Vitiligo in Children: Symptoms, Causes & Treatment

​​​By: Maria C. Garzon, MD, FAAD, FAAP & Jessica S. Hathaway

Vitiligo is a common skin condition that causes patches of skin to lose their color (pigment). This leaves areas that may look white or much lighter than the skin around them. The white patches may stay the same size, gradually spread or, in rare cases, improve on their own.

There are treatments for vitiligo, which are most effective when started early. Vitiligo may impact your child's self-esteem or confidence, so it is important to see a doctor to check whether your child has vitiligo and if treatment is right for them.

How common is vitiligo in children?

Vitiligo affects about 1% of people worldwide and occurs in people of all racial and ethnic backgrounds. About half of all people with vitiligo develop their first symptoms during childhood.

What causes vitiligo?

Vitiligo happens when the body's immune system reacts against the color-making cells in the skin. Special cells in the skin called melanocytes make melanin, a pigment that gives skin its color. When a patch of the skin lose melanocytes, the color fades because there is no more melanin being made in that area.

Possible factors involved

The reason why melanocytes are lost or destroyed is not fully understood, and the reasons may differ depending on the type of vitiligo. Scientific evidence suggests that vitiligo is an autoimmune condition, meaning a person's own immune system is attacking the color-making cell (melanocytes). Genetic and some environmental factors may make someone more likely to develop vitiligo.

Is vitiligo contagious?

No. Vitiligo is not contagious and cannot spread from one person to another. People are not born with vitiligo, so if your child was born with a white or light patch, it may be another condition that looks like vitiligo.

What does vitiligo look like?

Vitiligo is a flat patch of skin that looks pearly-colored or milky-white.

If you close your eyes and run your fingers over an affected area, you would not be able to feel any different in texture compared to the surrounding skin.

If there is a hair within a patch of vitilgo, the hair may turn white as well.

Vitiligo is often classified into two main groups:

• "Segmental" vitiligo is when a limited area or "segment" of the skin is involved

• "Non-segmental" vitiligo means the affected areas are not limited to one region of the body

Vitiligo can commonly happen on skin around the mouth and eyes, hands, feet, genitals and in areas of rubbing (for example, in the armpits or around the waistband). However, it can happen anywhere on your body.

Will vitiligo spread to other areas of the skin?

Some people may have a few spots of vitiligo on their body that stay the same size. In others, the areas may spread over months or years. There may be times when the vitiligo is active and spreading and times when it is stable. In some people, the patches may go away and do not return.

It is difficult to predict how vitiligo will affect your child and only time will tell. Treatments can help to prevent it from spreading.

Can vitiligo affect more than skin?

For most people with vitiligo, only their skin is affected. However, a small group of people may have other symptoms like hearing or vision changes.

People with vitiligo have a higher chance of having other autoimmune conditions like thyroid disease, where the immune system mistakenly attacks certain cells of the body. Be sure to tell your child’s doctor about any family history of autoimmune conditions or other symptoms your child is experiencing.

How is vitiligo diagnosed?

Vitiligo is usually diagnosed by doctors asking how the white areas began and looking at the appearance of the patches. The doctor may also shine a special light from a device called a Wood’s lamp that helps to highlight areas of pigment loss.

If there are family members who have vitiligo or another autoimmune condition, this information, along with the appearance of the white patches, might help your doctor make the diagnosis of vitiligo in your child.

In cases where the diagnosis is not clear, a skin biopsy may be needed. A skin biopsy is when the doctor takes a small sample of the affected skin and sends it to be analyzed to check if vitiligo is the cause of the white patches.

Can vitiligo be cured?

While there are treatments that can help vitiligo, there is currently no cure available. It is considered a long-term or lifelong condition that can be managed, with the aim of stopping the spread of white areas and returning color to the skin.

What types of treatments are available for vitiligo in children?

Dermatologists, or skin doctors, can help to treat your child’s vitiligo. Treatment choices depend on the size and location of the vitiligo patches, how quickly it is spreading and the age of the child. The earlier treatment is started, the more likely it might be to help. Multiple treatments can be used at the same time.

Skin creams and ointments

Medicated ointments and creams including corticosteroids and calcineurin inhibitors (for example, tacrolimus) are common treatments. Ruxolitinib cream, a Janus Kinase (JAK) inhibitor, is a newer treatment option that may be recommended in some children with vitiligo.

Phototherapy

Phototherapy is a type of treatment where a special ultraviolet (UV) light is shined on the whole body or parts affected by vitiligo. This type of UV light does not increase the risk of skin cancer. Treatments usually take place at a doctor’s office 2-3 times a week for several months.

Oral medications

Medications by mouth that suppress the body’s immune response may be considered in severe cases. There are new drugs being studied in adults that may possibly lead to more treatments for children in the future.

How effective is treatment for vitiligo?

Certain areas of the body tend to respond better to treatment, but it is difficult to predict whether or what treatments will bring the color back to the skin. Medical journals have published expert recommendations about how to best treat vitiligo in children. These guidelines are an important resource for your child’s doctor.