I saw a 10 year old patient last week for her routine physical. One of her mother's concerns was that her daughter had "white patches" under both of her arms. Once I examined her I told her mother that the "white patches" were actually due to Vitiligo, which is 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 and 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) and well as on the hands. The underarm area (axilla) is often involved, as are areas around the genitalia. In many cases the depigmentation 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 % 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 repigmentation in 10-20% of patients, especially in sun exposed areas of young patients.
The problem with Vitiligo is that treatment is often lengthy and is frequently unrewarding. There is not "one way" to treat Vitiligo that will ensure repigmentation and resolution. Dermatologists have used phototherapy for treatment, but facial areas and small patches seem to be 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.
With all of this being said, a referral to a dermatologist that is familiar with treating Vitiligo is of upmost importance. The sooner the treatment for these "white patches" the better.
That's your daily dose for today. We'll chat again tomorrow.
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