Epidemiological Study On The Relationship Between Vitiligo And Halo Nevus In Children

Background: Patients suffering from vitiligo often accompanied with halo nevus. However, the research on the relationship between vitiligo and halo nevus is not much. And the epidemiological survey of vitiligo with or without halo nevus in children is few.Objective: To evaluate the relevance of vitiligo and halo nevus on clinical epidemiology, we collected clinical epidemiological data of children with vitiligo with or without halo nevus.Materials and methods: The clinical cases were from the outpatients who were diagnosed with vitiligo visiting in our hospital from January 1, 2011 to December 30, 2013. Vitiligo was diagnosed according to "Clinical Dermatology" edited by Zhao. Following assessed the patient’s condition, a professional doctor collected some clinical epidemiological data. Non-segmental vitiligo patients between 0-14 years old were enrolled in our study. Patients were divided into two groups: vitiligo with halo nevus(test group), vitiligo without halo nevus(control group). Sex, age, incidence of the season, course of disease, clinical stage, type, the distribution of lesions, lesion area, family history of vitiligo or premature hair graying, and other auto-immune diseases were all considered. According to the condition some appropriate treatments were given. Patient was asked to visit every two months, some interviews were got through telephone to know their condition. Follow-up includes recoverage and new skin lesion involved of vitiligo and halo nevus, and they were compared.Results: In total, 245 patients with vitiligo(nonsegmental) with or without halo nevus were enrolled in this study. Among them, 42 cases(17.14%) were in the test group, the control group had 203 cases(82.86%). Children in the test group had 22 males and 20 females, male to female ratio was 1.1: 1; the control group, 105 cases of male children, 98 females, male to female ratio was 1.07: 1. The average age of onset of vitiligo was(7.57 ± 3.21) years in the test group, the control group was(7.45 ± 3.59) years, and the youngest onset age of test group was 3 years old, there were 5 cases in the control group less than 1 year old. The average duration of the test group was(6±3)months(range from 15 days to 5 years), and the control group was(6 ± 2) months(range from 15 days to 11 years). No significant difference in sex, the average age of onset between two groups.Because long course of disease, 70 cases of children with season of outburst was unknown. 26 patients of test group, the majority(12 cases) were at the onset of summer, accounting for 28.57%, followed by the onset of spring 16.67%(7 cases), then winter 11.90%(5 cases), last fall accounting for 4.76%(2 cases). Compared with in the test group, the summer was slightly higher incidence in the control group, accounting for 29.56%(60 cases), and a slightly higher incidence of winter, accounting for 21.67%(44 cases), No significant difference in onset of season between two groups.Generalized vitiligo was more commen in test group, accounting for 90.47%(38 cases), significantly more than the control group 59.61%(121 cases)(P=0.0017). And test group had only 4 cases of unclassified vitiligo, no mucosal or acrofacial vitiligo was found. 9 cases of mucosal vitiligo, 8 cases of acrofacial vitiligo and 65 cases of unclassified vitiligo were in the control group.Vitiligo and halo nevus were located in the head, face, neck mostly, in the test group there were 30 cases(71.43%) and control group had 125 cases(61.58%). Most There was significant difference in location of trunk between two groups(P=0.007). the experimental group had 28 patients(66.67%), while the control group had 89 cases(43.84%). No significant difference in location of other area between two groups.Most BSA involvements were 1% or less. Test group with 27 cases, accounting for 64.29%, the largest lesion area was 4%; control group with 172 cases, accounting for 84.73%, the largest lesion area was 7%. No significant difference in BSA involvements between two groups.There were 46 children with family history of vitiligo in total, 8 cases(19.05%) children with vitiligo were in the test group, 38 cases(18.72%) for the control group of children; and 41 children with family history of premature hair graying in total survey, test group had 7 cases(16.67%), control group 34 cases(16.75%).We found that there were only 6 cases children with vitiligo combined with other auto-immune diseases, including hypothyroidism, scleroderma, psoriasis, allergic purpura, rash and alopecia areata respectively. No significant difference in family history of vitiligo or premature hair graying, associated auto-immune diseases were observed in patients among two groups.During 3 years follow-up 181 cases of 245 patients, the follow-up rate was 73.88%. Their treatments and prognosises were not quite different. Vitiligo with halo nevus had less effective treatment than vitiligo without halo nevus(P=0.0470), and more children with new-onset vitiligo(P=0.0250). Test group had 13 cases(41.94%) of no effec therapy, and control group had 40 cases(30.00%). Test group made more new-onset vitiligo, accounting for 56.25%(18 cases), control group accounting for 34.07%(46 cases). Conclusion: No significant difference in sex, age, season of onset, BSA involvements, skin lesions area, family history or associated with other autoimmune diseases between two groups. Vitiligo with halo nevus had less effective treatment and more children with new-onset vitiligo than vitiligo without halo nevus in children.