Vitiligo is a skin condition that results in loss of skin pigment (color). Affected areas appear white or lighter than the normal skin color. Vitiligo may also affect the hair, causing it to appear light – colored or white. It is very common in children and overall is believed to affect about 1 in every 100 persons. It is more common in some families than others.
We believe that vitiligo comes from an autoimmune destruction of skin pigment cells. This means that the body makes antibodies (proteins) that destroy the skin pigment cells. We do not know why this happens. Children with vitiligo are usually otherwise healthy, and therefore no blood tests or other tests are generally needed. Rarely, vitiligo may develop in persons with other autoimmune diseases, such as thyroid disease or diabetes.
In most affected persons, vitiligo affects only a small number of areas on the body. It may very rarely progress to involve most or all of the skin. Vitiligo often develops in areas where there was a trauma or injury.
There are several types of vitiligo:
· Focal vitiligo: loss of pigment in one or two limited areas of the body
· Segmental vitiligo: loss of skin pigment in several areas on one side of the body, often the face, chest or back. This is common in children.
· Acrofacial vitiligo: loss of pigment on the face, hands and/or feet
· Mucosal vitiligo: loss of pigment around the eyes, mouth, nose, anus or genitalia
· Generalized vitiligo: loss of skin pigment in multiple areas on both sides of the body, commonly the hands, feet, arms, and legs.
· Universal vitiligo: loss of most or all of the skin pigment. This is very rare.
Will my child’s skin pigment (color) return?
Skin pigment may or may not come back completely. About 75% of affected persons will have some return of skin pigment. This may take months to years. There may be periods of improvement followed by more loss of skin pigment. You cannot do anything to prevent new areas of vitiligo from developing. When the skin pigment starts to return it may look like small dark spots inside the lighter areas or as darker skin color appearing around the edges of the light spots.
What determines if the skin pigment (color) returns?
Areas such as the face often improve, while the hands and feet often do not improve. Those persons with more areas of involvement are less likely to have all of their skin pigment return. The longer the skin pigment loss continues, the less likely it is to come back.
Your dermatology provider may prescribe a medication to try to help the skin color to return to normal. Treatment is usually limited to topical corticosteroids (a cream, ointment, or solution), topical calcineirin inhibitors (e.g. tacrolimus/Protopic® and Elidel®) and other topical medications such as minoxidil (Rogaine®) and topical retinoids. Corticosteroid injections are an option for children old enough to tolerate the discomfort of the procedure. Oral (by mouth) medications or other systemic medications are not generally recommended. Please follow the instructions for use of the medications very carefully. Your provider may suggest phototherapy, a type of light therapy that is available in some dermatology offices or may be prescribed for home use.
People with vitiligo are more likely to develop sunburn in the affected areas. Therefore, use of sunscreen lotions, sun avoidance, and sun-protective clothing is important. Your doctor can provide you with more information on how to keep your skin safe in the sun.