Vitiligo in Children: Causes, Symptoms, Treatment - Verywell Health

Vitiligo is a common inflammatory condition that causes patches of skin to lose their natural color. While the cause is unknown, it is thought to be an autoimmune disorder and often runs in families. It is not contagious and generally does not cause other health issues.

While vitiligo is not life-threatening, it can significantly impact self-esteem and mental health. In this overview article, you will learn about vitiligo in children, diagnosis, treatment, and more.

Verywell / Brianna Gilmartin

What Is Vitiligo?

Vitiligo is a skin condition that causes areas of the skin to lose color or pigmentation. These patches form because melanocytes, the skin cells that create the pigment, are destroyed, leading to areas of lighter skin. It is a chronic condition, meaning it lasts a long time.

Vitiligo is thought to be an autoimmune disease, but it is still unknown what exactly causes it. It is common, affecting about 0.5% to 1% of the world's population. It is seen more in those with a family history of it, with about 20% of people with vitiligo having at least one close relative with it.

Autoimmune Conditions and Vitiligo

Children with vitiligo often have another autoimmune condition, including:

• Addison's disease, a condition involving the adrenal glands
• Type 1 diabetes
• Thyroid disease

Types

There are two types of vitiligo: generalized, or nonsegmental, vitiligo and segmental vitiligo.

Generalized vitiligo is more common and usually affects larger areas of the skin in a symmetrical pattern, like both knees or both hands. Segmental vitiligo is rarer than the other type and occurs on only one side of the body. It commonly begins at an earlier age and continues to progress for a couple of years before stopping.

How Does Vitiligo Affect Children?

Vitiligo affects people of all genders and skin colors and can appear at any age. However, many patients begin to experience the coloring changes before 20 years of age, and some even start in early childhood. Segmental vitiligo affects about 30% of children with vitiligo.       

Living with vitiligo, especially in childhood and adolescence, can be difficult. It is a lifelong process that can alter a child's appearance. Those living with vitiligo have an increased risk of depression, anxiety, social isolation, and decreased self-esteem. Research has also shown that it impacts the emotions and quality of life of caregivers of children with vitiligo.

Signs and Symptoms of Vitiligo in Children

The main sign of vitiligo is loss of natural color on the skin, but it can occur anywhere on the body. Common locations of this loss of pigment are:

• Skin, especially the face, hands, feet, and arms
• Inside the mouth 
• Hair
• Eyes
• Genitals   

Many people with vitiligo do not have any other symptoms and feel healthy. However, some children can develop other medical concerns like inflammation in the ear, as there are melanocytes in the inner ear. If those cells are attacked, it can lead to hearing loss.

Vitiligo and Hearing Loss

Approximately 12% to 38% of people with vitiligo have some hearing loss, but most are unaware that they have it.

Vision and the ability to produce tears can also be affected. If a child's dermatologist suspects any of these problems, referrals will be made to the right specialists. This may include an ophthalmologist, which is a doctor who specializes in the eyes, or an ENT, also known as an ear, nose, and throat doctor.   

Diagnosis

In children, a diagnosis of vitiligo requires a thorough history and physical exam, during which the doctor will ask questions about family medical history and look at the skin. If there are concerns for vitiligo, the pediatrician or family medicine doctor will likely send the child to a dermatologist, which is a doctor who specializes in skin conditions. 

Doctors might use a device called a Wood's lamp, which is a black light used in different areas of medicine. If the light is shined on skin affected by vitiligo, it will appear bright white or blue-white in color. Skin that is unaffected does not shine under the light. There is no pain or risk associated with this test, as long as a person does not look directly into the light. 

Other tests or exams might include looking in the eyes for inflammation, testing the blood for other autoimmune diseases, or doing a skin biopsy. The last one is done by taking a small sample of the affected skin and looking at it under a microscope to see if the melanocytes are missing. 

Vitiligo Is More Than Appearance

It is important to remember that this is a medical condition and not just a difference in appearance. Finding a dermatologist specializing in vitiligo is important both to confirm the diagnosis and advise appropriate treatment.

Treatment

There is no cure for vitiligo, but treatments are available to try to slow the process or improve the appearance of the skin. These treatments take time, and unfortunately, not every person sees an improvement. In children, not every available treatment is an option. 

Treatments that might be offered to your child include: 

• Medicine applied directly to the skin, or topically: This is used more for smaller affected areas, and it is often a corticosteroid. However, if used long-term, this can cause skin thinning, dryness, and fragility.
• PUVA light therapy: This is used in combination with a medicine called psoralen applied to the skin. It can help restore the skin color and is used if someone has more areas that are affected. Psoralen can also be given as a pill, but it is not recommended in children younger than 12 years old. 
• Narrowband UVB treatment: This is a type of phototherapy, or light therapy, used to help bring back the color in the skin.
• No medical treatment: Sometimes no medical treatment is recommended, and those with vitiligo may utilize cosmetics to even their skin tone. This is often used in children because it avoids potential side effects from medications. 

The option of no medical treatment for children and the use of cosmetics instead has been studied, and the results showed that camouflaging the affected areas made children feel more comfortable and improved their self-esteem. However, this might not be the right option for every child.    

Vitiligo and Emotions

Vitiligo can take a mental and emotional toll on a child, so it is important to support them and tell their doctor if there are any emotional or behavioral changes. The doctor will be able to refer your child to a professional who can help with this.

Prevention

It is also important to protect skin from the sun, especially those areas that have lost pigmentation. Dermatologists recommend that anybody with vitiligo use sun protection, as a sunburn can worsen the effects of it. To protect skin from the sun, dermatologists recommend:

• Applying sunscreen daily, 15 minutes prior to going outside
• Wearing appropriate clothing
• Staying in the shade
• Avoiding tanning beds and sunlamps

A Word From Verywell

Vitiligo typically begins prior to adulthood and can alter a child's appearance. Having this chronic medical condition in childhood and adolescence can take a toll on both the child and their caregivers, especially since it is likely to be a lifelong process. It is important for you to support your child in this diagnosis, but also realize that it can impact your emotions as well. 

Finding a board-certified dermatologist who specializes in vitiligo will help to confirm the diagnosis and get the right treatment. They will also be able to direct you to resources like support groups for those living with vitiligo and mental health professionals if needed.

Frequently Asked Questions

• The progression of vitiligo depends on the type that a child has, meaning generalized or segmental. The more common generalized vitiligo can start with a rapid loss of color in an area, stop, and then start again in another area. Segmental vitiligo, which usually starts at an earlier age, appears in one area, continues to expand for about one to two years, and then stops.

• The appearance of vitiligo is the same in both children and adults. However, treatment options differ, as some are not safe to use in children. For example, an option not detailed in this article is surgery, as it is only an option for adults with vitiligo.

• Vitiligo typically begins with loss of color on the skin, especially the hands, feet, and around the mouth. However, it can also cause hair to turn white, especially on the scalp, eyebrows, or eyelashes in children.

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