Indeed, if the lesion is present at birth, inherited or genetically induced hypomelanoses should be ruled out. Int J Dermatol. Pseudocatalase and calcium topically, combined with narrowband UVB or climatotherapy at the Dead Sea, has been described to be effective at repigmentation of facial and dorsal hand vitiligo. A pilot study assessing the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris. Birt-Hogg-Dube syndrome; MEN-1 syndrome; Conditions associated with shagreen patch. Development and validation of the K-VSCOR for scoring Koebner’s phenomenon in vitiligo/non-segmental vitiligo. The differential diagnosis of ND includes ash-leaf spot of tuberous sclerosis, indeterminate leprosy, seborrheic dermatitis, lichen striatus, … Quality of life in pediatric dermatology. Segmental vitiligo may not be associated with risk of autoimmune thyroiditis. The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force. D, Hypopigmented mycosis fungoides. Folic acid and vitamin B12 in vitiligo: a nutritional approach. The earliest symptoms include purple or brown spots with a cream-colored center on new leaves. 1. Dr Silverberg has been an investigator for Astellas Pharmaceuticals. Moreover, the coexistence of both conditions has also been reported.25 Mixed vitiligo refers to the concomitance of SV and NSV in a single patient. KP, when present, is limited to the affected area. A 3-year-old female presents with an abnormal "dark spot" in certain parts of the body. Differential diagnosis. In addition, the pathophysiology and genetic determinants, the psychological impact of vitiligo, and management strategies are reviewed. These include endocrinology (eg, thyroid management), rheumatology (eg, ANA-positive photosensitivity), nutrition (eg, known vitamin deficiencies), psychology/psychiatry (eg, anxiety), developmental specialists (eg, school-based difficulties arising from vitiligo), hematology (eg, pernicious anemia), gastroenterology (eg, suspected ulcerative colitis), and pediatrics (eg, for coordination of care). Other forms of phototherapy that have been described as safe and effective for long-term therapy of pediatric vitiligo include excimer laser, targeted UVB, and targeted UVA1.67 Side effects of phototherapy include itch, burning, erythema, stinging, blistering, and phototoxicity.67 Targeted phototherapy may not allow for disease stabilization in extensive disease, but does limit side effects to the local site treated.41 Excimer laser is most beneficial in SV when performed early on in disease.68 Phototherapy is often more effective in darker patients and the benefits of phototherapy in Fitzpatrick type I skin (lightest skin type) do not outweigh the risk.53 Although long-term follow-up of pediatric patients with vitiligo who received phototherapy has not been conducted, the risk of carcinogenesis after phototherapy probably persists lifelong, requiring on-going full body skin examinations for screening after therapy. ... Clinical diagnosis. Moreover, once the diagnosis has been confirmed by a dermatologist, early recognition of new flare-ups by pediatricians and general physicians will allow rapid therapeutic intervention to prevent the wide spread of the disease. Hypomelanotic macules are otherwise known as ash-leaf spots due to their resemblance to Sorbus aucuparia, or mountain-ash, leaves. Of note, overlaps between these forms may exist; for example, NSV may initially have an acrofacial pattern, with a later evolvement to the generalized form. Elsevier Health Sciences, 1 Jan 2010. I was told by our doctor that ash-leaf spots certainly exist on folks that DO NOT have TSC. Interestingly, a recent study based on latent class analysis has distinguished 2 types of vitiligo with probable different pathophysiological pathways.8. Differential diagnosis will include metabolic derangements including hypoglycemia, non-accidental trauma, intracranial lesions, sepsis, and toxic ingestions. What Are The Adverse Effects Associated with Each Treatment Option? E-mail: Copyright © 2016 by the American Academy of Pediatrics. When first seeing a patient, it is of prime importance to differentiate between these 2 forms, as these are quite different in terms of prognosis, evolution, and response to treatment patterns. Acrofacial vitiligo is not very common in children. Leaves become distorted as orange fungal fruiting structures form on the underside of leaves and on petioles. For instance, in Nepal and India, 2.0% and 2.6%, respectively, of children attending a dermatology clinic were diagnosed with vitiligo.10 In general population-based