Türkiye’de çocukluk çağı vitiligolu hastaların klinik ve demografik özelliklerinin incelenmesi: prospektif, kesitsel çalışma

Öz

Amaç: Türkiye’de çocukluk çağı vitiligolu hastaların epidemiyolojisi ile ilgili yapılan çalışma sayısı oldukça azdır. Bu çalışma, Türk toplumundaki çocukluk çağı vitiligolu hastaların demografik ve klinik özelliklerinin prospektif olarak incelemeyi amaçlamıştır. Gereç ve yöntem: Bu çalışmaya 18 yaş altı vitiligosu olan hastalar dahil edildi. Hastaların klinik ve demografik özellikleri incelendi. Hastalığın aktifleşme durumu ve eşlik eden kızarıklık, kaşıntı, köbner fenomeni ile tutulum bölgeleri arasında istatistiksel inceleme yapıldı. Bulgular: Çalışmadaki 78 çocuğun 45’i (%57,7) kız, 33’ü (%43,3) erkekti. Hastalığın ortalama görülme yaşı 7,91 ±4,95 yıldı. Hastaların median vücut tutulum yüzdesi 1 (minimum 1, maksimum 25) idi. Dermatolojiye başvurulduğundaki hastaların yaşı ile hastalık süresi arasında istatistiksel olarak anlamlı korelasyon saptandı (p=0,07, Korelasyon katsayısı=0,313). En sık görülen vitiligo tipi 31 (%39,7) hastada görülen fokal vitiligo iken bunu sırasıyla jeneralize (%37,8), segmental (%14,1) ve akrofasiyal vitiligo (%8,97) izledi. Segmental vitiligo en sık boyunda görülürken sonrasında sırasıyla boyun (%33,3), bacak (%25), kol (%25), yüz (%8,3) ve gövdede (%8,3) görüldü. Akrofasiyal vitiligo kızlarda erkeklere oranla istatistiksel olarak anlamlı ölçüde fazla bulundu (p=0,017). Son iki ay içerisinde baş bölgesinde istatistiksel olarak anlamlı derecede vitiligoda aktifleşme vardı (p=0,007). Köbner fenomeni vücut yüzey tutulum alanı >%1 olanlarda ≤%1 olanlara göre istatistiksel olarak daha sık saptandı (0,009). Sonuç: Bu çalışmaya göre çocukluk çağı vitiligo en sık 10 yaş altında ortaya çıkmaktadır. Hastalık genel olarak vücut yüzey alanının %1’inden azını tutmaktadır ve köbnerizasyon ile bu oran artma eğilimindedir. Fokal ve jeneralize vitiligo en sık görülen formlardır. Segmental vitiligo en sık boyun bölgesinde görülmektedir. Dermatolojiye başvuru sırasında baş bölgesindeki hastalık aktivitesi diğer bölgelere göre daha yüksektir.

Anahtar Kelimeler

• çocukluk çağı vitiligosu,epidemiyoloji

Clinical and demographic characteristics of childhood vitiligo in Turkey: prospective, cross-sectional study

Öz

Purpose: Epidemiologic studies that are conducted on childhood vitiligo are quite rare in Turkey. This study aimed to prospectively investigate the demographic and clinical characteristics of patients with childhood vitiligo in a Turkish cohort.

Material and Method: Patients with vitiligo under the age of 18 were included in this study. The clinical and demographic characteristics of the patients were examined. A statistical examination was performed between the activation status of the disease, accompanying redness, itching, Koebner phenomenon and involvement sites.

Results: Of the 78 children, 45 (57.7%) were girls and 33 (43.3%) were boys. The mean age of occurrence of the disease was 7.91 ± 4.95 years. The median body involvement percentage of the patients was 1 (minimum 1, maximum 25). A statistically significant correlation was found between the age of the patients and the duration of the disease when presented to dermatology (p = 0.07, correlation coefficient = 0.313). The most common vitiligo type was focal vitiligo in 31 (39.7%) patients, followed by generalized (37.8%), segmental (14.1%) and acrofacial vitiligo (8.97%), respectively. Segmental vitiligo was most commonly seen in the neck (33.3%) followed by leg (25%), arm (25%), face (8.3%), and trunk (8.3%), respectively. Acrofacial vitiligo was statistically significantly higher in girls than in boys (p = 0.017). There was statistically significant activation of vitiligo in the head area in the last two months (p = 0.007). The Kobner phenomenon was statistically more common in those with a body surface involvement> 1% than those with ≤ 1% (0.009).

Conclusion: According to this study, childhood vitiligo frequently occurs in children aged under 10 years old. The disease generally involves less than 1% of the body surface area, and this ratio tends to increase with koebnerization. Focal and generalized vitiligo is the most common forms of childhood vitiligo. Segmental vitiligo is most common in the neck area. During the attending to dermatology, disease activity in the head area is higher than in other areas.

