Profile of childhood vitiligo with associated ocular abnormalities in South India

Abstract

Background: Vitiligo is a systemic autoimmune disease due to the loss of melanocytes from the epidermis. Very few reports in the literature are available about the ocular findings and associated cutaneous abnormalities in childhood vitiligo. Aims: Objective of this study was to evaluate the ocular findings, various clinical characteristics and associated cutaneous abnormalities of childhood vitiligo. Materials and Methods: We retrospectively analyzed the clinical data of children with vitiligo who presented to the Dermatology Outpatient Department from August 2011 to August 2014. All patients were assessed for the natural history, clinical characteristics, family history, and associated ocular and cutaneous abnormalities. Results: Of the total 180 children with vitiligo studied, 64 (35.6%) were boys and 116 (64.4%) were girls. The mean current age of the children visiting our hospital was 8 years. History of trauma prior to the onset of vitiligo was present in 13 patients (7.2%). The family history of vitiligo was present in 37 patients (20.6%). Most common clinical type of vitiligo seen in our patients was vitiligo vulgaris (n = 68, 37.8%), followed by segmental (n = 41, 22.8%). The most common site of initial lesion was head and neck followed by lower limbs. Leukotrichia was seen in 65 patients (36.1%), while Koebner phenomenon was observed in 48 children (26.7%). Vitiligo disease activity (VIDA) score of +4 was most commonly seen in 108 patients (60%), followed by +3 seen in 20 patients (11.1%). VIDA score 0 and −1 were seen in 15 (8.3%) and 22 (12.2%) patients, respectively. Cutaneous associations with vitiligo were found in 24 patients (13.3%). These were halo nevi in nine patients (5%), atopic dermatitis in six patients (3.3%), alopecia areata in four patients (2.2%), premature canities in three patients (1.7%), and nevus depigmentosus and lichen nitidus in one patient each (0.6%). Thirty-eight patients (21.1%) were found to have periocular depigmentation. Depigmented spots in the iris were seen in two patients (1.1%). Other findings were lamellar cataract and persistent papillary membrane in one patient each (0.6%). Conclusion: Childhood vitiligo in our study showed preponderance in females. Majority of patients (77.9%) had <5% body surface area involvement. Limited number of patients with ocular findings in comparison with adult population might suggest that childhood vitiligo patients do not have ocular pigmentary abnormalities in the beginning, but as they age or as the disease progresses they may develop ocular pigmentary changes. Anatomical localization of vitiligo to periorbital area may alert us to look for ocular findings.