番茄社区

NEW YORK -- Early-onset childhood vitiligo has an increased likelihood of progression and extensive skin area involvement but responds to treatment just as often as later-onset disease, a retrospective review showed.

Onset before 3 years of age was associated with >10% involvement of body surface area in 13% of cases versus 1% of cases with later onset in childhood. More than half of patients with early onset of vitiligo had progressive disease compared with about a third of patients within onset at age 3 or later.

A trend toward a lower frequency of halo nevi was seen in patients with early onset (13% vs 29%), Brandon Cohen, BS, of in New York City, reported here at the Summer Academy meeting.

"Most patients with childhood vitiligo are otherwise healthy and over half respond to standard treatments, regardless of whether onset is early in childhood or later," Cohen, a fourth-year medical student, told 番茄社区. "However, there remains a strong unmet need for more effective and safe treatments for vitiligo."

A separate analysis of the same 208-patient cohort showed no association between development of halo nevi and progressive vitiligo or response to treatment.

Adult- and childhood-onset vitiligo have a number of features in common but also some differences. For example, pediatric vitiligo is more likely to be segmental, and fewer patients have autoimmune disorders. Whether the timing of onset in childhood influences these associations has remained unclear, Cohen said.

To compare and contrast childhood vitiligo according to age at onset, investigators reviewed medical records of pediatric patients evaluated and treated for vitiligo from Jan. 1, 1990 to Nov. 15, 2014. Disease onset before age 3 was defined as early onset, whereas patients with vitiligo onset from ages 3 to 18 were considered to have late-onset disease.

Body surface area affected by vitiligo was estimated from diagrams included in patient charts. Vitiligo cases were categorized as focal (one or more macules in one area but clearly not segmental); segmental (one or more macules in a quasi-dermatomal distribution); and generalized (bilateral macules).

On the basis of the diagrams, progression was defined as the appearance of new depigmented patches or extension of previous patients. Additionally, investigators noted the occurrence of repigmentation when new pigmentation appeared on previous sites affected by vitiligo.

The cohort comprised 31 patients with early-onset vitiligo and 177 with late-onset vitiligo.

Four patients in the early-onset group had involvement of >10% of body surface area versus one in the later-onset group (P<0.001). One or more halo nevi were present in four (13%) patients with early-onset childhood vitiligo and 51 (29%) patients with later onset (P=0.064). Investigators noted disease progression in 15 (56%) patients with early-onset vitiligo and 61 (35%) patients with later onset (P=0.039).

The rate of repigmentation did not differ significantly between the early-onset and later-onset groups (61% versus 56%), nor rates of positive history of autoimmune disease (3% versus 5%), family history of autoimmune disease (29% versus 24%), sex distribution (51% to 52% female), or type of disease (focal, 42% versus 41%; segmental, 42% versus 32%; generalized 16% versus 28%).

are benign moles that occur commonly in children and young adults. In most cases, the lesions fade over time and eventually disappear. The lesions are significantly more common in patients with vitiligo and than in the general population and in children with vitiligo than in adults affected by the condition.

Halo nevi and vitiligo share a number of . However, halo nevi and vitiligo have , suggesting that vitiligo with and without halo nevi may represent distinct clinical entities.

Few studies have examined the features of childhood vitiligo associated with halo nevi, providing a rationale for the study conducted by Cohen and colleagues. Using data from the 208-patient cohort investigators found that 55 patients had halo nevi in association with childhood vitiligo and 153 did not. The study population had a mean follow-up of 1.9 years.

Patients with halo nevi were older at their initial vitiligo evaluation (mean of 7.3 versus 5.8 years) Halo nevi were more common in male patients (62% versus 44% patients with vitiligo and no halo nevi, P=0.027) and more likely to be associated with generalized vitiligo (56% versus 35%, P=0.015). Extent of vitiligo involvement, rates of progressive disease and repigmentation, and proportion of patients with family history of vitiligo or autoimmune disease did not differ between patients with and without halo nevi.

Vitiligo treatment led to similar response rates in patients with and without halo nevi.