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A Practical Approach To The Diagnosis and Treatment of Vitiligo in Children PDF
A Practical Approach To The Diagnosis and Treatment of Vitiligo in Children PDF
Rare Forms
Several forms may fit into the
spectrum of rare vitiligo and all
should be considered as NSV forms.
FIGURE 2
Punctate vitiligo was first described Universal vitiligo.
by Falabella et al27 and refers to pea-
sized depigmented macules that may
involve any area of the body.23 hairs and rare depigmented been described.23 In this type
macules.29 of vitiligo, the early involvement
Vitiligo minor is rarely reported of the follicular melanocyte
Segmental Vitiligo
in children. In this rare form, reservoir is common and the
hypopigmented macules are SV accounts for 10% to 15% of all disease rapidly stabilizes over a
distributed mainly on the face, types of vitiligo. SV is defined as a few months. Epidemiologic data
and the back has been recently unilateral and segmental or band- also show an earlier age of onset.30
reported.28 Another striking rare shaped distribution (asymmetric Finally, SV should be differentiated
form is follicular vitiligo, which has vitiligo) (Fig 3). Generally, 1 unique from focal vitiligo in which a
the particularity to primarily involve segment is involved in SV, but 2 unique small lesion without a clear
the melanocyte follicular reservoir or more segments with ipsi- or segmental distribution pattern is
with whitening of most of the body contralateral distribution have described.
One characteristic feature in SV The number of lifetime cycles and metabolic profile, thyroid function
is that once repigmentation has triggering factors are different in screen (thyrotropin) and antibodies
occurred, relapse is rare. each patient and yet still to be clearly (anti-thyroid peroxidase and anti-
elucidated. Epidemiologic studies thyroglobulin) to identify early
On the other hand, the course of NSV support the role of stress episodes as cases of thyroid disease requiring
is unpredictable. The natural history a trigger of disease and/or relapse. closer follow-up, as well as 25 (OH)
of the disease tends to be cyclic and An overall therapeutic algorithm for vitamin D, which when low may
includes a silent phase, during which the treatment of vitiligo is given in identify a subset of patients with
melanocyte destruction is minimal, Fig 5. greater propensity for secondary
and a so-called acceleration phase autoimmunity. Antinuclear antibody
Medical Workup
with rapid disease progression over (ANA) screening is recommended
a few weeks or months followed by a The care of SV does not require before phototherapy. Other screening
stabilization phase. Whitening of the medical workup, unless NSV or can be performed based on the
hairs may appear later in the course another systemic autoimmune presence of signs and symptoms
of the disease. Repigmentation disease is noted concurrently. of other autoimmune diatheses
may occur without any therapeutic The workup of children with NSV (eg, polyuria, polydipsia, gum
intervention or after sun exposure. includes a complete blood count, pigmentation, joint pain).37,40
REFERENCES
1. Ezzedine K, Eleftheriadou V, Whitton 12. Chen GY, Cheng YW, Wang CY, 22. Kyriakis KP, Palamaras I, Tsele E,
M, van Geel N. Vitiligo. Lancet. et al. Prevalence of skin diseases Michailides C, Terzoudi S. Case
2015;386(9988):74–84 among schoolchildren in Magong, detection rates of vitiligo by
Penghu, Taiwan: a community-based gender and age. Int J Dermatol.
2. Nair BK. Vitiligo—a retrospect. Int J clinical survey. J Formos Med Assoc. 2009;48(3):328–329
Dermatol. 1978;17(9):755–757 2008;107(1):21–29
23. Ezzedine K, Lim HW, Suzuki T, et al;
3. Gauthier YBL. Historical Aspects. 13. Howitz J, Brodthagen H, Schwartz Vitiligo Global Issue Consensus
Heidelberg, Germany: Springer Verlag; M, Thomsen K. Prevalence of vitiligo. Conference Panelists. Revised
2010 Epidemiological survey on the Isle of classification/nomenclature of vitiligo
Bornholm, Denmark. Arch Dermatol. and related issues: the Vitiligo Global
4. Koranne RV, Sachdeva KG. Vitiligo. Int J
1977;113(1):47–52 Issues Consensus Conference. Pigment
Dermatol. 1988;27(10):676–681
Cell Melanoma Res. 2012;25(3):
14. Yamamah GA, Emam HM, Abdelhamid
5. Ezzedine K, Sheth V, Rodrigues M, et al; E1–E13
MF, et al. Epidemiologic study of
Vitiligo Working Group. Vitiligo is not a dermatologic disorders among 24. Nicolaidou E, Antoniou C, Miniati A,
cosmetic disease. J Am Acad Dermatol. children in South Sinai, Egypt. Int J et al. Childhood- and later-onset vitiligo
2015;73(5):883–885 Dermatol. 2012;51(10):1180–1185 have diverse epidemiologic and clinical
6. Krüger C, Schallreuter KU. A review characteristics. J Am Acad Dermatol.
15. Tey HL. A practical classification of
of the worldwide prevalence of 2012;66(6):954–958
childhood hypopigmentation disorders.