studies, vitiligo occurs in fewer than a half percent of the population of children. Corrective camouflage in pediatric dermatology. Therefore, diagnostic criteria have been developed to aid the diagnosis of tuberous sclerosis. A Wood lamp can be used to highlight lesions of vitiligo for confirmation distinguishing vitiligo from pityriasis alba (Fig 4C); on the other hand, one of the neoplastic hypomelanoses to exclude is mycosis fungoides (Fig 4D), and that may highlight on Wood lamp examination.45,46 Therefore, biopsy may be required in atypical cases and where mycosis fungoides is suspected; in that setting, T cell gene rearrangement studies on the biopsy may be helpful. The border of a lesion may be noted visually to be inflamed (inflammatory vitiligo), and a notable inflammatory infiltrate of CD 4+ and CD 8+ T lymphocytes may be seen on biopsy of an “active” border,39 although the inflammation may be clinically absent. Hypochromic vitiligo: delineation of a new entity. The first step is to determine whether the lesion is inherited or not. On the other hand, the course of NSV is unpredictable. The disease is disfiguring, with a major psychological impact on children and their parents. Birt-Hogg-Dube syndrome; MEN-1 syndrome; Other hamartoma syndromes . The form may later evolve to typical generalized vitiligo. Antibodies to normal human melanocytes in vitiligo. The genetics of vitiligo are complex, as there are multiple determinants found in most genome-wide association studies. NSV is characterized by asymptomatic, well-circumscribed, milky-white macules involving multiple parts of the body, usually in a symmetrical pattern (Fig 1). The care of SV does not require medical workup, unless NSV or another systemic autoimmune disease is noted concurrently. 24.2 ). In vitiligo, biopsy will demonstrate in the center of a lesion the loss of melanocytes (pigment cells) with special stains of the epidermis. Hairs may be partially spared. Jóźwiak S, Schwartz RA, Janniger CK, Michałowicz R, Chmielik J. Topical therapies may be used solely in limited surface involvement (<20% of body surface area) or in combination with other treatments, mainly phototherapy, in wider involvement (>20% of body surface area). Proposed therapeutic algorithm for childhood vitiligo. PORTLAND, ORE. — If an infant presents with at least three hypopigmented macules, think tuberous sclerosis. There have been a few studies that suggest vitamin supplementation can enhance vitiligo outcomes. The disease can start at any site of the body, but the fingers, hands, and face are frequently the initial sites. The differential diagnosis includes the ash-leaf spot of tuberous sclerosis. For example, topical co-Q10 application is not advised because of potential triggering vitiligo through a putative mechanism of peroxide generation.55 Therefore, mineral complex cream is generally used adjunctively and should be used only when the product efficacy can be confirmed. • Koplik's spots are diagnostic and are visible before onset of rash as ‘‘tiny white spots” like grains of sand on mucous membrane of the cheeks opposite the lower molars. Epidemiological survey on the Isle of Bornholm, Denmark. When limited to mucosa, differential diagnosis should include lichen sclerosus. Achromic naevus is usually noted at birth or early childhood, although lesions may not be apparent until mid-childhood in those … Address correspondence to Khaled Ezzedine, MD, PhD, Department of Dermatology, Henri Mondor Hospital and EpiDermE, Université Paris-Est Créteil Val-de-Marne, 94010 Créteil, France. Vitiligo-epidemiological study of 4134 patients at the National Center for Vitiligo and Psoriasis in Central Saudi Arabia. Check for errors and try again. The association of vitiligo with other autoimmune diseases should prompt physicians to carefully seek any autoimmune/autoinflammatory-associated disease. Finally, as the disease is disfiguring, one should not neglect its potential psychological impact, especially if the onset occurs during adolescence. Multivariate analysis of factors associated with early-onset segmental and nonsegmental vitiligo: a prospective observational study of 213 patients. Enter multiple addresses on separate lines or separate them with commas. Important clinical differentials for ash-leaf spots, are sometimes difficult to ash leaf spots differential diagnosis other. For ash leaf spots differential diagnosis may be misdiagnosed as vitiligo, particularly when hypopigmentation is profound and anxiety in the dermatology. 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