At what age does vitiligo typically begin?

The vitiligo is a benign depigmenting disorder characterized by the progressive loss of functional melanocytes. Although the vitiligo is not strictly a hereditary condition, familial predispositions do exist. Indeed, 20% of individuals affected by vitiligo have at least one first-degree relative with this disease and are 7 to 10 times more likely to develop it.

The age of onset of vitiligo is variable: although it is more commonly observed in adults, it can also occur before age 12: it is then referred to as "childhood vitiligo." More than fifty studies estimate its global prevalence to be between 0.5% and 2.26%, with similar figures in children and adolescents (around 2.16%), suggesting a relatively frequent onset at a young age. The vitiligo that occurs in children also does not seem rare, as in 32% to 40% of cases it appears before the age of 12, according to an article published in the American Journal of Clinical Dermatology.

According to a study published in the journal Pediatric Dermatology and conducted with 625 children in northern India, it was found that 57.1% were girls and 42.9% were boys. Vitiligo therefore appears to affect the female population more frequently, although the reason for this remains unclear. In this study, the mean age at onset of vitiligo was 6.2 years, even though the average age at first consultation was 9 years. Regarding the youngest age at which the vitiligo was observed, it was 4 years in this study.

Vitiligo tends to manifest in early childhood, and early diagnosis allows for the prompt implementation of an appropriate therapeutic strategy.

These findings underscore that vitiligo often manifests very early, sometimes as early as infancy, yet diagnosis is typically delayed by several years. This lag can postpone the implementation of an appropriate therapeutic strategy, even though early intervention could limit lesion progression in vitiligo and improve prognosis. They also highlight a slight female predominance, suggesting that hormonal, genetic, or sociocultural factors may play a role in the early expression of the disease.

Although the symptoms of vitiligo are generally the same whether it appears in adults or in children, it is interesting to note some distinctions.

• The different areas of depigmentation in the child.

  In young children, vitiligo frequently involves the perineal and perianal region, and less commonly the oral mucosa, compared with adults. In the case of non-segmental vitiligo, which develops bilaterally, lesions predominantly appear on the face, trunk, neck, and limbs, whereas in segmental vitiligo they are primarily located on the face, hands, and friction-prone areas.

  Another characteristic of childhood vitiligo is the presence of halo nevi, areas of depigmentation surrounding a mole, although they can also appear in adults. It is important to note, however, that the presence of a halo nevus does not necessarily indicate vitiligo, since vitiligo can also develop on skin without this dermatological condition. In the case of vitiligo, halo nevi arise because the immune system recognizes the melanocytes, the cells responsible for skin pigmentation in the nevus, as foreign and attacks them, leading to depigmentation of the surrounding skin.

• Leukotrichia in the child affected by vitiligo.

  The scalp can also be affected by the appearance of white streaks or, in some cases, complete whitening of the hair, eyelashes, and eyebrows. In the study published in the journal Pediatric Dermatology, 12.3% of the 625 children were affected by leukotrichia. Leukotrichia is observed in both children and adults, but several studies indicate that it is more common in children with non-segmental vitiligo.

• The Koebner phenomenon in children.

  The Koebner phenomenon refers to the development of new lesions in areas of skin trauma in people with vitiligo. In a study of 625 children, it was observed in 71 patients, representing 11.3% of cases. This phenomenon is also well documented in adults, where it can be triggered by scratches, burns, friction, or tattoos. However, it appears to occur more frequently or more readily in children, likely due to higher disease activity at that age and increased exposure to microtrauma from play or physical activities. Thus, the Koebner phenomenon emerges as a common trigger in both pediatric and adult vitiligo, with potentially heightened sensitivity in the pediatric population.

• THOMSEN K. & al. Prevalence of vitiligo: Epidemiological survey on the Isle of Bornholm, Denmark. Archives of Dermatology (1977).

• POLKACKI M. & al. Vitiligo in childhood. Medicinski pregled (2002).

• DOGRA S. & al. Epidemiology of childhood vitiligo: A study of 625 patients from North India. Pediatric Dermatology (2003).

• MAZEREEUW-HAUTIER J. & al. Le vitiligo de l'enfant. Annales de Dermatologie et de Vénéréologie (2010).

• SCHALLREUTER K.U. & al. A review of the worldwide prevalence of vitiligo in children/adolescents and adults. International Journal of Dermatology (2012).

• J-H SAURAT. D LIPSKER . L THOMAS. J-M LACHAPELLE. Dermatologie et infections sexuellement transmissibles : Troubles de la pigmentation cutanée. Elsevier Masson (2017).

• RIGOPOULOS D. & al. Childhood vitiligo. American Journal of Clinical Dermatology (2019).