Childhood Vitiligo: Epidemiology, Clinical Spectrum and Therapeutic Responses

Rangaraj, M (2012) Childhood Vitiligo: Epidemiology, Clinical Spectrum and Therapeutic Responses. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Vitiligo is a common dermatologic disorder in children and one that has been observed since ancient times. It is characterized by asymptomatic, well-demarcated, ivory-white macules and patches that may be localized or generalized. Vitiligo is common in India affecting 3-4% of Indian population2. Childhood vitiligo is a special subtype and is seen in significant proportion of vitiligo patients. There are only a few clinical studies in the past which address the clinical spectrum of vitiligo in children. This study on eighty cases of childhood vitiligo will cover the epidemiology, clinical spectrum and review its therapeutic responses. This study was undertaken in view of the seriousness of the problem in children. AIM OF THE STUDY : To study the epidemiology, clinical spectrum and therapeutic responses in childhood vitiligo with an aim to observe the following parameters: 1. Prevalence of vitiligo in children under 12 yrs. 2. Age and sex distribution, associated family history. 3. Sites of involvement and type of vitiligo. 4. Associated autoimmune disorders and syndromes. 5. Therapeutic responses to various modalities of treatment MATERIALS AND METHODS : This was a prospective study conducted at Rajiv Gandhi Government General Hospital, Chennai in the Department of Dermatology for a period of over 1 ½ years from november 2009 to June 2011. During this period, all children less than 12 years of age were screened for vitiligo. Only untreated patients were included in the study. A total of 80 children with vitiligo of both sexes were enrolled. They were questioned in detail regarding the age of onset, site of initial lesion, duration of disease, progression and associated cutaneous disorder. Precipitating factors such as trauma, illness, stress and contact with chemicals were specifically asked for. History of ocular symptoms and systemic illness like diabetes, thyroid dysfunction, anaemia and Addison’s disease were recorded. History of vitiligo, premature canities or any other autoimmune disorder in the family was noted. The above therapeutic modalities were adopted according to the age of the patients, type of vitiligo, site of vitiligo and extent of vitiligo. A detailed history regarding the onset, duration and course of the disease, presence and absence of precipitating factor, family history, associated skin and systemic problems, were recorded. Dermatological assessment of the disease was carried out using down the sites of involvement total body surface area involved, total number of factors, size and distribution of the patches, presence of white hair in the patch. Details regarding the margin of the patch, skin texture, presence or absence of perifollicular pigmentation, Koebner’s phenomenon, associated with skin and systemic problems were noted. Focal sepsis was ruled out by referring the patient to ENT and Dental OPD for checkup. Other associations if any are noted and referred to respective departments for evaluation. After collecting the preliminary reports the patients were assessed and divided based on inclusion and exclusion criteria. OBSERVATIONS : A total of 80 children were enrolled during the study period. The male to female ratio in the study was 45% to 55% [1:1.2], with females in the majority (n=44 female, and n=36 male). The mean current age of the children visiting our hospital was 6 years. Forty children (50.0%) were in the age group of 7 to 12 years. The youngest child was one and 1/2 years old. The commonest age of onset was between 4 to 9 years. CONCLUSION : Vitiligo incidence during the study period was 0.27%. • The incidence of vitiligo in children was 15.87% of the total number of vitiligo patients over a period of 1 ½ years of study. • Females were predominantly affected than males which might be due to their increased cosmetic concern. • There was a positive family history in 12.5% of children. • Most common age group affected include 4-6 years. • Most common site of initial lesion was head and neck followed by upper limb, lower limb and trunk. • Most common clinical type was vitiligo vulgaris followed by focal type then segmental. Lip tip type was least common type. • Cutaneous association was seen in 26.25%. • Body surface area involving < 20% was found in 73.75%. • Localized facial and mucosal lesions best respond to topical steroid and immunomodulator combination. The compliance of the patients was very good with this treatment modality. • NBUVB therapy is an effective and safe modality to treat generalized vitiligo with cosmetically acceptable repigmentation. • Punch grafting proves to be easier, faster and least expensive method of treatment in stable vitiligo cases. • Split skin grafting carries a distinct advantage over mini punch grafting in producing excellent cosmetic matching over larger areas using fewer grafts. Further several such studies need to be done on a larger scale to compare the epidemiology, clinical spectrum and various newer modalities of treatment, their responses, adverse effects and to derive a standard protocol for treating this less studied entity childhood vitiligo.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Childhood Vitiligo ; Epidemiology ; Clinical Spectrum ; Therapeutic Responses.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 01 Mar 2018 17:16
Last Modified: 03 Mar 2018 07:38
URI: http://repository-tnmgrmu.ac.in/id/eprint/5951

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