Advertisement

Pediatric Drugs

, Volume 17, Issue 4, pp 303–313 | Cite as

Current Management of Pediatric Vitiligo

  • Freya Van Driessche
  • Nanette Silverberg
Review Article

Abstract

Vitiligo is a common inflammatory disorder with worldwide prevalence of 0.4–2 % of the population, with half of cases beginning in childhood. The management of childhood vitiligo should be tailored to avoid negative effects on the overall growth and psychological development of the patient. Therapy of vitiligo in childhood is chosen based on the location of the lesions, lesion age, and extent of lesions in the context of the child’s age and the developmental status of the child. There are four age categories in childhood vitiligo: [1] infantile and toddler (rare) (ages 0–3 years), [2] ages 4–8 years, [3] ages 9–12 years, and [4] 13+ years of age, based on developmental stage, psychological maturation, and ability to comply or participate in therapy. These categories are also differentiated psychologically by susceptibility to bullying, self-image development, and personal concern with lesion appearance, which increases with time. Intervention is advisable in cases with facial and leg involvement due to prominence of lesions and cosmetic defect. Medical interventions are largely the usage of topical therapies including corticosteroids and calcineurin inhibitors, some vitamin therapy (oral and topical vitamin D), and judicious introduction of phototherapy sources based on age and severity. Screening and appropriate subspecialist referral for co-morbidities (e.g., thyroid disease, celiac disease, psychological distress, and vitamin D deficiency) may enhance overall health. Cosmesis and camouflage are generally safe in childhood and have been noted to improve overall quality of life in this grouping. Genetic transmission of vitiligo is minimal at 5–6 % in first-degree relatives. This article reviews the therapeutics of pediatric vitiligo from the perspective of developmental stages and response to therapy.

Keywords

Atopic Dermatitis Topical Corticosteroid Vitiligo Pimecrolimus Mometasone Furoate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with ethical standards

The authors have received no funding in the development of this work. Freya Van Driessche has no conflicts of interest in the development of this work. Nanette Silverberg is or has been a consultant, monitor, or investigator for Astellas Pharmaceuticals, Galderma Pharmaceuticals, Novartis Pharmaceuticals and Leo Paharmaceuticals, makers of medications reviewed in the manuscript.

