Profile of childhood vitiligo in China: an analysis of 541 patients

From July to December 2002, we collected data from 2247 vitiligo patients in order to establish the clinical and epidemiologic profile of vitiligo in China. Of these patients, 541 (24.1%) were children aged equal to or less than 12 years. Of the 541 children, 274 (50.6%) were boys and 267 (49.4%) were girls, with a mean age of 8.87 years and a mean onset age of 7.28 years. Similar to adult patients, boys and girls were affected by vitiligo with equal frequency. The most frequent age of onset was between 4 and 8 years (42.5%). The mean duration of vitiligo was 19.71 months (range: 0-132 months). The most common type of vitiligo was vitiligo vulgaris, the frequency of which was 38.1%, followed by focal vitiligo (34.6%), segmental vitiligo (19.4%), acrofacial vitiligo (7.6%), and universal vitiligo (0.4%). Segmental vitiligo had an earlier the other types. Of the 541 children with vitiligo, 60 (11.1%) had a family history, and 3 (0.6%) had more than one family member who was affected. Forty-one (7.6%) children had an associated autoimmune disease: halo nevi and alopecia areata, which were observed in 39 (7.2%) and 2 (0.4%) children, respectively.     

儿童白癜风396例临床分析

目的 探讨汉族儿童白癜风的临床特点。方法 采用问卷调查方式对浙江省396例儿童白癜风及825例成人白癜风患者进行临床分析，用SPSS 10.0软件包对资料进行分析。结果 396例儿童白癜风患者中男183例占46.2%，女213例占53.8%，与成年患者相比，男女之间无性别差异。儿童患者中节段型的比例为33.3%，明显高于成人患者的13.5%，泛发型比例为4.3%，显著低于成人患者的11.6%。儿童患者家族史阳性比例为12.4%，成人患者家族史阳性比例为12.7%，两组间差异无统计学意义。有家族史患者一级亲属的发病率均明显高于二级亲属。儿童患者的诱发因素以外伤为主，伴发晕痣的比例明显高于成人患者；成人患者伴发甲状腺疾病的比例显著高于儿童患者。结论 儿童白癜风临床特点与成人相比有一定差异。     

Effects of age of onset on disease characteristics in non‐segmental vitiligo

In patients with vitiligo, the clinical and laboratory features of the disease may vary according to time of onset. This is addressed in the literature by only a few studies with conflicting results. The aim of this study was to determine the demographic and clinical features of patients with non‐segmental vitiligo and to establish the association between vitiligo and autoimmune diseases with a focus on time of disease onset. A total of 224 vitiligo patients for whom complete medical records were available were evaluated retrospectively. Demographic data, scores on the Vitiligo Area Score Index (VASI), clinical features, vitiligo disease activity, repigmentation status, presence of any accompanying autoimmune disease, antinuclear antibody (ANA) titers, serum levels of glucose, thyroid‐stimulating hormone (TSH), thyroxine (T4) hormone, anti‐thyroid peroxidase (anti‐TPO), and anti‐thyroglobulin (anti‐TG) were recorded. The prevalence of halo nevi was significantly higher (P < 0.001) among children than in other patient groups. The prevalence of leukotrichia was higher in adults with adult‐onset disease than in either pediatric patients or adults with childhood‐onset disease (P = 0.002). Both anti‐TG and anti‐TPO levels were significantly higher in adults with adult‐onset disease than in pediatric patients and adult patients with childhood‐onset disease. The prevalence of autoimmune disease was 22.2%. Anti‐TG levels were significantly higher in patients with treatment‐related repigmentation than in those without repigmentation. This study shows that clinical features and associations with autoimmune disease may vary according to the age of onset of vitiligo.     

