Breaking Barriers in Pediatric Vitiligo Treatment

As pediatric vitiligo research progresses, new insights into the condition’s pathogenesis and treatment options are emerging. At the 2025 Masters of Pediatric Dermatology Conference, Dermatology Times spoke with Nanette Silverberg, MD, chief of pediatric dermatology for Mount Sinai Health Systems and clinical professor of dermatology and pediatrics at the Icahn School of Medicine at Mount Sinai, to discuss the evolving landscape of pediatric vitiligo care.

“Pediatric vitiligo is a really robust conversation right now, and my talk has focused on some of the major topics,” said Silverberg. She highlighted the importance of understanding emerging molecular mechanisms, including the roles of CXCL9 and CXCL10, and the impact of the JAK-STAT pathway on T-cell activity. Additionally, interleukin-15 is being explored as a perpetuating agent for salt cells, contributing to disease persistence.

Genetics also play a crucial role in vitiligo, accounting for approximately 5% of risk, though it remains a necessary factor in disease manifestation. Advances in understanding genetic loci continue to enhance diagnostic and therapeutic approaches. Silverberg emphasized, “We have the idea in pediatric vitiligo that there's a holistic view of the child, and it's not just about loss of pigmentation or about inflammation that's systemic.” She says a comprehensive patient-centered approach considers autoimmune risk, oxidative stress, immune processes, and social determinants of health.

Treatment strategies are evolving, with a focus on shared decision-making between physicians and families. Emerging therapies include JAK inhibitors, which are expected to revolutionize repigmentation, particularly for adolescents. Silverberg introduced her “ice cream sundae method” to describe a layered treatment approach. “We start at the bottom with the scoops of ice cream, which are the anti-inflammatory agents—we have to get rid of the inflammation so we can free these nice melanocytes to do their thing.” This foundation is followed by therapies promoting melanocyte function, such as narrowband UVB phototherapy and JAK inhibitors, and maintenance strategies to sustain pigmentation.

For patients who do not achieve repigmentation through medical therapy, surgical interventions offer new possibilities. One promising advancement is melanocyte-keratinocyte transplant procedures (MKTP), which Silverberg has used in adult trials. “It’s a fabulous adjunct to what we already have in our office, and it takes patients to that 100%—people who couldn’t get there medically will be able to get there,” she noted. These innovations pave the way for a future where complete repigmentation is a realistic goal for all patients.

Ultimately, the field of pediatric vitiligo is advancing rapidly, bringing hope to patients and families. “The future is so bright we have towear shades,” Silverberg remarked, underscoring the optimism surrounding new therapies and comprehensive treatment strategies. With a combination of medical, systemic, and surgical approaches, clinicians are better equipped than ever to support children affected by vitiligo.