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Current Management of Pediatric Vitiligo

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Abstract

Vitiligo is a common inflammatory disorder with worldwide prevalence of 0.4–2 % of the population, with half of cases beginning in childhood. The management of childhood vitiligo should be tailored to avoid negative effects on the overall growth and psychological development of the patient. Therapy of vitiligo in childhood is chosen based on the location of the lesions, lesion age, and extent of lesions in the context of the child’s age and the developmental status of the child. There are four age categories in childhood vitiligo: [1] infantile and toddler (rare) (ages 0–3 years), [2] ages 4–8 years, [3] ages 9–12 years, and [4] 13+ years of age, based on developmental stage, psychological maturation, and ability to comply or participate in therapy. These categories are also differentiated psychologically by susceptibility to bullying, self-image development, and personal concern with lesion appearance, which increases with time. Intervention is advisable in cases with facial and leg involvement due to prominence of lesions and cosmetic defect. Medical interventions are largely the usage of topical therapies including corticosteroids and calcineurin inhibitors, some vitamin therapy (oral and topical vitamin D), and judicious introduction of phototherapy sources based on age and severity. Screening and appropriate subspecialist referral for co-morbidities (e.g., thyroid disease, celiac disease, psychological distress, and vitamin D deficiency) may enhance overall health. Cosmesis and camouflage are generally safe in childhood and have been noted to improve overall quality of life in this grouping. Genetic transmission of vitiligo is minimal at 5–6 % in first-degree relatives. This article reviews the therapeutics of pediatric vitiligo from the perspective of developmental stages and response to therapy.

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Compliance with ethical standards

The authors have received no funding in the development of this work. Freya Van Driessche has no conflicts of interest in the development of this work. Nanette Silverberg is or has been a consultant, monitor, or investigator for Astellas Pharmaceuticals, Galderma Pharmaceuticals, Novartis Pharmaceuticals and Leo Paharmaceuticals, makers of medications reviewed in the manuscript.

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  1. University of Miami Miller School of Medicine, Miami, FL, USA

    Freya Van Driessche

  2. Pediatric Dermatology, Mt. Sinai St. Luke’s-Roosevelt Hospital Center and Beth Israel Medical Center, 1090 Amsterdam Avenue, Suite 11D, New York, NY, 10025, USA

    Nanette Silverberg

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Van Driessche, F., Silverberg, N. Current Management of Pediatric Vitiligo. Pediatr Drugs 17, 303–313 (2015). https://doi.org/10.1007/s40272-015-0135-3

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