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Vitiligo is a condition that causes some areas of the skin to lose their pigment (color), leading to lighter patches that can appear anywhere on the body. About 50 percent of people with vitiligo develop the condition before age 20, and in about 25 percent of cases, it starts before age 14. Among children and adolescents, up to about 2 percent may have vitiligo, a prevalence that suggests the condition may be more common than many people realize.
Vitiligo can also cause mental and emotional distress because of the visible changes in the skin. This can affect quality of life, especially for children living with vitiligo. It’s no surprise that a top question parents and children ask is whether vitiligo can go away. Vitiligo is usually a chronic (long-term) condition — the symptoms may get better, but the condition itself isn’t cured.
Current treatment options for children with vitiligo aim at bringing color back to the skin. These include:
Surgical treatments are also available, but they’re usually used only in stable, localized cases (vitiligo that hasn’t spread and stays in one area) when other treatments haven’t worked.
Some MyVitiligoTeam members have described living with vitiligo since childhood. “I have been looking for help since I was very little,” one member wrote. Another has been “living with this condition since 5,” they said. “My grandmother had it, and my aunt had it.”
To learn more about treating vitiligo in children, MyVitiligoTeam talked with Dr. Pearl Grimes, director of the Vitiligo and Pigmentation Institute of Southern California.
Vitiligo isn’t life-threatening and doesn’t cause serious health problems. However, it’s often associated with other illnesses, including autoimmune thyroid disorders, alopecia areata (patchy hair loss caused by the immune system attacking hair follicles), inflammatory bowel disorders, and diabetes, Dr. Grimes said.
Vitiligo can lower self-esteem and create emotional stress. In one survey of 150 people with vitiligo, more than half said people stare at them, and 25 percent said the skin condition caused issues when interacting with strangers.
In a 2018 article in the journal Nature, vitiligo researcher Dr. John Harris wrote, “Some people with the condition are demanding that it be accepted as part of everyday diversity.”
That said, parents may still choose to seek treatment for their children. Dr. Grimes noted that many options exist — and the earlier treatment begins, the better.
“I love to treat kids,” Dr. Grimes said. “If we look at our database of outcomes in children versus my outcomes in adults, one thing we know is that kids have better outcomes. That’s why it’s so important that when you diagnose vitiligo in the pediatric population, you institute therapy because there’s a much greater likelihood that they’re going to do better over time.”
It’s not unusual for parents to request vitiligo treatment for their children, sometimes as young as 2 years old, Dr. Grimes said. That may seem early, but it could improve the child’s outcomes. “If you have onset at age 2, the data suggests that probably the prognosis is not as good,” Dr. Grimes explained. “That patient has a greater likelihood that they’re going to progress, and you may deal with more severe involvement over time.”
When evaluating young children, Dr. Grimes takes into account factors such as immune system status, progression of the disease, and severity of the body surface area affected. “The advantages of treatment must always outweigh the disadvantages,” she said. Assuming the criteria are met, Dr. Grimes said she would recommend treating a child with vitiligo.
When treating a child with vitiligo, Dr. Grimes focuses on three main goals:
By using this approach, Dr. Grimes can see how well treatments work over time and how long the results can last.
If a child’s vitiligo is progressing rapidly, Dr. Grimes may use a course of oral (taken by mouth) corticosteroids for about two weeks to slow or stop the spread. She may also consider other approaches, depending on where the vitiligo is on the body and how well it responds to treatment.
Another important goal in treating children is repigmentation, Dr. Grimes said. “The calcineurin inhibitors [such as tacrolimus (Protopic)] work extremely well,” she said. “They do phenomenally well on the face, the area of key cosmetic concern for children and adults. Topical corticosteroids offer comparable results. If it’s more extensive, we use narrow-band UVB phototherapy. ... For a stubborn, localized area, I use targeted phototherapy, the excimer laser.”