Relevance of autoimmune thyroiditis in children and adolescents with vitiligo

Background Vitiligo is the most common pigmentation‐related disorder worldwide. An autoimmune etiology is widely considered, and genetic factors may play an important role in its pathogenesis. The purpose of this study was to assess the incidence of thyroid dysfunctions and autoimmune thyroiditis in children with vitiligo and to identify related factors. Methods Fifty children with vitiligo and 50 control children were enrolled. Data on age, onset, duration, disease activity, presence of thyroid disorder, other autoimmune diseases, halo nevi, poliosis, and mucosal vitiligo were determined. Serum free triiodothyronine, free thyroxine, total T3, total T4, thyroid‐stimulating hormone, and antibodies to thyroperoxidase and thyroglobulin were measured. Thyroid gland efficiency was evaluated. Results The mean age at onset of vitiligo was 7.26 ± 4.43 years. The duration of vitiligo was 2.26 ± 2.95 years. Vulgaris‐type vitiligo was the most common form in our patients (56%), and 42% reported at least one family member with thyroid disorder, autoimmune disease, or both. Overt hypothyroidism or hyperthyroidism were not detected. We found a significant association between autoimmune thyroiditis and both sex and disease duration (P = 0.046 and P = 0.07, respectively), but no association between autoimmune thyroiditis and age, age at onset of vitiligo, halo nevi, poliosis, mucosal involvement, disease activity, or family history of vitiligo, autoimmunity, or thyroid disorders. Conclusions Children with vitiligo show an increased incidence of autoimmune thyroiditis. Children with vitiligo, especially girls and subjects with generalized/vulgaris‐type vitiligo, should be screened annually for thyroid function and antithyroid antibodies to assist in the early diagnosis and therapy of autoimmune thyroiditis.     

Epidemiology of childhood vitiligo: a study of 625 patients from north India

To study the clinical and epidemiologic profile of childhood vitiligo, we retrospectively analyzed the data of children with vitiligo attending the pigmentary clinic of our center. Of the 625 children seen over 10 years, 357 (57.1%) were girls and 268 (42.9%) were boys. As compared to adult patients with vitiligo, this sex difference was found to be statistically significant (p < 0.001). The mean age of onset of the disease was 6.2 years. Vitiligo vulgaris (generalized vitiligo) was the most common type, followed by focal, segmental, acrofacial, mucosal, and universal, in that order. The most frequent site of onset was the head and neck, followed by the lower limbs, trunk, upper limbs, and mucosae. Leukotrichia was present in 77 patients (12.3%), while Koebner phenomenon was observed in 71 patients (11.3%). Halo nevi were observed in 29 patients (4.4%). Seventy-six patients (12.2%) had a family history of vitiligo. Eight patients (1.3%) had an associated autoimmune disease. These associated disorders were alopecia areata in two patients, and diabetes mellitus, thyroid disease, Addison disease, polyglandular syndrome, and pemphigus vulgaris in one patient each.     

Late onset vitiligo: a study of 182 patients

The elderly constitute a large and rapidly growing segment of the population; however, there is complete lack of information about the epidemiology of vitiligo in this age group. To study the clinical and epidemiological profile of vitiligo in the elderly, we retrospectively analyzed the data of patients with vitiligo having onset of disease after 50 years of age attending the pigmentary clinic of our center. Of the 182 patients, 87 (47.8%) were males and 95 (52.2%) were females. The mean age of onset of disease was 55 +/- 2.3 years. Vitiligo vulgaris was the most common (83.5%) followed by focal (5.5%), segmental (4.4%), acrofacial (3.8%), mucosal (2.2%), and universal (0.5%). The most common site of onset was the head and neck (24.2%) followed by the upper limbs (23%), trunk (22%), lower limbs (17.6%), oral/genital mucosae (7.1%), and flexures (6%). Koebner's phenomenon was observed in 14.8% while leukotrichia was present in 47.3% of the patients. Halo nevi were observed in 3.8% of patients, and vitiligo was stable in 64.8%. Twenty-nine (15.9%) patients had family history of vitiligo. Associated autoimmune autoimmune/endocrine disorders were present in 39 (21.4%) of the patients. Differences in disease characteristics compared with vitiligo in children and young adults are discussed.     

