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ORIGINAL ARTICLE
Year : 2018  |  Volume : 19  |  Issue : 3  |  Page : 212-214

Childhood vitiligo: A clinicoepidemiological study


Treatwell Skin Centre, Jammu, Jammu and Kashmir, India

Date of Web Publication28-Jun-2018

Correspondence Address:
Dr. Mrinal Gupta
Treatwell Skin Centre, Canal Road, Jammu - 180 001, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_91_17

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  Abstract 


Background: Vitiligo is a chronic disorder of pigmentation which has serious psychosocial implications. Early onset or childhood vitiligo, although clinically similar to adult-onset vitiligo, has been found to have a distinct epidemiological, clinical, therapeutic, and prognostic profile. Aims and Objectives: This study was carried out to study the clinicoepidemiological characteristics of vitiligo in patients aged <18 years. Materials and Methods: It was a prospective, observational study carried out over a period of 1 year in which fifty children having vitiligo were examined. After taking an informed consent from the attendants/parents of the patients, a complete history including age, sex, duration of the disease, family history, history of Koebner's phenomenon, and history of associated diseases was noted. Results: The study group comprised of 29 females and 21 males (male:female 1:1.38), aged between 6 months and 17 years with a mean age of 8.45 ± 2.34 years and the mean age of onset was 5.6 years. The most common clinical subtypes observed in childhood vitiligo were vitiligo vulgaris in 42% (n = 21) followed by focal in 24% (n = 12), segmental in 12% (n = 6), and acrofacial in 10% patients (n = 5). A family history of vitiligo was seen in 16% patients (n = 8). Leukotrichia was observed in four patients, Koebner phenomenon in 5, and halo nevus in one patient. Conclusions: Childhood vitiligo is a common entity with vitiligo vulgaris being the most common subtype and lower limbs being the most common site of involvement. Children with positive family history had an earlier age of onset, and thyroid abnormalities were more common in nonsegmental variant.

Keywords: Autoimmunity, childhood vitiligo, segmental vitiligo, vitiligo


How to cite this article:
Gupta M. Childhood vitiligo: A clinicoepidemiological study. Indian J Paediatr Dermatol 2018;19:212-4

How to cite this URL:
Gupta M. Childhood vitiligo: A clinicoepidemiological study. Indian J Paediatr Dermatol [serial online] 2018 [cited 2018 Jul 19];19:212-4. Available from: http://www.ijpd.in/text.asp?2018/19/3/212/235499




  Introduction Top


Vitiligo is an acquired depigmenting disorder of the skin resulting from loss of functional melanocytes. It is a common disorder affecting between 0.5% and 4% of the general population. It can have a variable age of onset, but many studies have reported that around 50% of the patients have an onset before the age of 18 years and a quarter before the age of 8 years. Vitiligo in childhood can be associated with significant psychological distress that may have long-lasting effects on the psychosocial development of these children.[1],[2]

Childhood vitiligo, although clinically similar to adult-onset vitiligo, has been found to have a distinct epidemiological, clinical, therapeutic, and prognostic profile. We carried out this study to assess the clinicoepidemiological characteristics of vitiligo in pediatric patients.


  Materials and Methods Top


It was a prospective, observational study carried out over a period of 1 year in our center in which 50 pediatric patients with vitiligo were included. After taking an informed consent from the attendants/parents of the patients, the clinical characteristics of the patients were noted in a predesigned pro forma. A complete history including age, sex, duration of the disease, family history, history of Koebner's phenomenon, and history of associated diseases was noted. The patients were thoroughly examined, and data such as pattern of vitiligo, sites of involvement, leukotrichia, and halo nevus were noted.


  Results Top


The study group comprised of 29 females and 21 males (male:female 1:1.38), aged between 6 months and 17 years with a mean age of 8.45 ± 2.34 years. The duration of the disease ranged from 2 months to 11 years, the average duration was 1.9 years, and the mean age of onset was 5.6 years. A family history of vitiligo was seen in eight patients, and the mean age of onset in these patients was 5.1 years. Two patients had a history of hypothyroidism, and one had alopecia areata and was on treatment for the same. The most common clinical subtypes observed in childhood vitiligo were vitiligo vulgaris in 42% (n = 21) followed by focal in 24% (n = 12), segmental in 12% (n = 6), and acrofacial in 10% patients (n = 5). The most common site for vitiligo was lower limb seen in 22 patients (44%), followed by face (26%), upper limbs (20%), scalp and mucosal (18%)[Figure 1] and [Figure 2]. Leukotrichia was observed in 4 patients, Koebner phenomenon in 5, and halo nevus in one patient.
Figure 1: Childhood vitiligo involving various body sites (a) lip and (b) neck

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Figure 2: (a) Single lesion over upper back and (b) segmental vitiligo

