Vitiligo pp 141-151 | Cite as

Age and Vitiligo: Childhood, Pregnancy and Late-Onset Vitiligo

  • Steven ThngEmail author
  • Sai Yee Chuah
  • Emily Yiping Gan


Vitiligo usually begins in childhood or in young adults with some studies recording around half of patients with disease onset before the age of 20 years old. Childhood vitiligo tends to present more with segmental vitiligo and is associated with higher incidences of thyroid dysfunction as well as family history of autoimmune disease, significant psychological morbidity and quality of life (QOL) impairment in the patient and in the parent. Prepubertal onset of vitiligo associates with atopic dermatitis, halo naevi, family history of vitiligo and premature hair greying. When treating children with vitiligo, special considerations would include the need to coordinate treatments with school schedules and the significant psychosocial impact of the disease on children especially if they have visible lesions. Patients with vitiligo have possibly a higher incidence of worsening during pregnancy and 6 months’ post-partum. Treatment of vitiligo during pregnancy is largely influenced by how treatment may affect the foetus in utero, and treatment has to be balanced with possible adverse effects to foetus in utero. Late-onset vitiligo is an interesting subgroup of patients with vitiligo, and its prevalence ranges from 6.8% in Northern India to 14.7% in Singapore; they seem to progress faster than childhood vitiligo, and the disease progression is significantly associated with a stressful event.