More recently, topical ruxolitinib (Opzelura) was approved by the U.S. Food and Drug Administration (FDA) for treating vitiligo in people ages 12 and older. Ruxolitinib is a Janus kinase (JAK) inhibitor, which means it helps block certain inflammation signals in the body. This can reduce symptoms and improve repigmentation. Because this medication is applied directly to the skin, it has a lower risk of serious side effects than medications taken by mouth. Results may take a few months, but some people may notice improvements sooner.
Although vitiligo may not always go away completely or permanently, Dr. Grimes said she aims to help each child get the best results possible. “What I work to do is optimize the level of repigmentation to achieve as much as I can. If my patient is at 50 percent at six months,” she said, “I’m going to keep pushing to get 75 percent or more return of color.”
Outcomes are different for each child, so it can be difficult to know just when to stop treatment. “Once I think [the treatment has] definitely plateaued after adjusting multiple therapies, then at that point, I begin to back off,” she said. “If I can taper that patient out over time, discontinue treatment, and monitor, that’s ideal.”
Children with vitiligo may need ongoing maintenance treatment to keep the color they’ve regained, Dr. Grimes said.
“There’s a cohort of patients who require some type of maintenance treatment. That maintenance may be intermittent,” Dr. Grimes said. “It may be twice a week — calcineurin inhibitors.” Ruxolitinib has also shown promise as a maintenance option for vitiligo, with one study showing that people kept their repigmentation within three years of treatment.
Maintenance varies from child to child, and some may respond so well to treatment that they can eventually stop using it, Dr. Grimes said. However, even if treatment is ended, regular follow-up visits are important, just as with any other autoimmune condition.
“They’re still at risk for comorbidities [related health conditions],” she said. “It’s an autoimmune disease associated with other autoimmune comorbidities, so it’s important that patients understand ... how important it is, long term, to be monitored.”
Parents should be prepared to stay involved in their child’s vitiligo care for a while. “There’s no quick fix for vitiligo,” Dr. Grimes said. “You’ve got to be in for the long haul.”
Generally, children seem to have better outcomes than adults, she noted. In many cases, children and parents work together to manage the condition and stick with the treatment plan. “They’re good at playing a major role themselves,” she said of children with vitiligo. “I think it really has to be that partnership between the child and the adult to use the medications on a consistent basis, even for phototherapy.”
Over the past few years, treatment options for vitiligo have expanded. Ruxolitinib is one of the best-known new treatments, although it’s currently approved only for children and adolescents who are at least 12 years old.
Other medications, including other JAK inhibitors, are also being studied. Dr. Grimes believes this research could lead to even better treatments. “I think we will eventually begin to look at more aggressive agents for the pediatric population,” Dr. Grimes said.
However, she also emphasized that she’s cautious when treating children, and she doesn’t recommend using experimental therapies too soon. Any treatment must offer more benefits than risks. Traditional therapies can work very well when used correctly, and newer FDA-approved therapies may also be a good choice. If you have questions about vitiligo treatment for your child, speak with a dermatologist who has experience treating this condition.
Parents can offer support by encouraging children to take an active role in their treatment and helping kids stick to their prescribed treatment regimens, Dr. Grimes said.
“We have patients who come in for phototherapy,” she said. “There has to be a regimented approach, and getting it done two to three times a week [is ideal] if we’re really going to work to achieve the very best outcomes.”
Home phototherapy (light therapy done at home) is very popular with many of the children Dr. Grimes treats. Parents don’t have to take their children out of school for multiple weekly treatments, she said. Based on her experience, home treatment is safe and effective when used properly.
In addition to keeping up with treatment, parents can help protect their children’s skin from sunburn, which sometimes triggers vitiligo, Dr. Grimes said. She also recommended that parents help their children find ways to manage stress and encourage them to enjoy everyday life and have fun.
On MyVitiligoTeam, the social network for people with vitiligo and their loved ones, more than 14,000 members come together to ask questions, give advice, and share their stories with others who understand life with vitiligo.
Does your child have vitiligo? What has your family’s experience with treatment been like? Share your story in a comment below, or start a conversation by posting on your Activities page.
In partnership with the Global Vitiligo Foundation, which strives to improve the quality of life for individuals with vitiligo through education, research, clinical care, and community support.
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