Vitiligo

What is vitiligo?

Vitiligo is a condition that causes patches of skin, and sometimes hair, to lose their colour and turn white. This skin condition occurs in roughly one person in 100 and affects females and males equally.

How does vitiligo affect the body?

Vitiligo is a condition that affects skin or hair colour only. It is usually more obvious in those with darker skin tones. It can occur anywhere on the body, causing skin colour differences of various shapes and sizes. However, some areas of the body are more commonly affected than others.

In rare cases, children with vitiligo may have other conditions that are triggered by their immune system (autoimmune diseases). For example, their immune system may also attack their thyroid gland. If your child is diagnosed with vitiligo, their health-care provider will order blood tests to check for other autoimmune diseases.

What causes vitiligo?

The exact cause of vitiligo is not known, but it is thought to be an autoimmune reaction. This means that it occurs when the immune system attacks healthy cells in the body. In vitiligo, the cells that are attacked are called melanocytes. These are special cells that give skin and hair its pigment (colour).

Vitiligo may affect more than one person in a family. It does not spread from one person to another, but in some families, there might be a genetic predisposition to develop vitiligo. Some people notice that their vitiligo starts after a cut or other injury to their skin. You may hear your health-care provider call this a Koebner phenomenon.

How is vitiligo diagnosed?

Your child’s health-care provider will often diagnose vitiligo simply by looking at your child’s skin. Because vitiligo is less obvious in paler skin, the health-care provider might sometimes use a special light called a Wood’s lamp to help them detect changes more easily. If your child needs to be examined with the aid of a Wood’s lamp, they may be asked to go into a dark room so that the light can be shone on their skin.

How is vitiligo treated?

Different treatments are possible depending on how much vitiligo is present and where it appears on the body.

Topical treatments

Topical treatments are usually creams or ointments that are applied directly to the skin. These include topical anti-inflammatories such as topical steroids or calcineurin inhibitors. Newer topical medications are being developed for vitiligo as well.

Calcineurin inhibitors help regulate the immune system in the skin. They are especially useful when applied to the face, skin folds and flexural areas such as inside the elbow or the back of the knee.

Topical treatments are recommended for small areas of vitiligo, but they may be more challenging to use, and carry side effects, if vitiligo is more widespread. Depending on the part of their body that is affected, your child might receive different mixes and strengths of a topical steroid.

Light therapy

Light therapy involves focusing a special ultraviolet light on the affected areas of skin. The treatment usually requires several sessions and is reserved for children with very widespread vitiligo, for whom applying a topical medication is challenging.

This treatment requires a person to stand still in a small space with lamps around them, as they may be burned if they move. For this reason, light therapy may not be suitable for young children. Some concerns have also been raised about light therapy and the long-term increased risk for skin cancer, especially in those with paler skin.

Other treatments such as laser therapy and skin grafting are also possible, but there is limited information about their use in children. Camouflage make-up is also used to cover areas of vitiligo, particularly on the face.

How effective are treatments for vitiligo?

Unfortunately, vitiligo is a very unpredictable disease. Even with all the available treatments, some areas may not return to their usual colour. In addition, there is no way for health-care providers to prevent new areas of vitiligo from developing.

Because treatment is not always successful, some people may choose not to do anything or will instead use special make-up on the affected skin to make it blend in with the rest of the body.

Does my child’s vitiligo need any special long-term care?

Yes, the areas affected by vitiligo will need good sun protection to avoid sunburn and minimize the risks of skin cancer.

When to see a health-care provider for vitiligo

After initial diagnosis and treatment, see your child’s health-care provider if:

• Your child’s vitiligo is getting larger, not improving or looks different than before.
• You suspect your child has been experiencing symptoms such as gaining or losing weight easily or feeling tired easily. Their health-care provider may order blood tests other conditions that are more common in children with vitiligo, such as hypothyroidism.