Vitiligo pp 437-450 | Cite as

Treating the Disease: Age, Gender, Ethnic Skin, and Specific Locations

  • Savita Yadav
  • M. Ramam


Vitiligo treatment has to be tailored to every individual after considering several individual features, including age, gender, and ethnic skin type as well as the specific location of patches. Vitiligo affects people of all age groups though the highest incidence is seen in the second and third decades of life. Treatment options are limited in childhood vitiligo because some systemic therapies are contraindicated, phototherapy is difficult to administer, there are age-specific adverse effects of different medicines, and, finally, there are difficulties in undertaking surgical treatment in children. In spite of all these limitations, response to medical as well as surgical treatments is generally stated to be better in children compared to adults. Vitiligo in older patients does not usually produce as much distress as in young people since the psychosocial burden is considerably less at this stage of life when getting married and securing employment are not of concern. The social stigma and cosmetic disfigurement of vitiligo affect both men and women, but the burden is significantly heavier in women, particularly in communities where marriages are arranged by families. Treatment options and response are similar in men and women. Vitiligo in subjects with darker skin poses particular problems because of the greater visibility and disfigurement along with the widespread prejudices and taboos associated with the disease in these communities. The location of patches is an important determinant of response with vitiligo on the hands and feet, knees and elbows, and the mucosae responding poorly to all current treatment modalities. Choice of surgical technique, dressing, and postoperative care and instructions are guided by the site affected.


  1. 1.
    Nordlund J. The epidemiology and genetics of vitiligo. Clin Dermatol. 1997;15:875–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Sehgal VN, Srivastava G. Vitiligo: compendium of clinic-epidemiological features. Indian J Dermatol Venereol Leprol. 2007;73:149–56.CrossRefGoogle Scholar
  3. 3.
    Burns T, Breathnach S, Cox N, Griffiths C. Rook’s textbook of dermatology, vol. II. 7th ed. Oxford: Blackwell Science; 2004. pp. 32.57–32.59.Google Scholar
  4. 4.
    Howitz J, Brodthagen H, Schwartz M, Thomsen K. Prevalence of vitiligo. Arch Dermatol. 1977;113:47–52.CrossRefGoogle Scholar
  5. 5.
    Ramakrishna P, Rajni T. Psychiatric morbidity and quality of life in vitiligo patients. Indian J Psychol Med. 2014;36:302–3.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Parsad D, Pandhi R, Dogra S, et al. Dermatology Life Quality Index score in vitiligo and its impact on the treatment outcome. Br J Dermatol. 2003;148:373–4.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ. Fitzpatrick’s dermatology in general medicine, vol. I. 7th ed. New York: McGraw Hill; 2007. p. 616–21.Google Scholar
  8. 8.
    James WD, Berger TG, Elston DM. Andrews diseases of the skin: clinical dermatology. 10th ed. Philadelphia, PA: Saunders Elsevier; 2006. p. 860–3.Google Scholar
  9. 9.
    Kedward AL, Gawkrodger DJ. Congenital stable symmetrical type vitiligo in a patient whose mother developed vitiligo during pregnancy. Eur J Dermatol. 2008;18(3):353.Google Scholar
  10. 10.
    Catucci Boza J, Giongo N, Machado P, Horn R, Fabbrin A, Cestari T. Quality of life impairment in children and adults with vitiligo: a cross-sectional study based on dermatology-specific and disease-specific quality of life instruments. Dermatology. 2016;232(5):619–25.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Handa S, Dogra S. Epidemiology of childhood vitiligo: a study of 625 patients from north India. Pediatr Dermatol. 2003;20:207–10.CrossRefGoogle Scholar
  12. 12.
    Isenstein AL, Morrell DS, Burkhart CN. Vitiligo: treatment approach in children. Pediatric Ann. 2009;38(6):339–44.CrossRefGoogle Scholar
  13. 13.
    Shajil EM, Agrawal D, Vagadia K, Marfatia YS, Begum R. Vitiligo: clinical profiles in Vadodara, Gujarat. Indian J Dermatol. 2006;51:100–4.CrossRefGoogle Scholar
  14. 14.
    Cho S, Kang H, Hahm J. Characteristics of vitiligo in Korean children. Pediatr Dermatol. 2000;17:189–93.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Halder R, Grimes P, Cowan C, Enterline J, Chakabarti S, Kenney J. Childhood vitiligo. J Am Acad Dermatol. 1987;16:948–54.CrossRefGoogle Scholar
  16. 16.