vitiligo in children/adolescents and Acta Derm Venereol. 2010;90(1):6–11 25. Osborne GE, Francis ND, Bunker CB.
adults. Int J Dermatol. 2012;51(10): Synchronous onset of penile lichen
16. Marinho FS, Cirino PV, Fernandes NC.
1206–1212 sclerosus and vitiligo. Br J Dermatol.
Clinical epidemiological profile of
2000;143(1):218–219
7. Silverberg NB. The Epidemiology vitiligo in children and adolescents.
of Vitiligo. Curr Dermatol Rep. An Bras Dermatol. 2013;88(6): 26. Ezzedine K, Gauthier Y, Léauté-Labrèze
2015;4:36–43 1026–1028 C, et al. Segmental vitiligo associated
17. Agarwal S, Gupta S, Ojha A, Sinha R. with generalized vitiligo (mixed
8. Ezzedine K, Le Thuaut A, Jouary T,
Childhood vitiligo: clinicoepidemiologic vitiligo): a retrospective case series
Ballanger F, Taieb A, Bastuji-Garin
profile of 268 children from the of 19 patients. J Am Acad Dermatol.
S. Latent class analysis of a series
Kumaun region of Uttarakhand, India. 2011;65(5):965–971
of 717 patients with vitiligo allows
the identification of two clinical Pediatr Dermatol. 2013;30(3):348–353 27. Falabella R. Surgical treatment of
subtypes. Pigment Cell Melanoma Res. 18. Ayanlowo O, Olumide YM, Akinkugbe vitiligo: why, when and how. J Eur Acad
2014;27(1):134–139 A, et al. Characteristics of vitiligo Dermatol Venereol. 2003;17(5):
in Lagos, Nigeria. West Afr J Med. 518–520
9. Ezzedine K, Diallo A, Léauté-Labrèze
2009;28(2):118–121 28. Ezzedine K, Mahé A, van Geel N,
C, et al. Multivariate analysis of
factors associated with early-onset 19. Vora RV, Patel BB, Chaudhary AH, et al. Hypochromic vitiligo: delineation
segmental and nonsegmental vitiligo: Mehta MJ, Pilani AP. A clinical study of a new entity. Br J Dermatol.
a prospective observational study of vitiligo in a rural set up of Gujarat. 2015;172(3):716–721
of 213 patients. Br J Dermatol. Indian J Community Med. 2014;39(3): 29. Ezzedine K, Amazan E, Séneschal J,
2011;165(1):44–49 143–146 et al. Follicular vitiligo: a new form of
10. Shrestha R, Shrestha D, Dhakal AK, 20. Alissa A, Al Eisa A, Huma R, Mulekar vitiligo. Pigment Cell Melanoma Res.
Shakya A, Shah SC, Shakya H. Spectrum S. Vitiligo-epidemiological study 2012;25(4):527–529
of pediatric dermatoses in tertiary of 4134 patients at the National
30. Mazereeuw-Hautier J, Bezio S, Mahe
care center in Nepal. Nepal Med Coll J. Center for Vitiligo and Psoriasis in
E, et al; Groupe de Recherche Clinique
2012;14(2):146–148 Central Saudi Arabia. Saudi Med J.
en Dermatologie Pédiatrique (GRCDP).
2011;32(12):1291–1296
11. Wang X, Du J, Wang T, et al. Prevalence Segmental and nonsegmental
and clinical profile of vitiligo in China: 21. Pajvani U, Ahmad N, Wiley A, et al. The childhood vitiligo has distinct clinical
a community-based study in six cities. relationship between family medical characteristics: a prospective
Acta Derm Venereol. 2013;93(1): history and childhood vitiligo. J Am observational study. J Am Acad
62–65 Acad Dermatol. 2006;55(2):238–244 Dermatol. 2010;62(6):945–949
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