By Sue Hubbard, M.D.
I recently saw a 10-year-old patient for her routine physical. One of her mother's concerns was that her daughter had "white patches" under both arms. Once I examined her, I told her mother that the "white patches" were actually due to Vitiligo, an acquired disorder of pigment loss.
Vitiligo is caused by a reduction in functional melanocytes, the cells that cause pigmentation in the skin. Vitiligo often develops before the age of 20. There is no difference in predilection for male over female cases.
In children, the hypopigmented areas are often first noted on sun-exposed areas like the face (around the eyes and mouth), as well as on the hands. The underarm area (axilla) is often involved, as are areas around the genitalia. In many cases, the de-pigmentation is symmetrical (both arm pits, or hands or knees).
Although the exact cause of Vitiligo is not clear, it is known that it has an immunogenetic basis, as there is a positive family history of others with vitiligo in 30-40 percent of patients. There are numerous theories as to different reasons that the melanocytes (pigment cells) are not working. The genetics of vitiligo is also being studied, with changes seen on certain chromosomes.
So why doctors are not clear as to how and why Vitiligo occurs, in most cases it does seem to be slowly progressive. There is spontaneous re-pigmentation in 10-20 percent of patients, especially in sun-exposed areas in young patients.
The problem with Vitiligo is that treatment is often lengthy and frequently unrewarding. There is not "one way" to treat Vitiligo that will guarantee re-pigmentation and resolution. Dermatologists have used phototherapy for treatment, but facial areas and small patches seem most responsive. A recent study showed that narrow band UVB therapy was superior to UVA therapy, but studies continue.
Potent topical corticosteroids are also used to help promote re-pigmentation. Topical immune modulators such as Tacrolimus have also been tried.
All of this being said, a referral to a dermatologist familiar with treating Vitiligo is of upmost importance. The sooner the treatment for these "white patches," the better.
This column was printed in the September 21, 2014 - October 4, 2014 edition.