References

  1. 1.
    Spritz RA. Shared genetic relationships underlying generalized vitiligo and autoimmune thyroid disease. Thyroid. 2010;20:745–54.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Halder RM, Grimes PE, Cowan CA, Enterline JA, Chakrabarti SG, Kenney JA Jr. Childhood vitiligo. J Am Acad of Dermatol. 1987;16(5 Pt 1):948–54.CrossRefGoogle Scholar
  3. 3.
    Silverberg NB. The Epidemiology of vitiligo. Curr Derm Rep. 2015;4:36–43.CrossRefGoogle Scholar
  4. 4.
    Silverberg JI, Silverberg NB. Quality of life impairment in children and adolescents with vitiligo. Pediatr Dermatol. 2014;31:309–18.PubMedCrossRefGoogle Scholar
  5. 5.
    Taieb A, Alomar A, Böhm M, Dell’anna ML, De Pase A, Eleftheriadou V, Ezzedine K, Gauthier Y, Gawkrodger DJ, Jouary T, Leone G, Moretti S, Nieuweboer-Krobotova L, Olsson MJ, Parsad D, Passeron T, Tanew A, van der Veen W, van Geel N, Whitton M, Wolkerstorfer A, Picardo M, VitiligoEuropean Task Force (VETF), European Academy of Dermatology and Venereology (EADV), Union Europe´enne des Me´decins Spe´cialistes (UEMS). Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol. 2013;168(1):5–19.PubMedCrossRefGoogle Scholar
  6. 6.
    Gawkrodger DJ, Ormerod AD, Shaw L, Mauri-Sole I, Whitton ME, Watts MJ, Anstey AV, Ingham J, Young K, Therapy Guidelines and Audit Subcommittee, British Association of Dermatologists, Clinical Standards Department, Royal College of Physicians of London, Cochrane Skin Group, Vitiligo Society. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. 2008;159(5):1051–76.PubMedCrossRefGoogle Scholar
  7. 7.
    Whitton ME, Ashcroft DM, González U. Therapeutic interventions for vitiligo. J Am Acad Dermatol. 2008;59(4):713–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Meredith F, Abbott R. Vitiligo: an evidence-based update. Report of the 13th Evidence Based Update Meeting, 23 May 2013, Loughborough, UK. Br J Dermatol. 2014;170(3):565–70.PubMedCrossRefGoogle Scholar
  9. 9.
    Oiso N, Suzuki T, Wataya-Kaneda M, Tanemura A, Tanioka M, Fujimoto T, Fukai K, Kawakami T, Tsukamoto K, Yamaguchi Y, Sano S, Mitsuhashi Y, Nishigori C, Morita A, Nakagawa H, Mizoguchi M, Katayama I. Guidelines for the diagnosis and treatment of vitiligo in Japan. J Dermatol. 2013;40(5):344–54.PubMedCrossRefGoogle Scholar
  10. 10.
    Lotti T, D’Erme AM. Vitiligo as a systemic disease. Clin Dermatol. 2014;32(3):430–4.Google Scholar
  11. 11.
    Pietrzak A, Bartosińska J, Hercogová J, Lotti TM, Chodorowska G. Metabolic syndrome in vitiligo. Dermatol Ther. 2012;25(Suppl 1):S41–3.Google Scholar
  12. 12.
    Taïeb A. Vitiligo as an inflammatory skin disorder: a therapeutic perspective. Pigment Cell Melanoma Res. 2012;25(1):9–13.PubMedCrossRefGoogle Scholar
  13. 13.
    Silverberg NB. Pediatric vitiligo. Pediatr Clin N Am. 2014;61:347–66.CrossRefGoogle Scholar
  14. 14.
    Silverberg NB. Recent advances in childhood vitiligo. Clin Dermatol. 2014;32:524–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Ezzedine K, Lim HW, Suzuki T, Katayama I, Hamzavi I, Lan CC, et al. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigm Cell Melanoma Res. 2012;25:E1–13.CrossRefGoogle Scholar
  16. 16.
    Kakourou T, Kanaka-Gantenbein C, Papadopoulou A, Kaloumenou E, Chrousos GP. Increased prevalence of chronic autoimmune (Hashimoto’s) thyroiditis in children and adolescents with vitiligo. J Am Acad Dermatol. 2005;53(2):220–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Pagovich OE, Silverberg JI, Freilich E, Silverberg NB. Thyroid abnormalities in pediatric patients with vitiligo in New York City. Cutis. 2008;81(6):463–6.PubMedGoogle Scholar
  18. 18.
