|HOW I MANAGE?
|Year : 2000 | Volume
| Issue : 5 | Page : 254
Vitiligo in a child
C R Srinivas
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Srinivas C R. Vitiligo in a child. Indian J Dermatol Venereol Leprol 2000;66:254
Although there will be minor differences in the way each case is handled in general I assess the patient and parents. While the parents keep expressing concern and ask about prognosis, I with firm politeness continue with history taking and examination, which includes duration, history of improvement followed by relapse, sites involved, and evolution. Family history is often forthcoming without asking. I also carefully examine the border of the lesion and if well defined it can be helpful to reassure the parents. Age of the child is important. The psychological impact, most often imposed by parents, can be perceived in all cases, but very young children still are unaffected.
As the atmosphere becomes less tense I explain about the disease to parent. I draw and explain. This is a better method than pictures as we can keep their attention focussed where we want it focussed. We must win over the dominant parent, who is often, the more stable. Only half of what is spoken is listened to and half of what they listen is understood which underscores the need to recouncil.
Topical steroids such as fluticasone and mometasone form the first line of treatment. It is rarely effective but will buy time. Very very rarely I use oral mini pulse steroids. Although this may be frowned upon we cannot go by books authored by our fairer counterpart.
Oral psoralens are best avoided but a bucket or a plastic drum of varying size is good substitute for bath-tub as is bath-suit. One millilitre of 8-MOP of 0.75% concentration to every 2 L of water is a suitable concentration. Number of sittings of bathwater delivery of psoralen and sun exposure is limited by school timings. Twice a week with at least 2 days interval between treatment will be ideal but occasionally only once a week exposure is possible. Any time during the day is suitable but ideal time would be between 9 to 10 am to 3 to 4 pm; latter being more suitable in school going children. Cloth soaked in the solution after gentle squeezing can be placed over small areas or over sites which can not be soaked included by bath. If only part of the limb is involved affected part can be soaked in a bucket of water with 8-MOP and then exposed to UV light.
I have often observed vitiligo lesions become more prominent after PUVA. This is due to relative pigmentation of unaffected surrounding skin and can be reduced by UVA blocking sunscreen over normal skin prior to PUVA. Camouflage should be considered in all school going children.
To conclude, vitiligo among children is a difficult condition to manage and call for tact and skillful counseling.