ABSTRACT
A 2-year-old girl presented with this patchy area of hypopigmentation involving her vulva and rectal area (Image 26a). Her parents were very distraught and brought the child to the emergency department. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig26a.jpg"/>
What is the diagnosis?
Where else should you examine to confirm your diagnosis?
What tests (blood or skin) would be helpful?
What treatment options are there?
60 https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig26b.jpg"/>This child has vitiligo. In Image 26a there is an area of complete ‘white’ skin around the vaginal introitus and areas of patchy light brown and flesh-coloured skin on the buttocks and inner thighs. These latter areas were originally white and have filled in on their own.
Vitiligo comes in various distributions, one of which is ‘lip-tip’ syndrome. The vitiligo affects the perioral tissues, eyelids, vulvar and perianal areas, fingers and toe tips. A full medical examination with special attention to these areas is needed. Image 26b shows a child with vitiligo of the vulvar and perianal area.
A biopsy of the skin would show lack of melanocytes. Blood tests are not needed to confirm the diagnosis. Some experts would suggest checking for auto-antibodies or other conditions such as thyroid disease. This is controversial as the entities are found in parallel and not linked in a causative manner.
One of the most important concerns in vitiligo is cosmetic, which is a main concern for children and their parents. Treatment options include observation, ultraviolet light and vitiligo grafting surgeries. Topical steroids and topical immune modulators may have benefit. 1 Vitiligo in children causes marked psychosocial and long-lasting effects on the self-esteem of both the affected children and their parents. 2