VITILIGO IN CHILDREN

In our study the relative incidence of vitiligo among new patients was 2.6%. Twenty percent were children and 74% were adults. Of the 90 children, 38.9% were boys, and 61.1% were girls. This sex difference was statistically highly significant. The adult sex-ratio was not statistically significant. The relative incidence of the clinical subtypes in children and adults was compared, and the difference was found to be statistically highly significant only in the case of vitiligo vulgaris and segmental vitiligo. On the basis of the difference in the sex-ratio and in the relative incidence of the subtypes of vitiligo vulgaris and segmental vitiligo, we feel that childhood vitiligo is a distinct subtype of vitiligo.     

Different phenotypes of segmental vitiligo based on a clinical observational study

Background Segmental vitiligo and generalized vitiligo are in general considered separate entities. However, clinico‐epidemiological data on segmental vitiligo are scarce compared with those of generalized vitiligo. Objective To analyse the clinical profile and distribution pattern of lesions in segmental vitiligo patients. Methods Segmental vitiligo patients were examined and questioned in a prospective and retrospective setting. The distribution and extent of the lesions were evaluated using clinical photographs. Results Different phenotypes of segmental vitiligo were found, including the unilateral segmental type (124 patients; group 1), the bilateral segmental type (three patients; group 2) and the mixed segmental and generalized type (14 patients; group 3). Furthermore, lesions were present with (10%) or without associated halo naevi. The age of onset of segmental vitiligo (median 14 years) was significantly different between the three subgroups (P = 0.028). Extensive involvement of segmental vitiligo lesions on trunk and extremities was significantly (P = 0.031) more observed in patients with a lower age of onset, while the generalized vitiligo lesions in the mixed vitiligo group were mostly very mild. Associated autoimmune diseases were reported in 11%, whereas a positive family history for vitiligo was present in 14.9% of patients. Lesions were not strictly dermatomal nor Blaschkolinear, although a typical recurring pattern could be observed. Conclusion Our data provide clinical evidence that segmental vitiligo and generalized vitiligo are parts of the same disease spectrum and that segmental vitiligo could have a polygenetic background as well. Whether different aetiopathological mechanisms underlie the different clinical phenotypes of segmental vitiligo remain to be elucidated.     

153例儿童白癜风临床分析

分析了１５３例儿童白癜风的临床资料。结果显示儿童白癜风发病年龄早，以５－７岁娄病高峰平均发病年龄６、７岁，伴晕痣患儿病情发展快。其中节段性白癜风占１７．６５％。其临床表现不同于非节段性白癜风。     

儿童白癜风临床及免疫学研究

目的 探讨儿童白癜风与免疫的关系.方法 采用统一设计的儿童白癜风临床特点调查表对本院门诊的14岁以下患儿及其家属进行调查.对270例患儿检测外周血免疫球蛋白、补体水平和T细胞亚群.结果 白癜风患儿620例中男302例(48.71%),女318例(51.29%),平均就诊年龄8.81岁,平均发病年龄7.57岁,平均病程8.14个月.累及头颈部453例,占73.06%.节段型160例,占25.81%.发病季节和疾病进展均以春夏季为多.73例患儿伴有晕痣,占11.77%,以散发型者居多.有家族史者84例,占13.55%.节段型患儿中,进展期的患儿血C3、c4水平明显低于稳定期患儿(P<0.05).寻常型患儿中,进展期的患儿血CD3+,CD4+细胞水平和CD4+/CD8+比值明显低于稳定期患儿(P<0.01).结论 白癜风患儿体内存在某些免疫指标的异常,可能与免疫紊乱有关.     

Vitiligo: clinical findings in 1436 patients.

