I saw a 10-year-old patient recently for a routine physical. One of her mother's concerns was that her daughter had "white patches" under both arms. Once I examined her, I told her mother the "white patches" were actually due to vitiligo, an acquired disorder of pigment loss.
Vitiligo is caused by a reduction in functional melanocytes, the cells that cause pigmentation in the skin. The problem often develops before the age of 20, and there's no difference in predilection for male over female cases. In children, hypopigmented areas are often first noted on sun-exposed areas like the face (around the eyes and mouth) and hands. The underarm area (axilla) is often involved, as are areas around the genitalia. In many cases, the depigmentation is symmetrical (both arm pits, both hands or knees).
Although the exact cause of vitiligo is unclear, it is known to have an immunogenetic basis, as there is a positive family history of others with vitiligo in 30 percent to 40 percent of patients. There are numerous theories as to different reasons the melanocytes (pigment cells) are not working. The genetics of vitiligo is also being studied with changes seen on certain chromosomes.
While doctors are not clear as to how and why vitiligo occurs, in most cases it does seem to be progressive. There's spontaneous re-pigmentation in 10 percent to 20 percent of patients, especially in sun-exposed areas of young patients.
The problem with vitiligo is that treatment is often lengthy and frequently unrewarding. There's not "one way" to treat vitiligo that will ensure re-pigmentation 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 familiar with treating vitiligo is of upmost importance. The sooner the treatment for these "white patches" the better.
(Dr. Sue Hubbard is a nationally known pediatrician and co-host of "The Kid's Doctor" radio show. Submit questions at http://www.kidsdr.com.)
White patches on the skin likely vitiligo
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