Vitiligo in Kids and Toddlers: Genetic Transmission, Segmental and Focal

It is devastating when your infant or child displays white skin discolorations and you hear the diagnosis of chronic vitiligo which is a pigmentary disorder. Sufferers experience progressive death of cutaneous melanocytes. The hypopigmented areas turn amelontic. Half of all sufferers will display signs before they turn 20 and an additional 25 percent will have the diagnosis before they are 8 years old. The trauma and emotional devastation of a child or teenager facing life with vitiligo are heartbreaking. The psychological welfare of the child declines as they take a poor view of themselves. Also, peer pressure and incessant bullying are often problems difficult for children to overcome.

Understanding Vitiligo Baby Diagnosis

Few infants make it past their first birthday without a rash or some other issues. Cradle cap, baby acne, milia, nappy rash, kerotosis pilaris, prickly heat, hives, and erythema toxicum are just a few frequently diagnosed skin problems that send parents scrambling to the dermatologist. At first, if you notice a few lighter white spots on your baby you might not be concerned, but if the pale area grows, then you might book an appointment to figure out what is wrong with your little one.

A vitiligo baby diagnosis is shocking and frightening. You immediately realize that your beloved tiny bundle of joy will cope with the disorder for life and will face many hardships. Your heart probably breaks at the realization of what lays ahead. Vitiligo is genetic, so you probably know relatives that deal with the disorder so you know the emotional toll. Up to 20 percent have a close relative with the disorder.

Coping with Vitiligo in Toddlers

Unlike vitiligo in adults that show no sexual preference, when the changes occur in childhood, the segmental form is the most common.

The vitiligo in toddlers and children does not exist alongside systemic autoimmune disorders and endocrine malfunction as it does with adults.

Treating Vitiligo in Children

Treatment is a challenge at all ages, but especially so during childhood. Certain treatments that are deemed safe for adults have very different effects on children. Also, many physicians abstain from treating babies because of the delicate nature of their skin.

Treating vitiligo in children therapy options include:

Corticosteroids: Corticosteroids are the go-to therapy, but they lead to epidermal atrophy in kids. Also, steroid use over for an extended length of time in youngsters can cause stria, glaucoma, hypothalamus-pituitary axis suppression (HPA axis),tachyphlaxis, telangiactesia, and system absorption. In addition, growth retardation and Cushing’s syndrome often occur.

Calcipotriol: The calcipotriol topical cream is a synthetic vitamin D. They once used it only for psoriasis until peri lesional hyperpigmentation was noticed, and now it is often used in conjunction with other treatments for vitiligo. The cream usually only causes mild burning.

Calcineurin Inhibitors: These topicals include tacrolimus and pimecrolimus. They are popular for babies, toddlers, and children because they have few side effects. The US FDA has issued a warning that prolonged use can lead to certain malignancies, lymphoma, and increased skin cancer.

Systemic Therapy: Systemic therapy is common for children because the disease is focal and unstable. Oral corticosteroids slow the progression of vitiligo. Additional re-pigmentation happens with some young patients rendering what they consider acceptable effects. In fact, the progression of the disease becomes arrested in 89 percent of those treated. Using a small mini-pulse treatment that combines betamethasone/dexamethasone appears to dramatically induce spontaneous repigmentation in children.

Phototherapy: Combinations of Ultraviolet (UV) with plus psoralen (PUVA) combined UVA plus UVB, and a form called narrowband UVB have been used for vitiligo. Many physicians abstain from using phototherapy in children because the long-term toxicity over the child’s life expectancy might be dramatically increased. Narrowband UVB has started to be used in children with impressive results.

Excimer Laser for Targeted Phototherapy: The results of this are noticeable in 50 percent of children, especially those with facial lesions. Spots were reduced by as much as half the size with repigmentation. Children only reported burning of the skin. Chinese children seem to respond remarkably well to this form of therapy and show repigmentation improvement, especially on the face.

Surgery: Surgery is extreme. Although, it was once a standby; it has faded in popularity. Interestingly, it often holds the best promise of results when done on young children even though it is no longer a common standby. On the rare occasions when it is still performed the following are the most common procedures:

  • Minipunch grafts comprise small skin plugs placed into the lesion to darken it. Unfortunately, a cobblestone appearance occurs.
  • Thin Thiersh grafts are made up of thin grafts of skin placed together.
  • Suction blister epidermal grafts (SBEG) have proven very effective and are the go-to surgical treatment.
  • Transplantation of epidermal cell suspension takes two to four months of repigmentation but can be effective in small areas.
  • Cultured epidermis is a common treatment for burns and can be effective for vitiligo.
  • Cultured melanocyte suspension requires stability.

If surgery is the avenue you want to explore, then most researchers agree that SBEG has the best results. When performed on children, they experienced an 80 percent repigmentation in the area treated. This is far better than other methods. Children appear to have a much greater response compared to that of adults. Some achieved 90 percent repigmentation in less than a single year. Many researchers are encouraging physicians to consider SBEG as a viable and effective way to treat vitiligo in little ones.

 

 

Article References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816297/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816297/#ref2
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519254/#ref29
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519254/#ref32
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519254/#ref45
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519254/#ref48

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