Anahtar Kelimeler

• Childhood vitiligo,epidemiology

Kaynakça

1. 1. Malhotra N, Dytoc M. The pathogenesis of vitiligo. J Cutan Med Surg. 2013;17(3):153-72. 2. Hu Z, Liu JB, Ma SS, Yang S, Zhang XJ. Profile of childhood vitiligo in China: an analysis of 541 patients. Pediatr Dermatol. 2006;23(2):114-6. 3. Howitz J, Brodthagen H, Schwartz M, Thomsen K. Prevalence of vitiligo: epidemiological survey on the Isle of Bornholm, Denmark. Arch Dermatol. 1977;113(1):47-52. 4. Pajvani U, Ahmad N, Wiley A, Levy RM, Kundu R, Mancini AJ, et al. The relationship between family medical history and childhood vitiligo. J Am Acad Dermatol. 2006;55(2):238-44. 5. Kemp EH, Waterman EA, Weetman AP. Autoimmune aspects of vitiligo. Autoimmunity. 2001;34(1):65-77. 6. Andrade G, Rangu S, Provini L, Putterman E, Gauthier A, Castelo-Soccio L. Childhood vitiligo impacts emotional health of parents: a prospective, cross-sectional study of quality of life for primary caregivers. J Patient Rep Outcomes. 2020;4(1):1-5. 7. Önen Ö, Kundak S, Özek Erkuran H, Kutlu A, Çakaloz B. Quality of life, depression, and anxiety in Turkish children with vitiligo and their parents. Psychiat Clin Psych. 2019;29(4):492-501. 8. Aksoy F, Evans SE, Karaduman A. Childhood vitiligo: A prospective analysis of 63 patients. Turkiye Klinikleri J Dermatol. 2008;18(2):67. 9. Ezzedine K, Lim H, Suzuki T, Katayama I, Hamzavi I, Lan C, et al. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res. 2012;25(3):E1-E13. 10. Akbas A, Kılınç F, Aktaş A. Clinical and Demographic Characteristics of Children with Vitiligo: Retrospective Analysis of 105 Cases. Turkish J Pediatr Dis:1-8. doi.org/10.12956/tchd.538826 11. Handa S, Dogra S. Epidemiology of childhood vitiligo: a study of 625 patients from north India. Pediatr Dermatol. 2003;20(3):207-10. 12. Al‐Mutairi N, Kumar Sharma A, Al‐Sheltawy M, Nour‐Eldin O. Childhood vitiligo: a prospective hospital‐based study. Australas J Dermatol. 2005;46(3):150-3. 13. Habib A. Vitiligo in children: A distinct subset. J Coll Physicians Surg Pak. 2016;26(3):173-6. 14. Nicolaidou E, Antoniou C, Miniati A, Lagogianni E, Matekovits A, Stratigos A, et al. Childhood-and later-onset vitiligo have diverse epidemiologic and clinical characteristics. J Am Acad Dermatol. 2012;66(6):954-8. 15. Halder RM, Grimes PE, Cowan CA, Enterline JA, Chakrabarti SG, Kenney Jr JA. Childhood vitiligo. J Am Acad Dermatol. 1987;16(5):948-54. 16. Silverberg JI, Silverberg NB. Quality of life impairment in children and adolescents with vitiligo. Pediatr Dermatol. 2014;31(3):309-18. 17. Cho S, Kang HC, Hahm JH. Characteristics of vitiligo in Korean children. Pediatr Dermatol. 2000;17(3):189-93. 18. Pagovich OE, Silverberg JI, Freilich E, Silverberg NB. Thyroid abnormalities in pediatric patients with vitiligo in New York City. Cutis. 2008;81(6):463. 19. Mazereeuw-Hautier J, Bezio S, Mahe E, Bodemer C, Eschard C, Viseux V, et al. Segmental and nonsegmental childhood vitiligo has distinct clinical characteristics: a prospective observational study. J Am Acad Dermatol. 2010;62(6):945-9. 20. Nejad SB, Qadim HH, Nazeman L, Fadaii R, Goldust M. Frequency of autoimmune diseases in those suffering from vitiligo in comparison with normal population. Pak J Biol Sci. 2013;16(12):570-4. 21. Iannella G, Greco A, Didona D, Didona B, Granata G, Manno A, et al. Vitiligo: pathogenesis, clinical variants and treatment approaches. Autoimmun Rev. 2016;15(4):335-43. 22. Mazereeuw-Hautier J, Bezio S, Mahe E, Bodemer C, Eschard C, Viseux V, et al. Segmental and nonsegmental childhood vitiligo has distinct clinical characteristics: a prospective observational study. J Am Acad Dermatol. 2010;62(6):945–9. 23. Hann SK, Lee HJ. Segmental vitiligo: clinical findings in 208 patients. J Am Acad Dermatol. 1996;35(5):671-4. 24. El‐Husseiny R, Abd‐Elhaleem A, Salah El‐Din W, Abdallah M. Childhood Vitiligo in Egypt: Clinicoepidemiologic Profile of 483 patients. J Cosmet Dermatol. 2020. doi.org/10.1111/jocd.13451. 25. Lin X, Tang L-Y, Fu W-W, Kang K-F. Childhood Vitiligo in China. Am J Clin Dermatol. 2011;12(4):277-81. 26. Martins CPdS, Hertz A, Luzio P, Paludo P, Azulay‐Abulafia L. Clinical and epidemiological characteristics of childhood vitiligo: a study of 701 patients from Brazil. Int J Dermatol. 2020;59(2):236-44. 27. Jaisankar TJ, Baruah MC, Garg Br. Vitiligo in children. Int J Dermatol. 1992;31(9):621-3. 28. Agarwal S, Gupta S, Ojha A, Sinha R. Childhood vitiligo: clinicoepidemiologic profile of 268 children from the Kumaun region of Uttarakhand, India. Pediatr Dermatol. 2013;30(3):348-53. 29. Kayal A, Gupta LK, Khare AK, Mehta S, Mittal A, Kuldeep C. Pattern of childhood onset vitiligo at a tertiary care centre in south-west Rajasthan. Indian J Dermatol. 2015;60(5):520.