Youthful Solutions: Expert Advice on Treating Pediatric Vitiligo

Original Article: Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients

What are the key takeaways of this article?

The development of vitiligo in early adolescence (before the age of 12) is known to follow a more progressive and extended course in comparison to adult onset vitiligo. These patients suffer decreased quality of life with high rates of stigma, depression, and long term mental health outcomes. Compared to adults, distinguishing features of vitiligo in pediatric patients include a higher probability of presenting with segmental vitiligo (though some cases may transition to non-segmental vitiligo), an increased occurrence of halo nevi, a notable prevalence of atopic disorders among preadolescents, and an elevated incidence of autoimmune disorders within the family history. Given the increased severity of early onset vitiligo, early, effective, and sustained intervention is important. This article summarizes up to date evidence and consensus based recommendations on the diagnosis and treatment of vitiligo in adolescence.

Following the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines, the authors developed a protocol for recommendations on vitiligo in pediatric, adolescent, and young adult patients. After conducting a literature search, clinical recommendations were developed based on evidence quality, expert consensus, and stakeholder input. Stakeholders, including dermatology experts and support group leaders, reviewed recommendations and consensus statements, with surveys being used to measure stakeholder agreement. Statements achieving at least 70% agreement were considered consensus.

Forty-two recommendations were found and of these, 33 recommendations achieved a strong agreement, surpassing a 70% composite agreement threshold. General recommendations include the use of topical calcineurin inhibitors (TCIs), topical corticosteroids (TCSs), topical JAK inhibitors (tJAKi), and phototherapy (narrowband UV-B [NB-UV-B] light therapy). These treatments are considered effective and well-tolerated, with potential for enhanced repigmentation when used in combination. In addition, short outdoor UV exposure may augment response to topical therapy. Emerging data on tJAKi usage in patients under 12 years shows promise, though further research is needed. Specifically, TCIs applied twice daily, TCSs and off-label use of topical ruxolitinib 1.5% cream for patients under 12 years old with nonsegmental vitiligo were recommended. Additionally, while TCIs and TCSs are recommended as first-line therapies, caution is advised regarding their long-term use due to the risk of adverse effects such as atrophy. Topical JAK inhibitors, particularly ruxolitinib, are increasingly recognized as beneficial, especially for patients 12 years and older, although limited evidence exists for younger patients. Consideration of body surface area limitation and counseling on potential adverse events are recommended. Other experimental strategies such as topical pseudocatalase and microdermabrasion should be approached with caution due to limited evidence supporting their efficacy. The absence of patient-centered outcomes in pediatric vitiligo literature and heterogeneity in grading systems are noted concerns. Guidance included age-specific considerations, a minimum therapeutic trial of at least 6 months, extended therapy to prevent recurrence, and the advantageous coordination of UV therapeutic sources.

Early-onset vitiligo, particularly before age 12, is linked to a severe progression and reduced quality of life, marked by heightened stigma, depression, and long-term mental health challenges. These highlight the need for evidence based guidelines for the treatment and prevention of progressed presentations. This article outlines evidence-based recommendations for diagnosing and treating vitiligo in adolescents, emphasizing the use of topical therapies like calcineurin inhibitors, corticosteroids, JAK inhibitors, and phototherapy for optimal management and improved outcomes.

Publication Date: April 13th, 2024

Reference: Renert-Yuval Y, Ezzedine K, Grimes P, Rosmarin D, Eichenfield LF, Castelo-Soccio L, Huang V, Desai SR, Walsh S, Silverberg JI, Paller AS. Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients. JAMA dermatology. 2024 Mar 13.

Summary By: McKenzie Van Eaton