    Afsar FS, Isleten F. Prevalence of thyroid function test abnormalities and thyroid autoantibodies in children with vitiligo. Indian J Endocrinol Metab. 2013;17(6):1096–9.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Gey A, Diallo A, Seneschal J, Léauté-Labrèze C, Boralevi F, Jouary T, Taieb A, Ezzedine K. Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms. Br J Dermatol. 2013;168(4):756–61.PubMedCrossRefGoogle Scholar
  20. 20.
    Silverberg JI, Silverberg AI, Malka E, Silverberg NB. A pilot study assessing the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris. J Am Acad Dermatol. 2010;62(6):937–41.PubMedCrossRefGoogle Scholar
  21. 21.
    Ertekin V, Selimoglu MA, Altinkaynak S. Celiac disease in childhood: evaluation of 140 patients. Eurasian J Med. 2009;41(3):154–7.PubMedCentralPubMedGoogle Scholar
  22. 22.
    Yang Y, Huang G, Yan X, Qing Z. Clinical analysis of thyroglobulin antibody and thyroid peroxidase antibody and their association with vitiligo. Indian J Dermatol. 2014;59(4):357–60. doi: 10.4103/0019-5154.135485.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Linthorst Homan MW, de Korte J, Grootenhuis MA, Bos JD, Sprangers MA, van der Veen JP. Impact of childhood vitiligo on adult life. Br J Dermatol. 2008;159:915–20. 8.Google Scholar
  24. 24.
    Ongenae K, Van Geel N, De Schepper S, Vander Haeghen Y, Naeyaert JM. Management of vitiligo patients and attitude of dermatologists towards vitiligo. Eur J Dermatol. 2004;14:177–81.Google Scholar
  25. 25.
    Park JH, Park SW, Lee DY, Lee JH, Yang JM. The effectiveness of early treatment in segmental vitiligo: retrospective study according to disease duration. Photodermatol Photoimmunol Photomed. 2013;29:103–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Cockayne SE, Messenger AG, Gawkrodger DJ. Vitiligo treated with topical corticosteroids: children with head and neck involvement respond well. J Am Acad Dermatol. 2002;46:964–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Alkhateeb A, Fain PR, Thody A, Bennett DC, Spritz RA. Epidemiology of vitiligo and associated autoimmune diseases in Caucasian probands and their families. Pigment Cell Res. 2003;16(3):208–14.PubMedCrossRefGoogle Scholar
  28. 28.
    Silverberg NB, Travis L. Childhood vitiligo. Cutis. 2006;77:370–5.PubMedGoogle Scholar
  29. 29.
    Silverberg NB, Lin P, Travis L, Farley-Li J, Mancini AJ, Wagner AM, et al. Tacrolimus ointment promotes repigmentation of vitiligo in children: a review of 57 cases. J Am Acad Dermatol. 2004;51:760–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Park JH, Park SW, Lee DY, Lee JH, Yang JM. The effectiveness of early treatment in segmental vitiligo: retrospective study according to disease duration. Photodermatol Photoimmunol Photomed. 2013;29(2):103–5.PubMedCrossRefGoogle Scholar
  31. 31.
    West DP, Worobec S, Solomon LM. Pharmacology and toxicology of infant skin. J Invest Dermatol. 1981;76:147–50.Google Scholar
  32. 32.
    Isenstein AL, Morrell DS, Burkhart CN. Vitiligo: treatment approach in children. Ped Annals. 2009;38:339–44.CrossRefGoogle Scholar
  33. 33.
    Kwinter J, Pelletier J, Khambalia A, Pope E. High-potency steroid use in children with vitiligo: a retrospective study. J Am Acad Dermatol. 2007;56:236–41.PubMedCrossRefGoogle Scholar
  34. 34.
    Ho N, Pope E, Weinstein M, Greenberg S, Webster C, Krafchik BR. A double-blind, randomized, placebo-controlled trial of topical tacrolimus 0.1 % vs. clobetasol propionate 0.05 % in childhood vitiligo. Br J Dermatol. 2011;165:626–32.Google Scholar
  35. 35.
    Lepe V, Moncada B, Castanedo-Cazares JP, Torres-Alvarez MB, Ortiz CA, Torres-Rubalcava AB. A double-blind randomized trial of 0.1 % tacrolimus vs 0.05 % clobetasol for the treatment of childhood vitiligo. Arch Dermatol. 2003;139:581–5.Google Scholar
  36. 36.
    Coskun B, Saral Y, Turgut D. Topical 0.05 % clobetasol propionate versus 1 % pimecrolimus ointment in vitiligo. Eur J Dermatol. 2005;15:88–91.Google Scholar
