According to the American Academy of Dermatology Association, up to half of people who develop vitiligo do so before the age of 20. But despite its high incidence in childhood and early adulthood, vitiligo can happen at any age, says the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). What’s more, the symptoms of vitiligo may evolve over time. Vitiligo is a lifetime diagnosis, says Alpana Mohta, MD, a Jaipur, India–based dermatologist and medical adviser for Better Goods. And while the Mayo Clinic notes that there’s a chance your skin will stop losing pigment even without treatment, or even regain its color, it’s more likely that your skin will continue losing pigment over greater areas and longer periods of time. Read on to learn how vitiligo may evolve throughout your life, including during childhood, adulthood, and pregnancy.
Vitiligo During Childhood
Research suggests that most people who develop vitiligo do so during childhood. As you age, Dr. Mohta says untreated vitiligo often progresses to involve the surrounding skin or create new patches of discoloration. This is also known as generalized or nonsegmental vitiligo, which is the most common type. Children may also be more likely to develop a subtype of this condition called segmental vitiligo. According to NIAMS, segmental vitiligo tends to develop when you’re young and progresses for 6 to 12 months before stopping. It’s characterized by patches of depigmentation that appear on one side or “segment” of your body (such as one arm or leg) only. Still, segmental vitiligo is also far less common than nonsegmental subtypes, says NIAMS. “Treating childhood vitiligo is a tough challenge since we need to weigh the risk-to-benefit ratio and be careful while selecting the treatment option,” says Sanober Pezad, MD, a double board-certified specialist in integrative and holistic dermatology who’s based in Dallas. Although there are a number of potential treatments for vitiligo, she adds that not all of them are suitable for children. For children with vitiligo, Mohta says that phototherapy and topical calcineurin inhibitors (such as tacrolimus) may work well. The Nemours Foundation says that sunscreen and topical corticosteroid creams may also help treat vitiligo in children.
Vitiligo During Pregnancy
Hormonal changes can affect the progression of autoimmune diseases, including vitiligo. According to a 2021 review, pregnancy may worsen symptoms of vitiligo, and the effects may continue up to six months postpartum. “Estrogen may be involved in the development of vitiligo, since at times the condition is identified during pregnancy, or after contraceptives or hormonal replacement usage during the perimenopausal period,” says Mohta. That said, pregnancy could also have the opposite effect on vitiligo symptoms. Dr. Pezad points out that the appearance of vitiligo can stabilize or even improve during pregnancy. More research is needed in this area to determine the exact influence of pregnancy on the manifestation of this particular autoimmune disease. Treatment-wise, options during pregnancy may be limited to topical therapies, such as corticosteroid creams or phototherapy. Those treatments may still present a risk of fetal harm, so it’s important to weigh the pros and cons carefully with your ob-gyn and dermatologist. Additionally, some research suggests that vitiligo may adversely affect fetal development and increase the risk of preeclampsia, premature birth, or miscarriage. The aforementioned review noted that women with vitiligo had a higher risk of miscarrying, though the researchers noted that further study is needed on the topic. Outside of pregnancy, Mohta notes that women with vitiligo may experience patches of skin that turn pink or red during menstruation. This is also called Punshi’s sign, previous research notes; the skin returns to its depigmented state after the menstrual cycle, without any direct treatment required.
Late-Onset Vitiligo
According to the Mayo Clinic, vitiligo doesn’t exclusively develop during childhood or early adulthood, so it’s important to consider how this disease might show up in middle-aged and older adults. As a rule of thumb, late-onset vitiligo usually refers to cases in which the condition develops after age 40. Previous research also suggests that adults older than 40 with vitiligo may be more likely to have nonsegmental vitiligo and have symptoms on their arms and hands. Other research based on self-reported vitiligo in surveys found that, in adults, this condition is slightly more prevalent in women. At the same time, the authors also estimate that up to 40 percent of adults with vitiligo remain undiagnosed, so in reality more men may have the condition than reported. “Adults can be managed with a wide variety of treatments, including phototherapy, camouflage therapy, vitiligo surgeries (skin grafting), and immunosuppressives like oral and topical corticosteroids, tofacitinib, and cyclosporine,” Mohta explains. Compared with children, adults have more options for treating vitiligo, she adds. But she also notes that elderly adults may not benefit from the aforementioned treatments, due to changes in immunosuppression, delayed wound healing, and skin cancers (in the case of phototherapy).
Comorbidities of Vitiligo
While vitiligo itself may change with age, it’s also important to consider other autoimmune conditions that may develop at some point in your lifetime. According to Medline Plus, up to 25 percent of people with vitiligo have at least one additional autoimmune disorder. Those include (but are not limited to) autoimmune thyroiditis, type 1 diabetes, psoriasis, ulcerative colitis, Crohn’s disease, and rheumatoid arthritis. Mohta notes that other common comorbidities of Vitiligo include alopecia areata, pernicious anemia, Addison’s disease, scleroderma, dermatomyositis, and Sjögren’s syndrome. While Boston Children’s Hospital reports that the majority of autoimmune diseases develop during young adulthood and middle age, some of those conditions may be specific to childhood. Examples include juvenile dermatomyositis, juvenile diabetes (type 1 diabetes), and juvenile idiopathic arthritis. Plus, previous research notes that having vitiligo means you may be at risk of developing certain systemic diseases and dermatological disorders. Those include atopic dermatitis (eczema), eye problems, and hearing issues. Children who develop vitiligo may also be more likely to have thyroid disease, eczema, and premature hair graying. Finally, vitiligo can have a major effect on mental and emotional health. A randomized controlled trial published in Middle East Current Psychiatry in 2021 found that, compared with a 50-member control group who did not have vitiligo, 50 people with vitiligo between the ages of 12 and 60 were more likely to report feeling stressed, anxious, and depressed. “A major comorbidity often overlooked is the negative impact on one’s psychosocial well-being,” notes Pezad, who recommends “addressing healthy mental and social well-being” in addition to vitiligo management and treatment strategies.
Treating Vitiligo at Any Age
No matter how vitiligo may evolve with age, it’s important that you work with a dermatologist to determine the best treatment options for your own situation. According to Penn Medicine, vitiligo is difficult to treat, but options include phototherapy, topical steroids, topical immunosuppressants, and laser therapy. Depigmentation and skin grafts are other less common options. Mohta and Pezad say that there is not just one effective treatment for everyone, and treatment strategies can change throughout a person’s lifetime. Talk with a dermatologist about the pros and cons of each treatment option, based on your condition and age.
