Adults with a more extensive body involvement, moderate to extremely severe vitiligo and a prolonged clinical course have an early onset in childhood in addition to other prognostic factors as compared to individuals with later‐onset vitiligo

Abstract

Background The extent and disease severity, duration and other associated prognostic cofactors in vitiligo in adults may vary with the age of onset (before or after 10 years of age). Objectives To compare extent and disease severity, duration and other cofactors in adults with early‐onset and late‐onset vitiligo. Methods The medical records of 408 (M:F 1:1.1) adults aged 20‒75 years diagnosed with vitiligo between January 2016 and December 2019 were examined retrospectively. The extent and severity of vitiligo were defined. Characteristics of vitiligo with early onset and late onset were compared statistically and odds ratios calculated for risk assessment. Results 31 (7.6%, M:F 1:2.4) patients had early‐onset vitiligo, and 377 (92.4%, M:F 0.8:1) patients had later‐onset vitiligo. Compared to late onset, patients with early‐onset vitiligo had a significant number of males (71% vs 45.9%), higher percentages of body surface area involvement and moderate to extremely severe disease (29% vs 10.6%), longer duration of disease (41.9% vs 9%), Koebner’s phenomenon (48.4% vs 15.6%) and halo nevus (9.7% vs 1.9%). Differences between the two groups were not significant for types of vitiligo, family history of vitiligo and presence of cutaneous and systemic/autoimmune diseases. Conclusion The adults, males in particular, with generalised vitiligo (>10% BSA involvement) appear to have an early onset and a prolonged clinical course. The presence of Koebner’s phenomenon and halo nevus in patients with early‐onset vitiligo was other poor prognostic factors compared to patients with late‐onset vitiligo. The retrospective, hospital‐based cross‐sectional design and small sample size for stratification remain major limitations.

Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients

“…The 2 statements that did not meet the 70% strongly agree or agree threshold were excluded. Table 1 shows the general consensus recommendations; Table 2, the TCI recommendations; Table 3, the TCS recommendations; and Table 4, the tJAKi and pseudocatalase recommendations …”

Dietary habits in adult Japanese patients with vitiligo

“…Mahajan et al. reported that patients with vitiligo with early onset (< 10 years) are associated with a higher rate of vitiligo with > 10% body surface area involvement and higher proportion of males, compared with patients with later onset (≥ 10 years) 50 . Those studies indicate the association of severity with early childhood onset and of male preponderance with early onset.…”

Assessment of serum granulysin and cathepsin-L levels in vitiligo patients

“…The vitiligo area severity index (VASI) was used to evaluate the disease severity of the patient group, and the vitiligo disease activity score (VIDA) was used to evaluate disease activity. If vitiligo started before 10 years of age, it was defined as early onset, and if it started after 10 years of age, it was defined as late onset 12 . Those with a VIDA score of <0 were classified as stable, and those with a VIDA score of >1 were classified as active vitiligo 13 .…”