March 17, 2016

Does Childhood Vitiligo Differ When Halo Nevi Are Present?

Mary Wu Chang, MD, reviewing Cohen BE et al. Pediatr Dermatol 2016 Jan/Feb

HN are much more common in vitiligo patients, especially children, but they do not significantly alter treatment response or risk for disease progression.

Vitiligo, characterized by depigmented patches due to loss of melanocytes, affects up to 4% of individuals worldwide. Childhood vitiligo differs from adult vitiligo regarding higher prevalence of segmental disease, history of atopy, and family history of autoimmune disease. Halo nevi (HN) — nevi with an acquired depigmented peripheral zone (see NEJM JW Dermatol Nov 2012 and Am Acad Dermatol 2012; 67:582) that occur in 1% of the general population, usually on the trunk — are more common in vitiligo patients than in the general population and are considerably more common in children with vitiligo than in adults.

These authors retrospectively reviewed charts at an academic pediatric dermatology unit to characterize childhood vitiligo with and without associated HN. Over a 24-year period, 208 children presented with vitiligo, 55 (26%) of whom had HN. Children with vitiligo-associated HN were more likely to be male (62%; P = 0.03) and older at presentation than those with vitiligo alone (5.8 vs. 7.3 years; P = 0.01).

Children with vitiligo-associated HN were more likely to have the generalized vitiligo subtype. No between-group differences were observed in body surface area affected or family history of vitiligo or autoimmune diseases. Patients with HN were no more likely to develop new vitiligo over a mean of 1.9 years, and there were no significant differences in repigmentation.

Comment

HN are up to 10 times more common in vitiligo patients than in the general population, and even more common in children versus adult vitiligo patients. These findings reassure us that HN do not significantly alter treatment response or risk for disease progression.

Citations

Cohen BE et al. Comparison of childhood vitiligo presenting with or without associated halo nevi. Pediatr Dermatol 2016 Jan/Feb; 33:44. (http://dx.doi.org/10.1111/pde.12717. opens in new tab)