At what age does vitiligo begin?

The vitiligo is a benign depigmenting disorder characterised by the progressive loss of functional melanocytes. Although vitiligo is not strictly speaking a hereditary disease, there are familial predispositions to its development. Indeed, 20% of people affected by vitiligo have at least one first-degree relative with the condition and are seven to ten times more likely to develop it.

The age of onset of vitiligo is variable: while it is more frequently observed in adults, it may also occur before the age of 12: it is then referred to as "childhood vitiligo". More than fifty studies estimate its worldwide prevalence between 0.5% and 2.26%, with similar figures in children and adolescents (around 2.16%), suggesting a relatively frequent occurrence from a young age. The vitiligo that occurs in children does not appear to be rare either, since 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, although the underlying reasons for this remain unclear. In this study, the mean age at vitiligo onset was 6.2 years, although the mean age at first consultation was 9 years. With regard to the minimum age at which the vitiligo was observed, it was 4 years in these findings.

Vitiligo tends to manifest from an early age, and an early diagnosis enables the timely implementation of an appropriate therapeutic strategy.

These results emphasise that vitiligo appears very early, sometimes from early childhood, yet the diagnosis is generally delayed by several years. This delay can postpone the implementation of an appropriate therapeutic strategy, even though early management could limit the progression of vitiligo and improve prognosis. They also reveal 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 broadly the same whether it manifests in adults or in children, it is interesting to note certain distinctions.

• The different areas of depigmentation in the child.

  In young children, vitiligo often affects the perineal and perianal region, and more rarely the oral mucosa compared with adults. In the case of non-segmental vitiligo, which develops bilaterally, lesions appear mainly on the face, trunk, neck and limbs, whereas in segmental vitiligo they are mainly located on the face, hands and friction-prone areas.

  Another feature of childhood vitiligo is the presence of halo naevi, areas of depigmentation that surround a mole, although they can also appear in adults. It should be noted, however, that the presence of a halo naevus does not necessarily indicate vitiligo, as the condition may also develop on skin not previously affected by this disorder. In the case of vitiligo, halo naevi are explained as follows: the immune system recognises the melanocytes – the cells responsible for skin pigmentation – in the naevus as foreign and attacks them, leading to depigmentation of the surrounding skin.

• Leucotrichia in a child with vitiligo.

  The scalp can also be affected, presenting 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 appearance of new lesions on areas of skin trauma in individuals with vitiligo. In a study involving 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 even tattoos. However, it appears to occur more frequently or more readily in children, likely due to higher disease activity at this age and increased exposure to microtraumas associated with play or physical activities. Thus, the Koebner phenomenon emerges as a common trigger for vitiligo in both children and adults, albeit with potentially greater sensitivity in the paediatric population.

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• 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).