Vitiligo

Vitiligo (vit-ih-LI-go) is an autoimmune disease where the body’s immune system attacks the cells that make color (pigment). These cells are called melanocytes. As a result, white or lighter (depigmented) patches appear on the skin in different areas of the body. It usually starts as small areas that spread and become larger. It can happen on any part of the body.

How much vitiligo will spread is difficult to predict. Sometimes only a small area of the body will be affected. Very rarely, pigment loss can happen all over the body. Vitiligo cannot spread from person to person. It is not contagious.

Most children with vitiligo are completely healthy. There may be a family history of autoimmune diseases. Rarely, a person with vitiligo can develop other autoimmune diseases such as thyroid disease, hair loss (alopecia areata) or diabetes. It is important to let your child’s doctor know about any unexplained symptoms like drinking or peeing more frequently, fatigue, weight changes, always feeling hot or cold, or hair loss.

It can be difficult for children to deal with the emotional impact of having vitiligo, because they can view themselves as “different” than everyone else. Some children don’t mind their spots, but others are more affected. Talk with your child about vitiligo in a positive way and promote an open conversation about their feelings. Let your child’s healthcare provider know if your child exhibits any mood changes.

Treatment for vitiligo can be difficult. Not all people respond to treatment. Patches may stop forming without treatment, and sometimes pigment returns on its own. Check with your child’s healthcare provider before giving any type of medicine to your child.

First, it is common to try steroid creams on the skin (topical). Apply them to the affected areas as directed by your healthcare provider. Potential risks of topical steroids include thinning of the skin, stretch marks and reducing the body’s ability to make cortisol (a hormone your body releases during stress). This will only occur if the steroid cream is overused. Topical steroids are safe to use if you follow the instructions given.

Topical calcineurin (cal-sih-NOR-in) inhibitors are a type of medicine that work without steroids. Apply these creams or ointments to the skin, especially more delicate areas of the body like the face and neck. Just like topical steroids, they can help re-pigment the skin, but they have different side effects. Your child’s healthcare provider can talk about them with you.

We may consider light treatment (phototherapy) for patients with widespread vitiligo or those who don’t respond to other treatments. Phototherapy should be done under the direction of a dermatologist. It requires frequent office visits. Although we use light therapy to treat vitiligo, it is important to be careful in the sun as the depigmented areas can easily sunburn. Sun exposure may make the vitiligo worse and increase the risk of skin cancer.

Sometimes people choose to cover the white areas with makeup. There are several companies that sell makeup specifically designed for patients with skin conditions like vitiligo (such as Dermablend and Covermark).

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