We retrospectively analyzed the clinical and epidemiological profiles of patients with vitiligo attending the pigmentary dermatoses clinic. One thousand four hundred and thirty-six patients were seen between 1989 and 1993. Males constituted 54.5% of the group and females 45.5%. Mean age of the patients was 25 years, and average disease duration at the time of hospital visit was 3.7 years. Vitiligo vulgaris was the commonest form of the disease in 1002 (69.8%) patients followed by focal vitiligo in 214 (14.9%) and segmental vitiligo in 72 (5.0%). The sites of onset were the face, trunk, and legs in descending order of frequency. Less than 20% body area involvement was seen in 1356 (94.4%) of the patients. Leukotrichia was present in 165 (11.5%), and Koebner's phenomenon was observed in 72 (5.0%). Twenty nine (2.0%) patients had associated halo nevi. Of the various diseases associated with vitiligo, atopic/nummular eczema was seen in 20 (1.4%) patients, bronchial asthma in 10 (0.7%), diabetes mellitus in 8 (0.6%), thyroid disease in 7 (0.5%), and alopecia in 6 (0.4%). A family history of vitiligo was present in 165 (11.5%) patients.     

Childhood Vitiligo: Clinicoepidemiologic Profile of 268 Children from the Kumaun Region of Uttarakhand,India

Childhood vitiligo differs from adult vitiligo in many clinical parameters. The objective of the current study was to study the clinicoepidemiologic profile of childhood vitiligo and to compare various clinical characteristics of childhood‐ and later‐onset vitiligo. The clinical presentation of vitiligo was examined and analyzed in 762 individuals attending the Dermatology Clinic of Government Medical College, Haldwani, a referral center for the Kumaun region of Uttarakhand state, India, between January 2006 and December 2010. Of the 762 individuals with vitiligo, 268 (35.2%) were children: 152 (56.7%) female and 116 (43.3%) male. The mean age of onset of vitiligo was 6.9 years. A family history of vitiligo was found in 24.3% of children. The most common site of onset was the head and neck (36.9%), followed by the lower limbs and trunk. The most common type of vitiligo observed was acrofacial vitiligo (38.1%), followed by vulgaris, segmental, focal, and mucosal. Leukotrichia was observed in 32.5% of children and Koebner's phenomenon in 24.3%. On comparison of childhood‐ and later‐onset vitiligo, there were statistically significant differences (p < 0.05) in sex, family history, type of vitiligo (segmental and vulgaris), and site of onset. Atopic dermatitis was one of the important cutaneous diseases associated with childhood‐onset vitiligo. Thirty‐five percent of all patients with vitiligo were children (≤12 yrs). Childhood‐onset vitilgo differs from later‐onset vitiligo in many clinical parameters such as sex, family history, types of vitiligo, and sites of onset.     

不同治疗方法对晕痣疗效的影响因素分析

目的 探讨晕痣临床特征及疗效影响因素。方法 对2016年2 - 11月门诊晕痣患者临床资料进行前瞻性研究,分析影响晕痣疗效相关因素。结果 250例患者共293处皮损,单发219例（87.6%）,多发31例（12.4%）;皮损位于躯干部154处（52.6%）、面颈部127处（43.3%）,直径5 ~ 20 mm。248例（99.2%）晕痣在自然病程中未完全自发消退。122例（48.8%）患者伴发白癜风。单因素分析显示,年龄、皮损数目、伴发白癜风和治疗方法是晕痣疗效的影响因素,多因素logistic回归分析显示年龄 ≤ 19岁或 ≥ 40岁、病程 > 1年、皮损单发、不伴发白癜风、接受祛痣治疗是晕痣治疗有效的独立影响因素。结论 大部分晕痣不能完全自发性消退。CO2激光或手术祛痣联合外用药是治疗晕痣的有效方法,未伴发白癜风晕痣患者可优先祛痣,伴白癜风者可在白癜风稳定后祛痣。多发晕痣或白癜风面积较大者更易复发,应密切随访。     