    Kato H, Furuhashi T, Ito E, Kaneko N, Nakamura M, Watanabe S, Shintani Y, Maeda A, Yamaguchi Y, Morita A. Efficacy of 1-mm minigrafts in treating vitiligo depends on patient age, disease site and vitiligo subtype. J Dermatol. 2011;38:1140–5.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Lepe V, Moncada B, Castaneda-Cazares J, Torres-Alvarez M, Ortiz C, Torres-Rubalcalva A. 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.CrossRefGoogle Scholar
  18. 18.
    Cockayne S, Messenger A, Gawkrodger D. Vitiligo treated with topical corticosteroids: children with head and neck involvement respond well. J Am Acad Dermatol. 2002;46:964–5.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Schaffer J, Bolognia J. The treatment of hypopigmentation in children. Clin Dermatol. 2003;21:296–310.CrossRefGoogle Scholar
  20. 20.
    Khalid M, Mujtaba G. Response of segmental vitiligo to 0.05% clobetasol propionate cream. Int J Dermatol. 1998;37:705–8.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Khalid M, Mujtaba G, Haroon TS. Comparison of 0.05% clobetasol propionate cream and topical Puvasol in childhood vitiligo. Int J Dermatol. 1995;34:203–5.CrossRefGoogle Scholar
  22. 22.
    Kose O, Riza GA, Kurumlu Z, Erol E. Calcipotriol ointment versus clobetasol ointment in localized vitiligo: an open, comparative clinical trial. Int J Dermatol. 2002;41:616–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    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.CrossRefGoogle Scholar
  24. 24.
    Grimes P, Soriano T, Dytoc M. Topical tacrolimus for repigmentation of vitiligo. J Am Acad Dermatol. 2002;47:789–91.CrossRefGoogle Scholar
  25. 25.
    Silverberg N, Lin P, Travis L, Farely-Li J, Mancini A, Wagner A, Chamlin S, Paller A. Tacrolimus ointment promotes repigmentation of vitiligo in children: a review of 57 cases. J Am Acad Dermatol. 2004;51(3):760–6.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Kanwar A, Dogra S, Parsad D. Topical tacrolimus for treatment of childhood vitiligo in Asians. Clin Exp Dermatol. 2004;29:589–92.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Farajzadeh S, Daraei Z, Esfandiarpour I, Hosseini SH. The efficacy of pimecrolimus 1% cream combined with microdermabrasion in the treatment of non segmental childhood vitiligo: a randomized placebo-controlled study. Pediatr Dermatol. 2009;26:286–91.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Gargoom AM, Duweb GA, Elzorghany AH, Benghazil M, Bugrein OO. Calcipotriol in the treatment of childhood vitiligo. Int J Clin Pharmacol Res. 2004;24:11–4.PubMedGoogle Scholar
  30. 30.
    Travis LB, Silverberg NB. Calcipotriene and corticosteroid combination therapy for vitiligo. Pediatr Dermatol. 2004;21:495–8.CrossRefGoogle Scholar
  31. 31.
    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.CrossRefGoogle Scholar
  32. 32.
    Drake LA, Dinehart SM, Farmer ER, Holtz RW, Graham GF, Hordinsky MK, et al. Guidelines of care for vitiligo. J Am Acad Dermatol. 1996;35:620–6.CrossRefGoogle Scholar
  33. 33.
    Antoniou C, Katsambas A. Guidelines for the treatment of vitiligo. Drugs. 1992;43:490–8.CrossRefGoogle Scholar
  34. 34.
    Koh MJ, Mok ZR, Chong WS. Phototherapy for the treatment of vitiligo in Asian children. Pediatr Dermatol. 2015;32:192–7.CrossRefGoogle Scholar
  35. 35.
    Hadi S, Spencer J, Lebwohl M. The use of the 308 nm excimer laser for the treatment of vitiligo. Dermatol Surg. 2004;30(7):983–6.PubMedGoogle Scholar
  36. 36.
    Passeron T, Ostovari N, Zakaria W, et al. Topical tacrolimus and the 308 nm excimer laser: a synergistic combination for the treatment of vitiligo. Arch Dermatol. 2004;140(9):1065–9.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Sassi F, Cazzaniga S, Tessari G, et al. Randomized controlled trial comparing the effectiveness of 308 nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck. Br J Dermatol. 2008;159:1186–91.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Yang HL, Huang XY, Yong FJ, Rong L. Combination of 308-nm excimer laser with topical pimecrolimus for the treatment of childhood vitiligo. Pediatr Dermatol. 2009;26:354–6.CrossRefGoogle Scholar
  39. 39.
    Cho S, Zheng Z, Park YK, Roh MR. The 308-nm excimer laser: a promising device for treatment of childhood vitiligo. Photodermatol Photoimmunol Photomed. 2011;27:24–9.CrossRefGoogle Scholar
  40. 40.