  1. 1.
    Halder RM, Chappell JL. Vitiligo update. Semin Cutan Med Surg. 2009;28:86–92.CrossRefGoogle Scholar
  2. 2.
    Lerner AB. Vitiligo. J Invest Dermatol. 1959;32:285–310.CrossRefGoogle Scholar
  3. 3.
    Krüger C, Schallreuter KU. A review of the worldwide prevalence of vitiligo in children/adolescents and adults. Int J Dermatol. 2012;51:1206–12.CrossRefGoogle Scholar
  4. 4.
    Howitz J, Brodthagen H, Schwartz M, Thomsen K. Prevalence of vitiligo: epidemiological survey on the isle of Bornholm, Denmark. Arch Dermatol. 1977;113:47–52.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Halder RM, Grimes PE, Cowan CA, Enterline JA, Chakrabarti SG, Kenney JA. Childhood vitiligo. J Am Acad Dermatol. 1987;16:948–54.CrossRefGoogle Scholar
  6. 6.
    Handa S, Dogra S. Epidemiology of childhood vitiligo: a study of 625 patients from North India. Pediatr Dermatol. 2003;20:207–10.CrossRefGoogle Scholar
  7. 7.
    Jain DK, Bhargava P, Mathur DK, Agarwal US, Bhargava R. Congenital familial acral vitiligo. Indian J Dermatol Venereol Leprol. 1997;63:193.PubMedGoogle Scholar
  8. 8.
    Kambhampati BN, Sawatkar GU, Kumaran MS, Parsad D. Congenital vitiligo: a case report. J Cutan Med Surg. 2016;20:354.CrossRefGoogle Scholar
  9. 9.
    Al-Mutairi N, Sharma AK, Al-Sheltawy M, Nour-Eldin O. Childhood vitiligo: a prospective hospital-based study. Australas J Dermatol. 2005;46:150–3.CrossRefGoogle Scholar
  10. 10.
    Jaisankar TJ, Baruah MC, Garg BR. Vitiligo in children. Int J Dermatol. 1992;31:621–3.CrossRefGoogle Scholar
  11. 11.
    Kayal A, Gupta LK, Khare AK, Mehta S, Mittal A, Kuldeep CM. Pattern of childhood onset vitiligo at a tertiary care centre in south-west Rajasthan. Indian J Dermatol. 2015;60:520–6.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Marinho FS, Cirino PV, Fernandes NC. Clinical epidemiological profile of vitiligo in children and adolescents. An Bras Dermatol. 2013;88:1026–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Pajvani U, Ahmad N, Wiley A, Levy RM, Kundu R, Mancini AJ, Chamlin S, Wagner A, Paller AS. The relationship between family medical history and childhood vitiligo. J Am Acad Dermatol. 2006;55:238–44.CrossRefGoogle Scholar
  14. 14.
    Hu Z, Liu JB, Ma SS, Yang S, Zhang XJ. Profile of childhood vitiligo in China: an analysis of 541 patients. Pediatr Dermatol. 2006;23:114–6.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Lin X, Tang LY, Fu WW, Kang KF. Childhood vitiligo in China: clinical profiles and immunological findings in 620 cases. Am J Clin Dermatol. 2011;12:277–81.CrossRefGoogle Scholar
  16. 16.
    de Barros JC, Machado Filho CD, Abreu LC, de Barros JA, Paschoal FM, Nomura MT, Marques E, Martins LC. A study of clinical profiles of vitiligo in different ages: an analysis of 669 outpatients. Int J Dermatol. 2014;53:842–8.CrossRefGoogle Scholar
  17. 17.
    Mazereeuw-Hautier J, Bezio S, Mahe E, Bodemer C, Eschard C, Viseux V, Labreze C, Plantin P, Barbarot S, Vabres P, Martin L, Paul C, Lacour JP, on behalf of the Groupe de Recherche Clinique en Dermatologie Pédiatrique (GRCDP). Segmental and nonsegmental childhood vitiligo has distinct clinical characteristics: a prospective observational study. J Am Acad Dermatol. 2010;62:945–9.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ezzedine K, Diallo A, Léauté-Labrèze C, Seneschal J, Boniface K, Cario-André M, Prey S, Ballanger F, Boralevi F, Jouary T, Mossalayi D, Taïeb A. Pre- vs. post-pubertal onset of vitiligo: multivariate analysis indicates atopic diathesis association in pre-pubertal onset vitiligo. Br J Dermatol. 2012;167:490–5.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Nicolaidou E, Antoniou C, Miniati A, Lagogianni E, Matekovits A, Stratigos A, Katsambas A. Childhood- and later-onset vitiligo have diverse epidemiologic and clinical characteristics. J Am Acad Dermatol. 2012;66:954–8.CrossRefGoogle Scholar
  20. 20.
    Mu EW, Cohen BE, Orlow SJ. Early-onset childhood vitiligo is associated with a more extensive and progressive course. J Am Acad Dermatol. 2015;73:467–70.CrossRefGoogle Scholar
  21. 21.
    Ezzedine K, Diallo A, Léauté-Labrèze C, Seneschal J, Mossalayi D, AlGhamdi K, Prey S, Boutchnei S, Cario-André M, Boralevi F, Jouary T, Taïeb A. Halo nevi association in nonsegmental vitiligo affects age at onset and depigmentation pattern. Arch Dermatol. 2012;148:497–502.CrossRefGoogle Scholar
  22. 22.
    Cohen BE, Mu EW, Orlow SJ. Comparison of childhood vitiligo presenting with or without associated halo nevi. Pediatr Dermatol. 2016;33:44–8.CrossRefGoogle Scholar
  23. 23.
    Gan EY, Gahat T, Cario-André M, Seneschal J, Ezzedine K, Taïeb A. Clinical repigmentation patterns in paediatric vitiligo. Br J Dermatol. 2016;175:555. Scholar
  24. 24.
    Prcic S, Djuran V, Mikov A, Mikov I. Vitiligo in children. Pediatr Dermatol. 2007;24:666.CrossRefGoogle Scholar
  25. 25.
    Gey A, Diallo A, Seneschal J, Léauté-Labrèze C, Boralevi F, Jouary T, Taïeb A, Ezzedine K. Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms. Br J Dermatol. 2013;168:756–61.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Vrijman C, Kroon MW, Limpens J, Leeflang MMG, Luiten RM, van der Veen JPW, Wolkerstorfer A, Spuls PI. The prevalence of thyroid disease in patients with vitiligo: a systematic review. Br J Dermatol. 2012;167:1224–35.CrossRefGoogle Scholar
  27. 27.
    Iacovelli P, Sinagra JL, Vidolin AP, Marenda S, Capitanio B, Leone G, Picardo M. Relevance of thyroiditis and of other autoimmune diseases in children with vitiligo. Dermatology. 2005;210:26–30.CrossRefGoogle Scholar