Childhood Vitiligo in China

Background: Childhood vitiligo is a common pediatric skin disorder. The pathogenesis of vitiligo is unclear, and immunological dysfunction may play an important role. Objectives: This prospective study aimed to profile childhood vitiligo and to discuss its correlation with immunological dysfunction. Methods: All of the 620 enrolled patients were aged younger than 14 years, and were assessed with a standard questionnaire. The levels of immunoglobulins, complement, and T-lymphocyte subsets were measured in 270 of these 620 patients. Results: Of the 620 children, 302 (48.71%) were boys and 318 (51.29%) were girls, with an average disease onset age of 7.57 years. The average duration was 13.45 months. 453 (73.06%) children had head and neck involvement and 160 (25.81%) children had segmental vitiligo. 84 (13.55%) children had a family history. There was a correlation between the disease and seasons. The onset or progression usually occurred in summer and spring. Halo nevus was seen in both segmental and non-segmental vitiligo. Precipitating factors such as stress appeared more commonly in segmental vitiligo. As to the immunological findings, in segmental vitiligo, the levels of C3 and C4 were lower in the active relative to the quiescent stage (p < 0.05); and in non-segmental vitiligo, the percentages of CD3+ and CD4+ lymphocytes and the CD4+/CD8+ ratio were lower in the active relative to the quiescent stage (p < 0.01). Conclusions: Childhood vitiligo has its own clinical features. The different types of vitiligo have different characteristics. There is immunological dysfunction in children with vitiligo. Dysfunction of humoral immunity may play a role in the progression of segmental vitiligo, while non-segmental vitiligo is more related to cellular immunity.     

Vitiligo presentation in adults

The characteristics of vitiligo in 41 adults presenting to a university dermatology clinic in Sheffield, UK were studied in a case review. Of 41 patients, 29 women and 12 men, there were 37 European Caucasians, three Asian Caucasians and one black African. Symmetrical and acrofacial types of vitiligo predominated but there were no segmental cases. Age of onset was before 20 years in 17, with a mean of 28 years; the oldest onset was 74 years. The average duration of the disease was 16 years. Autoimmune thyroid disease was present in 14 cases (34%). Only seven (18%) gave a family history of vitiligo. A precipitating factor was identified in nine (22%), including pregnancy, sunburn and skin trauma. Topical steroid treatment was given in 33 and narrow-band ultraviolet B was prescribed in nine. This series is unusual in having no cases of segmental vitiligo, perhaps because no children are included, and in having a high prevalence of thyroid disease.     

Vitiligo in an Italian Outpatient Center

Background: Vitiligo is a depigmentation disorder resulting from destruction of cutaneous melanocytes that affects 0.1–2% of the world’s population, irrespective of sex and race. Objective: To investigate the clinical and immunopathologic characteristics of a series of Italian vitiligo patients. Methods: We examined clinical and immunopathologic data of 204 patients affected by vitiligo at a university-based dermatology outpatient hospital (second clinic) between January 1998 and March 2008. In particular, the clinical-epidemiologic characteristics of our patients, serologic parameters suggestive of immune/autoimmune activity (autoantibodies, immune complexes, complement, immunoglobulins), and the association between vitiligo and HLAs were investigated. Results: Upon comparison of our results with control and literature values, the following aspects appeared to be in complete agreement: the frequency of clinical subtypes of vitiligo, an earlier onset of segmental compared with non-segmental vitiligo, the association of familial vitiligo with other autoimmune diseases, the greater association of non-segmental vitiligo than segmental vitiligo with autoimmune diseases, and some features of pediatric vitiligo. Other data were partially consistent with the literature, such as the association between vitiligo and autoimmune diseases/autoantibody activities, and the association between vitiligo and HLAs. Finally, a portion of our data did not concur with the literature, including the sex distribution and mean age of onset, the lack of association between halo nevi and autoimmune diseases, and some aspects of pediatric vitiligo. Conclusions: This study provides novel information regarding clinical features and serologic parameters in different subgroups of vitiligo, namely a significant association between active vitiligo and autoantibody activities, and significant clinical differences (i.e. activity of disease, age of onset, and coexistence of other autoimmune diseases) between vitiligo associated with autoantibodies and vitiligo negative for autoantibodies.     