  37. 37.
    Yaghoobi R, Omidian M, Bagherani N. Original article title: “Comparison of therapeutic efficacy of topical corticosteroid and oral zinc sulfate-topical corticosteroid combination in the treatment of vitiligo patients: a clinical trial”. BMC Dermatol. 2011;11:7.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Kojima R, Fujiwara T, Matsuda A, Narita M, Matsubara O, Nonoyama S, et al. Factors associated with steroid phobia in caregivers of children with atopic dermatitis. Pediatr dermatol. 2013;30:29–35.PubMedCrossRefGoogle Scholar
  39. 39.
    Ghosh A, Sengupta S, Coondoo A, Jana AK. Topical corticosteroid addiction and phobia. Ind J dermatol. 2014;59:465–8.CrossRefGoogle Scholar
  40. 40.
    Juan D, Qianxi X, Zhou C, Jianzhong Z. Clinical efficacy and safety of tacrolimus ointment in patients with vitiligo. J Dermatol. 2011;38:1092–4.PubMedCrossRefGoogle Scholar
  41. 41.
    Udompataikul M, Boonsupthip P, Siriwattanagate R. Effectiveness of 0.1 % topical tacrolimus in adult and children patients with vitiligo. J Dermatol. 2011;38:536–40.PubMedCrossRefGoogle Scholar
  42. 42.
    Travis LB, Weinberg JM, Silverberg NB. Successful treatment of vitiligo with 0.1 % tacrolimus ointment. Arch Dermatol. 2003;139:571–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Silverberg NB, Lin P, Travis L, Farley-Li J, Mancini AJ, Wagner AM, et al. Tacrolimus ointment promotes repigmentation of vitiligo in children: a review of 57 cases. J Am Acad Dermatol. 2004;51:760–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Silverberg JI, Silverberg NB. Topical tacrolimus is more effective for treatment of vitiligo in patients of skin of color. J Drug Dermatol. 2011;10:507–10.Google Scholar
  45. 45.
    Mikhail M, Wolchok J, Goldberg SM, Dunkel IJ, Roses DF, Silverberg NB. Rapid enlargement of a malignant melanoma in a child with vitiligo vulgaris after application of topical tacrolimus. Arch Dermatol. 2008;144:560–1.PubMedGoogle Scholar
  46. 46.
    Harper J, Smith C, Rubins A, Green A, Jackson K, Zigure S, et al. A multicenter study of the pharmacokinetics of tacrolimus ointment after first and repeated application to children with atopic dermatitis. J Invest Dermatol. 2005;124:695–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Patel RR, Vander Straten MR, Korman NJ. The safety and efficacy of tacrolimus therapy in patients younger than 2 years with atopic dermatitis. Arch Dermatol. 2003;139:1184–6.PubMedCrossRefGoogle Scholar
  48. 48.
    Eichenfield LF, Thaci D, de Prost Y, Puig L, Paul C. Clinical management of atopic eczema with pimecrolimus cream 1 % (Elidel) in paediatric patients. Dermatol. 2007;215(Suppl 1):3–17.CrossRefGoogle Scholar
  49. 49.
    Radakovic S, Breier-Maly J, Konschitzky R, Kittler H, Sator P, Hoenigsmann H, et al. Response of vitiligo to once- vs. twice-daily topical tacrolimus: a controlled prospective, randomized, observer-blinded trial. JEADV. 2009;23:951–3.Google Scholar
  50. 50.
    Farajzadeh S, Daraei Z, Esfandiarpour I, Hosseini SH. The efficacy of pimecrolimus 1 % cream combined with microdermabrasion in the treatment of nonsegmental childhood vitiligo: a randomized placebo-controlled study. Pediatr Dermatol. 2009;26:286–91.PubMedCrossRefGoogle Scholar
  51. 51.
    Berti S, Buggiani G, Lotti T. Use of tacrolimus ointment in vitiligo alone or in combination therapy. Skin Ther Lett. 2009;14:5–7.Google Scholar
  52. 52.
    Esfandiarpour I, Ekhlasi A, Farajzadeh S, Shamsadini S. The efficacy of pimecrolimus 1 % cream plus narrow-band ultraviolet B in the treatment of vitiligo: a double-blind, placebo-controlled clinical trial. J Dermatol Treat. 2009;20:14–8.CrossRefGoogle Scholar
  53. 53.