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  Discussion Top


In our study, altogether, 50 patients were included and females outnumbered the males (male:female 1:1.38). Various studies have reported a female predominance among the pediatric age group while a few have found equal distribution among the two sexes. Indian studies have reported the incidence among females ranging from 55% to 61%, but a few Chinese studies have reported equal incidence.[2],[3],[4],[5] In an Indian study by Jaisankar et al., out of the 90 children, with vitiligo, 38.9% were boys and 61.1% were girls, which was statistically significant.[6] The female predominance could be attributed to the fact that early medical help is sought by parents of the female patients owing to the cosmetically disfiguring nature of the disease. The mean age of onset of childhood vitiligo has been reported to range from 5.6 to 7.28 years, which in our study was 5.6 years.[4],[7],[8] A positive family history of vitiligo was seen in eight patients and the mean age of onset in these patients was lesser in our study population (5.1 years vs. 5.6 years). Different studies have reported the incidence of positive family history ranging from 11% to 46% and researchers have reported a lower age of onset in this subgroup of patients.[4],[5],[9] Pajvani et al. reported a lower age of onset of vitiligo in patients with positive family history of vitiligo or other autoimmune disorders.[9] In our study, 16% (n = 8) patients had a positive family history of vitiligo, and the mean age of onset among this subgroup was 5.1 years as compared to 5.6 years in the total study population.

Vitiligo can have a variable presentation in the pediatric population. Various studies have reported vitiligo vulgaris to be the most common presentation followed by focal and segmental vitiligo.[3],[4],[5] Kanwar et al., in their study of childhood vitiligo in 100 patients, reported vitiligo vulgaris to be the most common subtype seen in 61%, followed by focal vitiligo in 23%.[10] Similar findings were noted in our study too with vitiligo vulgaris being the most common subtype in 42% (n = 21) followed by focal in 24% (n = 12), segmental in 12% (n = 6), and acrofacial in 10% patients (n = 5). The most common site for vitiligo was lower limb seen in 22 patients (44%), followed by face (26%), upper limbs (20%), scalp and mucosal (18%), which corroborated with the study by Sheth et al., who also reported that the most common sites of involvement were lower limbs seen in 62%, followed by face (46%), upper limbs (30%), scalp (25%), and mucosal (18%).[11] This finding was in contrast to Hann and Lee who reported that the most common initial site of onset of both NSV and SV in children is the face and neck.[12]

Leukotrichia is a common presentation in vitiligo with various studies reporting an incidence rate varying from 3.7% to 32.5%, being most commonly associated with vitiligo vulgaris. In our study, the incidence of leukotrichia was comparatively lesser with only 8% (n = 4) patients showing leukotrichia. Koebner's phenomenon is another common feature seen in vitiligo, which is an indicator of disease activity. In our study, Koebner's phenomenon was seen in five patients (10%), which was lesser than the rates reported in various other studies which vary from 21.5% to 34%.[3],[5],[11]


  Conclusions Top


The prevalence of vitiligo among children is high with a female predominance and an earlier age of onset seen among patients with family history of vitiligo or autoimmune disorders. Vitiligo vulgaris is the most common presentation with lower limbs being the most common site of involvement.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Iacovelli P, Sinagra JL, Vidolin AP, Marenda S, Capitanio B, Leone G, et al. Relevance of thyroiditis and of other autoimmune diseases in children with vitiligo. Dermatology 2005;210:26-30.  Back to cited text no. 1
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2.
Jain M, Jain SK, Kumar R, Mehta P, Banjara N, Kalwaniya S. Clinical profile of childhood vitiligo patients in Hadoti region in Rajasthan. Indian J Paediatr Dermatol 2014;15:20-3.  Back to cited text no. 2
  [Full text]  
3.
Agarwal S, Gupta S, Ojha A, Sinha R. Childhood vitiligo: Clinicoepidemiologic profile of 268 children from the Kumaun region of Uttarakhand, India. Pediatr Dermatol 2013;30:348-53.  Back to cited text no. 3
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4.
Hu Z, Liu JB, Ma SS, Yang S, Zhang XJ. Profile of childhood vitiligo in China: An analysis of 541 patients. Pediatr Dermatol 2006;23:114-6.  Back to cited text no. 4
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5.
Lin X, Tang LY, Fu WW, Kang KF. Childhood vitiligo in China: Clinical profiles and immunological findings in 620 cases. Am J Clin Dermatol 2011;12:277-81.  Back to cited text no. 5
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6.
Jaisankar TJ, Baruah MC, Garg BR. Vitiligo in children. Int J Dermatol 1992;31:621-3.  Back to cited text no. 6
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7.
Handa S, Dogra S. Epidemiology of childhood vitiligo: A study of 625 patients from North India. Pediatr Dermatol 2003;20:207-10.  Back to cited text no. 7
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8.
Prcic S, Djuran V, Mikov A, Mikov I. Vitiligo in children. Pediatr Dermatol 2007;24:666.  Back to cited text no. 8
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9.
Pajvani U, Ahmad N, Wiley A, Levy RM, Kundu R, Mancini AJ, et al. The relationship between family medical history and childhood vitiligo. J Am Acad Dermatol 2006;55:238-44.  Back to cited text no. 9
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10.
Kanwar AJ, Dhar S, Kaur S. Vitiligo in children. Indian J Dermatol 1993;38:47-52.  Back to cited text no. 10
    
11.
Sheth PK, Sacchidanand S, Asha GS. Clinicoepidemiological profile of childhood vitiligo. Indian J Paediatr Dermatol 2015;16:23-8.  Back to cited text no. 11
  [Full text]  
12.
Hann SK, Lee HJ. Segmental vitiligo: Clinical findings in 208 patients. J Am Acad Dermatol 1996;35:671-4.  Back to cited text no. 12
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