Childhood Vitiligo: A Long‐term Study of Localized Vitiligo Treated by Noncultured Cellular Grafting

Abstract: Segmental type was the second most commonly reported in childhood vitiligo. No significant difference has been reported in the prevalence of childhood and adult focal vitiligo. However, the prevalence of segmental vitiligo has been found to be higher in children compared with that in adults. All available medical and phototherapy options are limited by adverse effects or unsatisfactory efficacy. Surgical techniques may be preferred but are not recommended for children as they are time consuming and associated with technical difficulties. In a retrospective review, 25 children aged 4 to 16 years were treated by autologous, noncultured cellular grafting performed under sedation supplemented with local anaesthesia and were followed up for a period of 9 to 54 months postgrafting. Repigmentation was graded as excellent with 95% to 100% pigmentation, good with 65% to 94%, fair with 25% to 64%, and poor with 0% to 24% of the treated area. In the segmental group, eight (62%) showed excellent, two (15%) good, one (8%) fair, and two (15%) poor pigmentation, which was retained until the end of the respective follow‐up period. In the focal group, nine (75%) showed excellent, and one (8%) each showed good, fair, and poor pigmentation, which was retained until the end of the respective follow‐up period. Noncultured cellular grafting may be considered to treat childhood localized vitiligo.     

Prognostic value and clinical significance of halo naevi regarding vitiligo

Background Vitiligo and halo naevi can present together or separately. Whether they are different entities remains unclear. Objectives To assess the clinical significance of halo naevi, both with respect to the future development of vitiligo, and to the clinical profile and course of vitiligo. Methods In total, 291 patients were included in this study: patients with only halo naevi (group 1; n = 40), patients with generalized vitiligo without halo naevi (group 2; n = 173) and patients with generalized vitiligo with halo naevi (group 3; n = 78). Results Patients with only halo naevi (group 1) reported significantly less associated autoimmune disease (P = 0·001), were less likely to have a family history of vitiligo (P = 0·013) and were less likely to have presence of Koebner phenomenon (P < 0·001) compared with patients with generalized vitiligo (groups 2 + 3). Multiple halo naevi (≥ 3) were significantly more frequently observed (P = 0·002) in patients from group 1 compared with patients from group 3. In group 3, halo naevi were reported prior to the development of vitiligo in 61% (mean ± SD time interval of 33·7 ± 5·17 months). No significant correlation was observed between the presence of halo naevi and the extent, activity or subtype of vitiligo. However, halo naevi in patients with vitiligo significantly reduced the risk for associated autoimmune diseases, and age at onset of vitiligo was significantly lower compared with patients with vitiligo without halo naevi (P < 0·001). Conclusions Our results support the hypothesis that halo naevi can represent a distinct condition. In a subset of patients, the occurrence of halo naevi may be an initiating factor in the pathogenesis of vitiligo.     

Topical tacrolimus for treatment of childhood vitiligo in Asians

Childhood vitiligo is a common disorder of pigmentation in India. Considering the lack of uniformly effective and safe treatment modalities for children with vitiligo, search for newer therapeutic agents continues. This study was designed to evaluate the role of topical tacrolimus in the treatment of childhood vitiligo. Twenty-five children with vitiligo were treated with topical 0.03% tacrolimus ointment applied twice daily for 12 weeks. Response was noted as marked to complete (> 75% repigmentation), moderate (50-75% repigmentation) and mild (< 50% repigmentation). Twenty-two children (9 boys and 13 girls) of mean age 7.2 +/- 1.4 years completed the study. Twelve (54.5%) children had vitiligo vulgaris, nine (40.9%) had focal vitiligo and one (4.5%) had segmental vitiligo. The mean duration of disease was 8 +/- 3 months. Nineteen (86.4%) children showed some repigmentation at the end of 3 months and other three had no response. Of these 19 children, repigmentation was marked to complete in 11 (57.9%), moderate in five (26.3%) and mild in three (15.7%) children. Side effects were minimal, such as the pruritus and burning noted in only three patients. Topical tacrolimus is an effective and well-tolerated treatment modality in Asian children with vitiligo.     

Vitiligo Occurring after Halo Formation around Congenital Melanocytic Nevi

Abstract: We present two cases wherein vitiligo developed after the onset of halo formation involving congenital melanocytic nevi to emphasize the possibility of this finding as a potential albeit unusual presentation of vitiligo.