    Mulekar SV, Al Eisa A, Delvi MB, et al. Childhood vitiligo: a long-term study of localized vitiligo treated by noncultured cellular grafting. Pediatr Dermatol. 2009;27:132–6.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Mulekar SV, Isedeh P. Surgical interventions for vitiligo: an evidence-based review. Br J Dermatol. 2013;169(Suppl 3):57–66.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Gupta S, Kumar B. Epidermal grafting for vitiligo in adolescents. Pediatr Dermatol. 2002;19:159–62.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Gupta S, Kumar B. Epidermal grafting in vitiligo: influence of age, site of lesion, and type of disease on outcome. J Am Acad Dermatol. 2003;49:99–104.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Halaban R. The regulation of normal melanocyte proliferation. Pigment Cell Res. 2000;13:4–14.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Abdel-Malek ZA, Swope VB, Nordlund JJ, Medrano EE. Proliferation and propagation of human melanocytes in-vitro are affected by donor age and anatomical site. Pigment Cell Res. 1994;7:116–22.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Gilchrist BA, Vrabel MA, Flynn E, Szabo G. Selective cultivation of human melanocytes from newborn and adult epidermis. J Invest Dermatol. 1984;83:370–6.CrossRefGoogle Scholar
  47. 47.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Handa S, Kaur I. Vitiligo: clinical findings in 1436 patients. J Dermatol. 1999;26:653–7.CrossRefGoogle Scholar
  49. 49.
    Koranne RV, Sehgal VN, Sachdeva KG. Clinical profile of vitiligo in North India. Indian J Dermatol Venereol Leprol. 1986;52:81–2.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Sarin RC, Kumar AS. A clinical study of vitiligo. Indian J Dermatol Venereol Leprol. 1977;43:300–14.Google Scholar
  51. 51.
    Lerner AB. Vitiligo. J Invest Dermatol. 1959;32:285–310.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Lerner AB, Nordlund JJ. Vitiligo. What is it? Is it important? JAMA. 1978;239:1183–7.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Howitz J, Brodthagen H, Schwartz M, Thomsen K. Epidemiological survey on the Isle of Bornholm, Denmark. Arch Dermatol. 1977;113:47–52.CrossRefGoogle Scholar
  54. 54.
    Bolognia JL, Pawelek JM. Biology of hypopigmentation. J Am Acad Dermatol. 1988;19:217–55.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Mosher DB, Fitzpatrick TB, Hori Y, Ortonne JP. Disorders of pigmentation. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF, editors. Dermatology in general medicine. New York: McGraw Hill; 1993. p. 903.Google Scholar
  56. 56.
    Shah H, Mehta A, Astik B. Clinical and sociodemographic study of vitiligo. Indian J Dermatol Venereol Leprol. 2008;74:701.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Dogra S, Parsad D, Handa S, Kanwar AJ. Late onset vitiligo: a study of 182 patients. Int J Dermatol. 2005;44:193–6.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Akrem J, Baroudi A, Aichi T, Houch F, Hamdaoui MH. Profile of vitiligo in the south of Tunisia. Int J Dermatol. 2008;47:670–4.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Mchepange UO, Gao XH, Liu YY, Liu YB, Ma L, Zhang L, Chen HD. Vitiligo in North-Eastern China: an association between mucosal and acrofacial lesions. Acta Derm Venereol. 2010;90:136–40.CrossRefGoogle Scholar
  60. 60.
    Arýcan O, Koç K, Ersoy L. Clinical characteristics in 113 Turkish vitiligo patients. Acta Dermatovenerol Alp Panonica Adriat. 2008;17:129–32.Google Scholar
  61. 61.
    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.CrossRefGoogle Scholar
  62. 62.
    Koronne RV, Sachdevo KG. Vitiligo. Int J Dermatol. 1998;27:676–81.CrossRefGoogle Scholar
  63. 63.
    Porter J, Beuf AH, Nordlund JJ, AB L. Response to cosmetic disfigurement: patients with vitiligo. Cutis. 1987;39:493–4.PubMedGoogle Scholar
  64. 64.
    Pahwa P, Mehta M, Khaitan BK, Sharma VK, Ramam M. The psychosocial impact of vitiligo in Indian patients. Indian J Dermatol Venereol Leprol. 2013;79:679–85.CrossRefGoogle Scholar
  65. 65.
    Xu AE, Zhang DM, Wei XD, Huang B, Lu LJ. Efficacy and safety of tarcrolimus cream 0.1% in the treatment of vitiligo. Int J Dermatol. 2009;48:86–90.CrossRefGoogle Scholar
  66. 66.
