The effect of age on vitiligo

Last Updated on 25th April 2022 by Caroline Haye

Does how old you are make a difference?

As my lovely husband reminded me on my last birthday, age is just a number. I do so agree with him! To a great extent, age is what you make it. It can be an asset, a burden or an utter irrelevance, depending on your mind set. When it comes to health, though, it can have particular significance. And, with that in mind, I have been wondering about the effect of age on vitiligo. For example, does the age at which lesions first appear have any impact on its severity later in life? And does our response to treatments depend on the age of onset; or perhaps on our age at the time of treatment?

There does not appear to have been much research done into this subject. But I would like to share with you what I have been able to find out because it is pretty interesting.

At what age does vitiligo start?

The answer to this question depends on how you define “start”. If we accept that the root cause of vitiligo is a genetic one, then you could argue that the disorder, or at least the risk of developing it, is present from conception. But, as far as I am aware, there are no cases of babies being born with the condition.

Vitiligo can start at any time of life; but there is some difference of opinion as to the most common age for the first signs to appear. According to some sources, 50% of cases develop before the age of 20, with this proportion decreasing with increasing age. Other sources put the typical age of onset at around 10 and 30 years of age. Either way, it appears that it takes a combination of genes and environmental factors to produce the symptoms of vitiligo. And it seems that these typically appear, on average, somewhere in or around the age of 20.

That said, there are plenty of examples of pigment loss starting later than this. Many women, for example, report their first symptoms during or after pregnancy or, in some cases, around the menopause. This presumably indicates a hormonal involvement. My first white patches, on the other hand, became visible when I was just a toddler. And many vitiligo friends I speak to developed theirs during early childhood too. So that would suggest some other environmental trigger must have been the reason for such early onset.

Does age of onset affect the spread of vitiligo?

Research reported to the American Academy of Dermatology, found that patients who developed vitiligo at a very young age were more likely to see the condition spread extensively than patients who developed their symptoms later in life. (This fits with my own experience: mine continued to spread throughout my life until it had covered roughly 80% of my skin.) But, on the plus side, the same research concluded that there was no difference in the rate of response to treatment between these two groups. (A fact which also supports my own experience of re-pigmentation so late in life.)

Research into the implications of age of onset in autoimmune diseases in general found that these varied from one condition to another. But the study did not include vitiligo. However, another study which focused on late onset vitiligo identified significantly different clinical features in these cases as compared to childhood onset vitiligo. According to this research, vitiligo that develops during childhood is often associated with a family history of skin conditions and with Koebnerisation. Whereas adult onset vitiligo is more often linked to stress and thyroid disease.

Environmental factors and age of onset

One rather unexpected research result, announced in July 2019, noted that the average age of onset for vitiligo patients has actually risen dramatically over recent decades. Researchers at the University of Colorado School of Medicine reported that over the period between 1970 and 2004 vitiligo changed from being a mainly childhood onset condition to mainly adult onset. They suggested that this could be a result of various improvements in the (United States) environment during that time frame. This conclusion struck me as surprising because my perception is that environmental hazards have been proliferating along with consumerism. And I don’t know if the same conclusions would have been reached had the research been done in a different country.

The same researchers also wondered if the trend in delayed vitiligo onset might have something to do with improvements in patients’ gut microbiome; possibly due to the increased popularity of yoghurt. This explanation strikes me as more plausible than the environmental one. My own experiences definitely point to a strong link between gut health and vitiligo. I suffered all through childhood and early adulthood with digestive problems. And I believe these led to poor nutritional absorption and a leaky gut.

During the period studied in the Colorado University research I, like most people in the west, added yoghurt to my diet. This almost certainly helped. But most brands I ate contained high levels of sugar; and they probably had insufficient live bacteria to make a huge difference in my case. So it was not until I began taking certain vitamins, minerals and amino acids that my vitiligo began to improve.

So why are people developing vitiligo later in life?

If people really are developing vitiligo later in life nowadays, it seems to me the reasons must be more complex. It can’t simply be down to an improvement in air and water quality or an increase in yoghurt consumption. One explanation may be that the vitiligo patients themselves (or their parents) have become better informed about their condition. They may be taking greater care with diet and exposure to environmental risks than previous generations ever did. The internet would certainly account for increased awareness. But, since the internet did not exist until the 1990s, this does not explain changes dating back to 1970.

A general trend towards healthier eating among people with particular health issues (including vitiligo) might be a factor. There has certainly been a growth in the use of health foods and supplements during the period studied. But, on the other hand, there has also been a massive increase in the availability of junk foods. And high-sugar, high-fat fast foods and drinks have resulted in a corresponding increase is obesity.

Add to that the reduction in nutritional content of most vegetables, due to soil depletion, and you start to realise the picture is a lot more complicated than it might initially seem. And I haven’t even touched on the use of hormones in meat and the production of GM crops.

All you can really deduce from all this is that changes in diet may have affected the age at which people typically develop vitiligo. But no one really knows exactly how or why.

Vitiligo risks posed by chemicals

As for improvements to the environment, this is also not at all clear cut. There will have been some improvements to some aspects of the environment in certain countries. But then I am sure there will have been a simultaneous decline in other environmental conditions. And some risk factors may even be age specific.

I was shocked to read an article, published in June 2019, called Harmful Chemicals in Children’s Products. This article suggests that exposure to environmental risks is higher now for the young than ever before. Products aimed at children, like “Slime”, glitter and adhesive decorations evidently contain a variety of harmful ingredients. As do textiles, household cleaners and other every day products that they may also come into contact with. And the most worrying thing about this is the lack of regulation. There is no requirement (in some countries at least) for hazardous ingredients even to be declared or listed on consumer product labelling.

So, it’s all very well to point to improvements in air and water quality; but it is a bit too soon to be talking about a reduction in environmental risks. Because it seems we are exposing our children and ourselves to hundreds of potentially harmful chemicals every day.

My conclusions

As I have been writing this post I have realised what a huge and complex topic this is. It is one I will probably want to delve into again at some point. But, for now, the only clear conclusions I am able to draw on the subject of age and vitiligo are these:

1. People are apparently not born with vitiligo
2. Vitiligo has both genetic and an environmental causes
3. Genes determine an individual’s risk of vitiligo
4. Environmental factors (including diet) can act as vitiligo triggers
5. De-pigmentation can begin at any age
6. The earlier it starts, the more widespread it is likely to become
7. Response to treatment is not dependent on the age of onset
8. Regardless of our age, we should avoid known environmental risks as much as possible