Disorders of Pigmentation in Infants and Children

Vitiligo, an autoimmune disorder causing ivory-white patches due to melanocyte destruction, affected 1-2% of the population and was inherited as autosomal dominant with variable penetrance. It commonly appeared in young adults, with 50% of cases before age 20 and 25% before age 8, but was rare in infancy. Lesions typically developed symmetrically on sun-exposed areas and body folds, and could be disfiguring in darker-skinned individuals. Segmental vitiligo, more common in children, was associated with autoimmune disorders and premature graying. Vitiligo had a 10-20% incidence in endocrine autoimmune disorders and was linked to higher incidences of lymphoma, leukemia, and other conditions. Patients often had ocular abnormalities and could be affected by syndromes like Vogt-Koyanagi-Harada and Alezzandrini. The differential diagnosis included conditions like postinflammatory hypopigmentation and albinism.