Nanette B. Silverberg, MD: The Prevalence of Vitiligo in Pediatric Patients

Dermatological conditions have always affected pediatric populations in unique ways, and vitiligo is no exception.

In an interview with HCPLive, Nanette B. Silverberg, MD, Chief of Pediatric Dermatology for Mount Sinai Health System and Member of Society for Pediatric Dermatology, spoke of how the dermatological condition can pose unique complications for this patient population.

“Pediatric vitiligo, like all vitiligo, has been something that's been overlooked quite a long time, and I've been working with vitiligo patients for about 20 years,” Silverberg said. “One of the things that we see in in studies that have been published (is) half of cases of vitiligo do occur in childhood; about 50% of cases will have occurred by age 20, and about a half of those cases by age 10.”

Additionally, recent investigations in vitiligo management have shown that patients are not being offered treatment for their condition, which Silverberg cited as a significant source of problems in patient care.

This is duly important when the comorbidities of vitiligo are considered.

Silverberg noted that roughly 10-25% of pediatric patients with vitiligo will develop thyroid problems, and autoimmune conditions such as type 2 diabetes and pernicious anemia have also been associated with the skin disease, along with psychological complication such as depression.

Luckily, topical therapies for the treatment of vitiligo are varied, with many studies citing their efficacy and safety.

“Therapeutics for vitiligo include a very wide range of topical therapies,” Silverberg said. “Some are more focused for facial lesions, because they're non steroids, some steroid creams for the body. Often parents are very concerned about steroid creams about thinning of the skin, but we have a really long term data on these kids on kids who've been treated with vitiligo and their skin does very well with these products.”

Crucially, Silverberg noted that these therapies often require roughly 6 months to 1 year of intense treatment, followed by standard maintenance in problematic areas, if applicable.

Janise-kinase (JAK) inhibitors and other forms of immune suppressing medications have also shown promise in the management of pediatric vitiligo. Specifically, JAK inhibitors will function by blocking immune activity in the skin

She added that the process of regaining color in the skin is considerably easier the earlier a patient is admitted for treatment.

Silverberg took issue with how companies and providers have categorized vitiligo as a “cosmetic condition”, the implications of which could prevent pediatric patients with vitiligo from receiving proper care.

“(Vitiligo) is an obvious condition, it has comorbidities, but it affects people deeply because they can't hide it,” Silverberg. “You can hide your heart disease; you can hide your asthma most of the time. But you can't hide your vitiligo well, and it has strong implications for how people interact every day, and it's been a disservice that many companies have not covered medications, calling it a cosmetic condition when we know it so deeply affects children and their families.”

To hear more from Dr. Silverberg on pediatric vitiligo, as well as some of her own research into the condition, watch the video interview above.