Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism.

The objective of a new study published in Current Pediatric Reviews was to familiarize physicians with the clinical manifestations, evaluation, diagnosis and management of vitiligo.

This narrative review entailed a Pubmed search in Clinical Queries using the key term vitiligo – that included meta-analyses, randomized controlled trials, clinical trials, observational studies and reviews.

The findings revealed that nearly one quarter of patients with vitiligo have onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role in the pathogenesis. While vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunkand upper limbs. The clinical course is generally unpredictable.

In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors and narrowband ultraviolet B phototherapy are the mainstays of treatment.

It was inferred thattherapeutic effect of all the treatment modalities varies considerably amongst individuals; thus, treatment must be individualized. The best treatment response is seen in younger patients, recent disease onset, darker skin typesand head and neck lesions. Topical corticosteroids and calcineurin inhibitors are treatments of choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life, who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.

Source: Current Pediatric Reviews. 2020 Dec 10. doi: 10.2174/1573396316666201210125858.