Let’s see how pediatric vitiligo is treated.
Although half of all vitiligo cases start before the age of 20, there are no specific treatments for pediatric vitiligo.
This is alarming for a disease with an incidence in the global population of 0.4% to 2%.
Additionally, Vitiligo has a major impact on the psychosocial health of developing children and young adults.
Pediatric Vitiligo and Autoimmune Diseases
Studies have shown that vitiligo, an autoimmune disease, is associated with atopy (strong immune response) and nevi alone (white spots around moles).
Other connections with autoimmune diseases include:
- alopecia areata
- Hashimoto’s thyroid gland
- pernicious anemia
- diabetes
On the other hand, in the period following puberty, the autoimmune diseases linked to vitiligo are:
- thyroid disorders
- acrofacial disease
This suggests that addressing the generalized autoimmune trend through early therapy for comorbidities can aid in the patient’s long-term health without further worsening the patient’s vitiligo.
In fact, researchers are studying therapies that include targeted immunomodulators that could improve the condition of vitiligo even in children.
Types of pediatric vitiligo
Pediatric vitiligo is typically divided into two categories: segmental vitiligo and non-segmental vitiligo.
Non-segmental vitiligo is found in 80% of cases.
Vitiligo can usually occur in all parts of the body, but the segmental usually appears as white macules on the fingers, hands and face.
Instead, segmental vitiligo has an incidence that varies from 10% to 15% of cases.
This typology is characterized by asymmetrical bands.
Pediatric Vitiligo Diagnosis
Pediatric dermatologists for a complete diagnosis of the condition of vitiligo subject children to a Wood’s lamp examination.
This examination consists of natural light useful for determining the extent of the disease.
In addition, it will ask parents questions about family and patient history to identify potential causes.
How pediatric vitiligo is treated to stabilize and depigment the skin
How is pediatric vitiligo treated? The treatment for vitiligo, even for pediatric ones, is chosen based on the locations of the spots and the type.
For example, segmental vitiligo does not require treatment unless the child has a comorbid autoimmune disease.
Children with non-segmental vitiligo before undergoing treatment undergo certain tests such as:
- complete blood count
- metabolic profile
- thyroid screening to determine the presence of thyroid disease.
In addition, antinuclear antibody screening is required if patients are indicated for phototherapy treatment to determine if they can be sensitized to light.
Based on the state of vitiligo, doctors can adopt two strategies: stabilize vitiligo to prevent further spread or re-pigmentation in the affected areas.
children with active disease with trichrome and inflamed macules around the margins should be stabilized.
Topical calcineurin inhibitors are first-line therapy for the head and neck, while topical corticosteroids can be used on the rest of the body.
For larger areas, dermatologists may employ narrow-band ultraviolet B light therapy, noting that phototherapy is more effective in patients with darker skin.
Pediatric Vitiligo Medications
Drugs effective in slowing the progression of pediatric vitiligo are:
- methotrexate
- azathioprine
- systemic corticosteroids
- prednisolone
- dexamethasone
- betamethasone.
Phototherapy in pediatric age
Phototherapy is one of the few modalities that has the potential to both stabilize and re-pigment the skin.
Studies have shown how sunlight can lead to spontaneous re-pigmentation in children.
However, skin surfaces that experience frequent friction, such as hands and fingers, may not respond as effectively to sunlight.
It is important to consider the patient’s age when considering phototherapy, as patients must remain motionless during treatment and sessions are usually 2 per week.
Other treatments
Most therapies are topical or involve light but there are other types of treatment.
UVB and vitamin B and D supplements can compensate for vitamin deficiencies found in children with vitiligo.
In children with stable segmental vitiligo, skin grafting may be an option.
Additionally, patients with both types of Vitiligo can benefit from camouflage or heavy makeup to mask the depigmented areas.