    Singh S, Khandpur S, Sharma VK, Ramam M. Comparison of efficacy and side-effect profile of oral PUVA vs. oral PUVA sol in the treatment of vitiligo: a 36-week prospective study. J Eur Acad Dermatol Venereol. 2013;27:1344–51.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Park KK, Liao W, Murase JE. A review of monochromatic excimer light in vitiligo. Br J Dermatol. 2012;167:468–78.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Sapam R, Agrawal S, Dhali TK. Systemic PUVA vs. narrowband UVB in the treatment of vitiligo: a randomized controlled study. Int J Dermatol. 2012;51:1107–15.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Budania A, Parsad D, Kanwar AJ, Dogra S. Comparison between autologous noncultured epidermal cell suspension and suction blister epidermal grafting in stable vitiligo: a randomized study. Br J Dermatol. 2012;167:1295–301.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Holla AP, Sahni K, Kumar R, Kanwar A, Mehta S, Parsad D. Repigmentation of leukotrichia due to retrograde migration of melanocytes after noncultured epidermal suspension transplantation. Dermatol Surg. 2014;40:169–75.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Singh AK, Karki D. Micropigmentation: tattooing for the treatment of lip vitiligo. J Plast Reconstr Aesthet Surg. 2010;63:988–91.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Kim H, Kang JN, Hwang SH, Seo JK, Sung HS. Fibrin glue fixation for suction blister epidermal grafting in two patients with stable vitiligo. Ann Dermatol. 2014;26:751–4.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Laxmisha C, Thappa DM. Surgical Pearl: surgical tape for dressing of epidermal grafts in lip vitiligo. J Am Acad Dermatol. 2005;53:498–9.CrossRefGoogle Scholar
  74. 74.
    Babu A, Thappa DM, Jaisankar TJ. Punch grafting versus suction blister epidermal grafting in the treatment of stable lip vitiligo. Dermatol Surg. 2008;34:166–78.CrossRefGoogle Scholar
  75. 75.
    Souza Leite RM, Craveiro Leite AA. Two therapeutic challenges: periocular and genital vitiligo in children successfully treated with pimecrolimus cream. Int J Dermatol. 2007;46:986–9.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Fai D, Cassano N, Vena GA. Narrow–band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients. J Eur Acad Dermatol Venereol. 2007;21:916–20.CrossRefGoogle Scholar
  77. 77.
    Mulekar SV, Al Issa A, Al Eisa A, Asaad M. Genital vitiligo treated by autologous, noncultured melanocyte-keratinocyte cell transplantation. Dermatol Surg. 2005;31:1737–9.PubMedGoogle Scholar
  78. 78.
    Matsuzaki K, Chiyokura T, Kumagai N. Special considerations when grafting cultured epithelial sheets in male genital vitiligo. Dermatol Surg. 2016;42:128–30.CrossRefGoogle Scholar
  79. 79.
    Esmat SM, El-Tawdy AM, Hafez GA, Zeid OA, Abdel Halim DM, Saleh MA, Leheta TM, Elmofty M. Acral lesions of vitiligo: why are they resistant to photochemotherapy? J Eur Acad Dermatol Venereol. 2012;26:1097–104.CrossRefGoogle Scholar
  80. 80.
    Garg T, Chander R, Jain A. Combination of microdermabrasion and 5-fluorouracil to induce repigmentation in vitiligo: an observational study. Dermatol Surg. 2011;37:1763–6.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Bayoumi W, Fontas E, Sillard L, Le Duff F, Ortonne JP, Bahadoran P, Lacour JP, Passeron T. Effect of a preceding laser dermabrasion on the outcome of combined therapy with narrow band ultraviolet B and potent topical steroids for treating nonsegmental vitiligo in resistant localizations. Br J Dermatol. 2012;166:208–11.CrossRefGoogle Scholar
  82. 82.
    Li L, Wu Y, Li L, Sun Y, Qiu L, Gao XH, Chen HD. Triple combination treatment with fractional CO2 laser plus topical betamethasone solution and narrowband ultraviolet B for refractory vitiligo: a prospective, randomized half-body, comparative study. Dermatol Ther. 2015;28:131–4.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Mohamed HA, Mohammed GF, Gomaa AH, Eyada MM. Carbon dioxide laser plus topical 5-fluorouracil: a new combination therapeutic modality for acral vitiligo. J Cosmet Laser Ther. 2015;17:216–23.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Mulekar SV, Al Issa A, Al Eisa A. Treatment of vitiligo on difficult-to treat sites using autologous noncultured cellular grafting. Dermatol Surg. 2009;35:66–71.PubMedPubMedCentralGoogle Scholar
  85. 85.
    Suga M, Butt KI, Takimoto R, et al. Successful treatment of vitiligo with PUVA pigmented autologous epidermal grafting. Int J Dermatol. 1996;35:518–22.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Savita Yadav
    • 1
  • M. Ramam
    • 1
  1. 1.Department of Dermatology & VenereologyAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations