Clinical Characteristics and Management of Late-Onset Vitiligo

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A recent review recognized late-onset vitiligo (LOV) as an increasingly notable distinct subtype of vitiligo, yet found its definition and clinical features to be inconsistent across studies. Commonly categorized as vitiligo onset at age 30 or older, some studies specifically identify it as starting at age 50 or older.¹ With these inconsistencies in mind, the review evaluated the epidemiology, clinical characteristics, associated comorbidities, and treatment responses of LOV to guide diagnostic accuracy and patient management.

The review stated LOV has distinct clinical, epidemiological, and therapeutic implications, necessitating a tailored approach to diagnosis and management. Synthesizing data from studies following Prisma guidelines, the review aimed to delineate key features of LOV and its differences from early-onset vitiligo.²

“The late-onset vitiligo differed significantly from early-onset vitiligo in its clinical traits, epidemiology, and treatment response,” researchers wrote. “This review highlights the importance of recognizing these distinctions for a holistic approach to effective management and better outcomes.”

Methods

Searches of databases, including PubMed, EMBASE, Google Scholar, Cochrane Library, and Web of Science, were conducted using terms such as "late-onset vitiligo," "adult-onset vitiligo," and "vitiligo in elderly populations." Studies reporting age of onset, prevalence, clinical characteristics, comorbidities, and treatment responses were included.

Epidemiology

The review found the prevalence of LOV varied regionally, ranging from 6.5% in Iran to 14.7% in Southeast Asia. The average onset age was mid-to-late 50s, with slight regional variations (mean onset: 52.5 to 59.4 ± 7.4 years). Gender distribution was generally balanced, although some studies noted a slight female predominance.

Clinical Characteristics

Researchers found vitiligo vulgaris was the most common subtype, comprising 59.3% to 83.5% of cases, while focal vitiligo was significant in some studies, particularly by Kong et al., where it accounted for 45.3% of cases.³ Common initial sites included the head and neck, upper limbs, and face. They stated leukotrichia (72% to 77.8%) and Koebner's phenomenon (79.6%) were frequently observed. Disease stability, characterized by non-progression over 2 years, was a hallmark of LOV.

Comorbidities

The review found autoimmune and endocrine disorders were prevalent among LOV patients (18.5% to 27.41%), with diabetes mellitus (11.1% to 27.41%) and thyroid diseases (1.9% to 9.64%) being the most common. Other conditions included alopecia areata, rheumatoid arthritis, pernicious anemia, and Addison's disease. Non-autoimmune conditions like hypertension and seizure disorders were also reported. Researchers stated a familial history of vitiligo was noted in 23.2% to 27.8% of cases.

Treatment Response

The review found that combination therapies, including topical agents and phototherapy, showed favorable outcomes, particularly for focal vitiligo. Phototherapy demonstrated effectiveness and tolerability in elderly patients with LOV.

Conclusion

Researchers behind the review statedLOV exhibits unique clinical and epidemiological traits compared to early-onset vitiligo. They wrote that the higher prevalence of associated systemic diseases suggests shared autoimmune mechanisms, and stability of the disease in many patients underscores the potential for long-term management strategies. The findings highlight the need for further longitudinal studies to refine treatment protocols and enhance understanding of LOV's progression.

This review emphasizes the importance of recognizing LOV as a distinct clinical entity with specific features and management needs. Researchers stated personalized care that accounts for its unique characteristics, comorbidities, and treatment responses can improve outcomes. Additionally, they noted educating clinicians about these distinctions could enhance diagnostic accuracy and patient quality of life.

According to the review, longitudinal studies and focused clinical trials are essential to better understand the natural history and optimal management of LOV. Researchers stated these efforts will enable more targeted and effective approaches for this unique patient population.

References

1. Arcos-Burgos M, Parodi E, Salgar M, et al. Vitiligo: complex segregation and linkage disequilibrium analyses with respect to microsatellite loci spanning the HLA. Hum Genet. 2002;110(4):334-342. doi:10.1007/s00439-002-0687-5
2. Hasan Z, Pathania YS. Late-onset vitiligo: Epidemiology, clinical characteristics, and management strategies. J Cosmet Dermatol. Published online November 28, 2024. doi:10.1111/jocd.16705
3. Kong YL, Ching VHL, Chuah SY, et al. Retrospective study on the characteristics and treatment of late-onset vitiligo. Indian J Dermatol Venereol Leprol. 2017;83(5):625. doi:10.4103/ijdvl.IJDVL_650_16