    Margolis DJ, Abuabara K, Hoffstad OJ, Wan J, Raimondo D, Bilker WB. Association between malignancy and topical use of pimecrolimus. JAMA Dermatol. 2015. doi: 10.1001/jamadermatol.2014.4305.
  54. 54.
    Siegfried EC, Jaworski JC, Hebert AA. Topical calcineurin inhibitors and lymphoma risk: evidence update with implications for daily practice. Am J Clin Dermatol. 2013;14:163–78.PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Xing C, Xu A. The effect of combined calcipotriol and betamethasone dipropionate ointment in the treatment of vitiligo: an open, uncontrolled trial. J Drugs Dermatol JDD. 2012;11:e52–4.PubMedGoogle Scholar
  56. 56.
    Newman MD, Silverberg NB. Once-daily application of calcipotriene 0.005 %-betamethasone dipropionate 0.064 % ointment for repigmentation of facial vitiligo. Cutis. 2011;88:256–9.PubMedGoogle Scholar
  57. 57.
    Travis LB, Silverberg NB. Calcipotriene and corticosteroid combination therapy for vitiligo. Pediatr Dermatol. 2004;21:495–8.PubMedCrossRefGoogle Scholar
  58. 58.
    De-Regil LM, Palacios C, Ansary A, Kulier R, Pena-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochr Rev. 2012;2:CD008873.Google Scholar
  59. 59.
    Weisberg P, Scanlon KS, Li R, Cogswell ME. Vitamin D dose requirements for fracture prevention. Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003. Am J Clin Nutr. 2004;80(6 Suppl):1697S–705S.Google Scholar
  60. 60.
    Rosen CJ, Mayne ST. IOM Committee on dietary reference intakes for vitamin D and calcium. N Engl J Med. 2012;367(14):1368.PubMedGoogle Scholar
  61. 61.
  62. 62.
    Finamor DC, Sinigaglia-Coimbra R, Neves LC, Gutierrez M, Silva JJ, Torres LD, Surano F, Neto DJ, Novo NF, Juliano Y, Lopes AC, Coimbra CG. A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis. Dermatoendocrinol. 2013;5(1):222–34. doi: 10.4161/derm.24808.
  63. 63.
    Kim SM, Kim YK, Hann SK. Serum levels of folic acid and vitamin B12 in Korean patients with vitiligo. Yonsei Med J. 1999;40(3):195–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Park HH, Lee MH. Serum levels of vitamin B12 and folate in Korean patients with vitiligo. Acta Derm Venereol. 2005;85(1):66–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Hovdenak N, Haram K. Influence of mineral and vitamin supplements on pregnancy outcome. Eur J Obstet Gynecol Reprod Biol. 2012;164:127–32.PubMedCrossRefGoogle Scholar
  66. 66.
    Gadgil MS, Joshi KS, Naik SS, Pandit AN, Otiv SR, Patwardhan BK. Association of homocysteine with global DNA methylation in vegetarian Indian pregnant women and neonatal birth anthropometrics. J Mat Fetal Neon Med. 2014;27(17):1749–53.CrossRefGoogle Scholar
  67. 67.
  68. 68.
    Szczurko O, Shear N, Taddio A, Boon H. Ginkgo biloba for the treatment of vitilgo vulgaris: an open label pilot clinical trial. BMC Comp Alt Med. 2011;11:21.CrossRefGoogle Scholar
  69. 69.
    Esposito M, Carotenuto M. Ginkgolide B complex efficacy for brief prophylaxis of migraine in school-aged children: an open-label study. Neurol Sci. 2011;32:79–81.PubMedCrossRefGoogle Scholar
  70. 70.
    Dugoua JJ, Mills E, Perri D, Koren G. Safety and efficacy of ginkgo (Ginkgo biloba) during pregnancy and lactation. Can J Pharmacol. 2006;13:e277–84.Google Scholar
  71. 71.
    Zehra U, Tahir M, Lone KP. Ginkgo biloba induced malformations in mice. J CollPhys Surg-Pak. 2010;20:117–21.Google Scholar
  72. 72.
    Ramien ML, Ondrejchak S, Gendron R, Hatami A, McCuaig CC, Powell J, et al. Quality of life in pediatric patients before and after cosmetic camouflage of visible skin conditions. J Amer Acad Dermatol 2014;71(5):935–40.CrossRefGoogle Scholar
  73. 73.
    Hsu S. Camouflaging vitiligo with dihydroxyacetone. Dermatol Online J. 2008;14:23.PubMedGoogle Scholar
  74. 74.
    Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol. 2014;70(401):e1–14.Google Scholar
