Access Dermatology

Summary

Vitiligo vulgaris is a skin hypopigmentation or depigmentation caused by loss of functional melanocytes activity in the skin. Experimental and clinical evidence supports an autoimmune etiology in the onset of vitiligo vulgaris. A variety of additional mechanisms have credible scientific evidence backing their role in vitiligo as an illness, including free-radical oxygen species production, neurological alterations, chemically induced melanocyte toxicity and psychological distress. Vitiligo is estimated to occur in 0.4-1% of the worldwide populus. Vitiligo first appears in individuals under the age of 20 years in 30-60% of cases. One-third of these cases will be segmental, which is a localized mosaic variant. Generalized illness tends to affect the periorificial areas, the intertriginous skin and the skin overlying the joints. The fact that vitiligo can be cosmetically disfiguring may cause alterations in psychological well-being during the formative years of emotional development. Treatments are aimed at slowing or stopping disease progression, effecting repigmentation, covering up any cosmetic defects and addressing psychological distress. A cyclic approach to treatment includes alternating topical calcineurin inhibitors, topical corticosteroids with or without topical calcipotriene, ultraviolet light sources including narrowband UVB and excimer laser, and surgical intervention where tolerated. Adjunctive therapy including self-tanners, cosmetic cover-up and psychological interventions should be offered where necessary. In addition, work-up for autoimmune thyroiditis should be initiated in children with generalized vitiligo. This article reviews important recent advances in the diagnosis and treatment of pediatric and adolescent vitiligo vulgaris.