Prof. Dr. Yan Valle
Vitiligo Research Foundation (New York, USA)
MANAGEMENT OF PEDIATRIC VITILIGO.
Author: Prof. Dr. Yan Valle
Vitiligo is a non-communicable skin disease, with an average prevalence at 0.4-2.1% of the total population that dips and spikes outside this range in some ethnic subgroups. Its ethiopathogenesis is complex and involves the interplay of multiple factors. Aberrations of melanocytes are responsible for vitiligo onset. Immune system mistakenly identifies these melanocytes as intruders and actively seeks to destroy them.
Nearly half of vitiligo cases have a childhood onset. Three visually different forms are diagnosed, based on the distribution of lesions – non-segmental, segmental and mixed vitiligo, – although difference between the first two is often elusive. They have different treatment approaches, with different therapeutics, timelines and outcome expectations.
Four age psychological categories are often used during a pediatric vitiligo patient evaluation: (a) 0-3 years, (b) 4-8 years, (c) 9-12 years, and (d) 13+ years of age, differentiated by ability to participate in therapy, self-image development and susceptibility to bullying.
Management of pediatric vitiligo should take into account several factors, including location, extension, activity, psychological impact, – in the context of the child’s age, and possible associations with autoimmune diseases among close relatives. The treatment protocol needs to be tailored to individual health condition, in order to avoid negative effects on the overall growth and psychological development of the child.
An early intervention, typically within first 2-3 months of the lesion development, provides better outcomes. The first line of treatment typically includes topical corticosteroids and calcineurin inhibitors of different potency. The second line includes a cautious introduction of UVB phototherapy, based on age and disease severity, in combination with topical treatments. Microsurgery is not recommended in pediatric age. Treatment duration in pediatric age commonly ranges from 3 to 8 months, with nearly 80% success rate. Strict compliance to the protocol greatly improves the outcomes. Screening for co-morbidities – e.g. celiac disease or thyroid disease – may be required to rule out the underlying or borderline conditions.
A life-long supporting skincare is necessary to achieve acceptable and continuous cosmetic results, and to reduce chance for symptomatic recurrence rate after a successful treatment.
Professor at “Centro Studi per la Ricerca Multidisciplinare Rigenerativa, Università degli Studi Guglielmo Marconi” – 2014 – present
Chief Executive Officer, Vitiligo Research Foundation (New York, USA) – 2010 – present
VP, Business Development, Ethnic Television Network (Toronto, Canada) – 2007 – 2010
Director, Business Development, Airborne Media (Toronto, Canada) – 2000 – 2007
Director, Business Development, RuConsulting (Moscow, Russia) – 1992 – 2000
Master of Business Administration, Academy For National Economy (Moscow, Russia) – 1992 – 1993
Master of Science, Electroengineering, Russian Technology University, RTU MIREA (Moscow, Russia) – 1987-1992
Associated Editor: Dermatologic Therapy, Wiley – 2018 – present
Associated Editor: World Health Academy Publication House – 2012 – present
1. Patient-reported outcomes: a five-year long study reveals previously unreported therapeutic, demographic, socio-economic and other correlations in vitiligo. Dermatol Ther. 2018 Sep;31(5):e12620. doi: 10.1111/dth.12620. Epub 2018 Sep 25.
2. Controversial issues in vitiligo patients: a review of old and recent treatments. Dermatol Ther. 2018 Sep 17:e12745. doi: 10.1111/dth.12745.
3. Functional nutrition as integrated approach in vitiligo management. Dermatol Ther. 2018 Aug 28:e12625. doi: 10.1111/dth.12625.
4. An Innovative Therapeutic Protocol for Vitiligo: Experience with the Use of Fraxel Herbium Laser, Topical Latanoprost and Successive Irradiation with UVA – 1 Laser. Open Access Maced J Med Sci. 2018 Jan 21;6(1):49-51. doi: 10.3889/oamjms.2018.059. eCollection 2018 Jan 25.
5. Micro – Focused Phototherapy Associated To Janus Kinase Inhibitor: A Promising Valid Therapeutic Option for Patients with Localized Vitiligo. Vol. 6 No. 1 (2018): Jan 25 (OAMJMS) Global Dermatology-2.
6. A No-Nonsense Guide To Vitiligo. ASIN Paperback: 1973371049. November 2017.
7. Vitiligo: A Step-By-Step Guide to Diagnosis, Treatment And Prophylaxis. VR Foundation. ASIN: B077Q37PFZ. November 2017.
8. Artificial Hair: By the Dawn to Automatic Biofibre® Hair Implant. Open Access Maced J Med Sci. 2017 Dec 30;6(1):156-162. doi: 10.3889/oamjms.2018.001. eCollection 2018 Jan 25.
9. Enhanced genome-wide association studies of autoimmune vitiligo identify 23 novel loci and high-light key pathobiological pathways and causal regulatory variation. Nat Genet. 2016 Nov;48(11):1418-1424. doi: 10.1038/ng.3680. Epub 2016 Oct 10.
10. Methods of Vitiligo Treatment. Collective Monography. ISBN: 978-601-80599-3-3. 2016.
11. VITILIGO. Perspektive I Smjernice. ISBN: 978-953-7959-26-5 HDVD HLZ-a. April 2015.
12. Vitiligo: Challenges and Opportunities for social entrepreneurs and community. Pigmentary Disorders. 1/5. November 2014.
13. Letter to Editor on the World Vitiligo Day Campaign. Pigmentary Disorders: 1/1. June 2014.
14. Natural Antioxidants in General Medicine and in Dermatology. World Health Academy Publishing House. ASIN: B00BKWE3ZU. February 2013.
15. Vitiligo : What’s New, What’s True. World Health Academy Publishing House. ASIN: B00DH2RJZ2. June 2013.
16. Multidisciplinary approach to R&D in vitiligo, a neglected skin disease. Dermatol Ther. 2012 Nov-Dec;25 Suppl 1:S1-9. doi: 10.1111/dth.12009.
17. Treatments of vitiligo: what’s new at the horizon. Dermatologic Ther. 2012 Sept-Oct; 25: S32–S40, 2012.
18. Vitiligo road map. Dermatol Ther. 2012 Nov-Dec;25 Suppl 1:S44-56. doi: 10.1111/dth.12006.
19. Cloud Medical Research Management: a Bio-IT tool for correlative studies in dermatology. Treat Strategies (Dermatol). 1(1): 82-86, 2011.