Childhood facial vitiligo: how intractable is it?

BACKGROUND: Following the recent elucidation of its pathogenic mechanisms involving reactive oxygen species, use of vitamins, folic acid and antioxidants as adjuvant therapy has been suggested.

OBJECTIVE: To evaluate the long-term outcome of childhood facial vitiligo who were treated with nutritional education, vitamin E (α-tocopherol 100-400 IU/day), folic acid (1-2 mg/day) and multivitamin intake and antioxidant cosmetics as the mainstay of treatment as well as the conventional therapies including oral, topical and/or intralesional corticosteroid, topical macrolactam, Excimer laser and epidermal graft.

METHODS: Medical data and photographs of 111 paediatric facial vitiligo patients who had been followed up for longer than 1 year from March 1, 2003 to June 30, 2013 were extracted from data warehouse of electric medical records. Photographic evaluation and final visual outcome assessment was performed.

RESULT: By investigator's assessment, 9% of patients demonstrated no improvement regardless of treatment modality, whereas 91% showed improvement of lesions. Among the latter, 33.3% resulted in >75% improvement; 18% in 50%-75% improvement; 26.1% in 25%-50% improvement; and 13.5% in <25% improvement. In the final visual outcome assessment, 'Looking excellent' was seen in 42.3%; 'looking very good' in 30.6%; 'looking good' in 17.1%; 'looking fair' in 9.0%; and 'looking bad' in 0.9%.

CONCLUSION: Although childhood facial vitiligo is quite refractory to treatment, the long-term outcome of this condition is not dismal with conventional vitiligo therapy along with basic nutritional therapeutic regimen.