  75. 75.
    Veith W, Deleo V, Silverberg N. Medical phototherapy in childhood skin diseases. Minerva Pediatr. 2011;63(4):327–33.PubMedGoogle Scholar
  76. 76.
    Yoshida A, Takagi A, Ikejima A, Takenaka H, Fukai T, Ikeda S. A retrospective study of 231 Japanese vitiligo patients with special reference to phototherapy. Acta Dermatovenerol Croat. 2014;22(1):13–8.Google Scholar
  77. 77.
    Njoo MD, Bos JD, Westerhof W. Treatment of generalized vitiligo in children with narrow-band (TL-01) UVB radiation therapy. J Am Acad Dermatol. 2000;42(2 Pt 1):245–53.PubMedCrossRefGoogle Scholar
  78. 78.
    Kanwar AJ, Dogra S. Narrow-band UVB for the treatment of generalized vitiligo in children. Clin Exper Dermatol. 2005;30:332–6.CrossRefGoogle Scholar
  79. 79.
    Tamesis ME, Morelli JG. Vitiligo treatment in childhood: a state of the art review. Pediatr Dermatol. 2010;27:437–45.PubMedCrossRefGoogle Scholar
  80. 80.
    Cho S, Zheng Z, Park YK, Roh MR. The 308-nm excimer laser: a promising device for the treatment of childhood vitiligo. Photodermatol Photoimmunol Photomed. 2011;27:24–9.PubMedCrossRefGoogle Scholar
  81. 81.
    Yoshida A, Takagi A, Ikejima A, Takenaka H, Fukai T, Ikeda S. A retrospective study of 231 Japanese vitiligo patients with special reference to phototherapy. Acta Dermatovenerol Croat. 2014;22(1):13–8.PubMedGoogle Scholar
  82. 82.
    Paradisi A, Tabolli S, Didona B, Sobrino L, Russo N, Abeni D. Markedly reduced incidence of melanoma and nonmelanoma skin cancer in a nonconcurrent cohort of 10,040 patients with vitiligo. J Am Acad Dermatol. 2014;71(6):1110–6.PubMedCrossRefGoogle Scholar
  83. 83.
    Park KK, Liao W, Murase JE. A review of monochromatic excimer light in vitiligo. BrJ Dermatol. 2012;167:468–78.CrossRefGoogle Scholar
  84. 84.
    Lim HW, Grimes PE, Agbai O, Hamzavi I, Henderson M, Haddican M, et al. Afamelanotide and narrowband UV-B phototherapy for the treatment of vitiligo: A Randomized Multicenter Trial. JAMA Dermatol. 2015;151(1):42–50.PubMedCrossRefGoogle Scholar
  85. 85.
    Hui-Lan Y, Xiao-Yan H, Jian-Yong F, Zong-Rong L. Combination of 308-nm excimer laser with topical pimecrolimus for the treatment of childhood vitiligo. Pediatr Dermatol. 2009;26(3):354–6.Google Scholar
  86. 86.
    Patel N, O’Haver J, Hansen RC. Vitiligo therapy in children: a case for considering excimer laser treatment. Clin Pediatr (Phila). 2010;49(9):823–9.PubMedCrossRefGoogle Scholar
  87. 87.
    Grau C, Silverberg NB. Vitiligo patients seeking depigmentation therapy: a case report and guidelines for psychological screening. Cutis. 2013;91:248–52.PubMedGoogle Scholar
  88. 88.
    Linthorst Homan MW, Spuls PI, Nieuweboer-Krobotova L, de Korte J, Sprangers MA, Bos JD, Wolkerstorfer A, van der Veen JP. A randomized comparison of excimer laser versus narrow-band ultraviolet B phototherapy after punch grafting in stable vitiligo patients. J Eur Acad Dermatol Venereol. 2012;26(6):690–5.PubMedCrossRefGoogle Scholar
  89. 89.
    Yao L, Li SS, Zhong SX, Song Y, Hu DN, Guo JW. Successful treatment of vitiligo on the axilla in a 5-years-old child by cultured-melanocytetransplantation. J Eur Acad Dermatol Venereol. 2012;26(5):658–60.PubMedCrossRefGoogle Scholar
  90. 90.
    Zhang DM, Hong WS, Fu LF, Wei XD, Xu AE. A randomized controlled study of the effects of different modalities of narrow-band ultraviolet B therapy on the outcome of cultured autologous melanocytes transplantation in treating vitiligo. Dermatol Surg. 2014;40(4):420–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.University of Miami Miller School of MedicineMiamiUSA
  2. 2.Pediatric DermatologyMt. Sinai St. Luke’s-Roosevelt Hospital Center and Beth Israel Medical CenterNew YorkUSA

Personalised recommendations