will refer you to a dermatologist. A dermatologist will look closely at your child's skin and will use a special light called a Wood's Lamp that will light up their skin to confirm the diagnosis. If there is concern about another cause of pigment loss within the skin, they make take a small sample of an affected area of skin to look at under the microscope.
Because vitiligo may be linked with other conditions the doctor may perform certain blood tests to identify if they are also present.
What treatments are available?
What can I do?
Practice sun safety: Use regular sun protection on your child such as sunscreen, protective clothing and reduce sun exposure where possible (see Sun Protection fact sheet).
Protect the skin: Help your child avoid skin injury which is known to worsen vitiligo.
Cosmetic camouflage: Consider camouflaging affected areas by using cosmetics such as makeup, dyes or pigment tattoos. Your dermatologist will be able to recommend some brands that provide great colour match for your child's skin tone.
Psychological well being: Your child may suffer from social anxiety or low self-esteem as a result of their physical appearance. Normalise discussion about the condition, empower them with information and address their emotional well-being by seeking out psychological support through the GP and dermatologist as well as counselling.
Medical therapies
There is currently no cure for vitiligo. However, to improve the appearance of affected areas and limit the spread of white patches, a number of treatment options are available. All treatments for vitiligo require months of use before improvement can be noticed. You should expect improvement to be slow and build your child's expectation accordingly.
Creams: Steroid creams or alternative creams (such as tacrolimus) are good treatment options for small patches.
Laser: specialised laser treatments are helpful when small areas of skin are affected.
Phototherapy: UV light from a light box can be used to stimulate the pigment cells when large areas of skin are affected. A cream or tablet may be given to use before the light treatment.
Immune medications: Short courses of steroid tablets or other medications that help calm the immune system (e.g. methotrexate) can be given in more severe cases or when the condition is progressing very quickly.
Depigmentation cream: In children who have white patches affecting more than 80% of their body, whitening treatment can be given to remove pigment from normal unaffected parts of the skin, this gives a single colour appearance.
Surgery: If your child's white patches of skin appear to have stopped growing, they can be replaced with normal areas of coloured skin from other parts of your child's body. This is a specialised graft.
What happens after treatment?
Vitiligo is a condition that can usually presist for a long period of time. As time passes, more areas of skin tend to become involved and lose their colour. It is difficult to predict which children will have a rapid or slow increase in their vitiligo. Some children experience a return of some skin colour in previously affected areas with or without treatment.
What support is available?
The Vitiligo Association of Australia is a not-for-profit organisation that provides information and support to children with vitiligo, and their parents. To find out more about the association, or to become a member, please visit their website on https://vitiligo.org.au/
Authors/Reviewers:
Author: Dr Akshay Flora
Paediatric Reviewer: Dr Mayuri Sivagnanam
Editor in Chief: Dr Tevi Wain