  28. 28.
    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;53:220–3.CrossRefGoogle Scholar
  29. 29.
    Cho SB, Kim JH, Cho S, Park JM, Park YK, Oh SH. Vitiligo in children and adolescents: association with thyroid dysfunction. J Eur Acad Dermatol Venereol. 2011;25:64–7.CrossRefGoogle Scholar
  30. 30.
    Cho S, Kang HC, Hahm JH. Characteristics of vitiligo in Korean children. Pediatr Dermatol. 2000;17:189–93.CrossRefGoogle Scholar
  31. 31.
    Amer AAA, Mchepange UO, Gao XH, Hong Y, Qi R, Wu Y, Cai Y, Zhai J, Chen HD. Hidden victims of childhood vitiligo: impact on parents’ mental health and quality of life. Acta Derm Venereol. 2015;95:322–5.CrossRefGoogle Scholar
  32. 32.
    Silverberg JI, Silverberg NB. Quality of life impairment in children and adolescents with vitiligo. Pediatr Dermatol. 2014;31:309–18.CrossRefGoogle Scholar
  33. 33.
    Bilgic O, Bilgic A, Akis HK, Eskioğlu F, Kilic EZ. Depression, anxiety and health-related quality of life in children and adolescents with vitiligo. Clin Exp Dermatol. 2011;36:360–5.CrossRefGoogle Scholar
  34. 34.
    Ramien ML, Ondrejchak S, Gendron R, Hatami A, McCuaig CC, Powell J, Marcoux D. Quality of life in pediatric patients before and after cosmetic camouflage of visible skin conditions. J Am Acad Dermatol. 2014;71:935–40.CrossRefGoogle Scholar
  35. 35.
    Koh MJ, Mok ZR, Chong WS. Phototherapy for the treatment of vitiligo in Asian children. Pediatr Dermatol. 2015;32:192–7.CrossRefGoogle Scholar
  36. 36.
    Anbar TS, Westerhof W, Abdel-Rahman AT, El-Khayyat MA. Evaluation of the effects of NB-UVB in both segmental and non-segmental vitiligo affecting body sites. Photodermatol Photoimmunol Photomed. 2006;22:157–63.CrossRefGoogle Scholar
  37. 37.
    Mulekar SV, Al Eisa A, Delvi MB, Al Issa A, Al Saeed AH. Childhood vitiligo: a long-term study of localized vitiligo treated by noncultured cellular grafting. Pediatr Dermatol. 2010;27:132–6.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Hong WS, Hu DN, Qian GP, McCormick SA, Xu AE. Treatment of vitiligo in children and adolescents by autologous cultured pure melanocytes transplantation with comparison of efficacy to results in adults. J Eur Acad Dermatol Venereol. 2011;25:538–43.CrossRefGoogle Scholar
  39. 39.
    Tsuchiyama K, Watabe A, Sadayasu A, Onodera N, Kimura Y, Aiba S. Successful treatment of segmental vitiligo in children with the combination of 1-mm minigrafts and phototherapy. Dermatology. 2016;232:237–41.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Jørgensen KT, Pedersen BV, Nielsen NM, Jacobsen S, Frisch M. Childbirths and risk of female predominant and other autoimmune diseases in a population-based Danish cohort. J Autoimmun. 2012;38(2-3):J81–7.CrossRefGoogle Scholar
  41. 41.
    Delatorre G, Bruno C a, Chaves TP, Von Linsingen RF, de Castro CCS. A Study of the prognosis of vitiligo during pregnancy. Surg Cosmet Dermatol. 2013;5(1):37–9.Google Scholar
  42. 42.
    Horev A, Weintraub AY, Sergienko R, Wiznitzer A, Halevy S, Sheiner E. Pregnancy outcome in women with vitiligo. Int J Dermatol. 2011;50(9):1083–5.CrossRefGoogle Scholar
  43. 43.
    El-Saie LT, Rabie AR, Kamel MI, Seddeik AK, Elsaie ML. Effect of narrowband ultraviolet B phototherapy on serum folic acid levels in patients with psoriasis. Lasers Med Sci. 2011;26(4):481–5. Scholar
  44. 44.
    Ezzedine K, Le Thuaut A, Jouary T, et al. Latent class analysis of a series of 717 patients with vitiligo allows the identification of two clinical subtypes. Pigment Cell Melanoma Res. 2014;27(1):134–9.CrossRefGoogle Scholar
  45. 45.
    Speeckaert R, van Geel N. Distribution patterns in generalized vitiligo. J Eur Acad Dermatol Venereol. 2014;28(6):755–62.CrossRefGoogle Scholar
  46. 46.
    Kanwar AJ, Mahajan R, Parsad D. Effect of age at onset on disease characteristics in vitiligo. J Cutan Med Surg. 2013;17(4):253–8.CrossRefGoogle Scholar
  47. 47.
    Al-Mutairi N, Al-Sebeih KH. Late onset vitiligo and audiological abnormalities: is there any association. Indian J Dermatol Venereol Leprol. 2011;77(5):571–6.CrossRefGoogle Scholar
  48. 48.
    Dogra S, Parsad D, Handa S, et al. Late onset vitiligo: a study of 182 patients. Int J Dermatol. 2005;44(3):193–6.CrossRefGoogle Scholar
  49. 49.
    Esfandiarpour I, Farajzadeh S. Clinical characteristics of late-onset vitiligo in an Iranian population. Dermatol Sinica. 2012;30:43–6.CrossRefGoogle Scholar
  50. 50.
    Arcos-Burgos M, Parodi E, Salgar M, et al. Vitiligo: complex segregation and linkage disequilibrium analyses with respect to microsatellite loci spanning the HLA. Hum Genet. 2002;110:334–42.CrossRefGoogle Scholar
  51. 51.
    Taieb A, Alomar A, Böhm M, et al. Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol. 2013;168(1):5–19.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Tay EY, Chong CLV, Chong WJJP, Gan YE, Chuah SY, Tan WDV, Thng TGS. Treatment outcomes of vitiligo in Asian children. Pediatr Dermatol. 2018;35(2):265–7.Google Scholar
  53. 53.
    Kong YL, Ching VHL, Chuah SY, Thng TG. Retrospective study on the characteristics and treatment of late-onset vitiligo. Indian J Dermatol Venereol Leprol. 2017;83(5):625.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Steven Thng
    • 1
    Email author
  • Sai Yee Chuah
    • 1
  • Emily Yiping Gan
    • 1
  1. 1.National Skin CentreSingaporeSingapore

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