Nanette Silverberg, MD, on Managing Comorbidities and Quality of Life in Pediatric Vitiligo

At the 2026 Society for Pediatric Dermatology Annual Meeting, Nanette Silverberg, MD, chief of pediatric dermatology and clinical professor of dermatology and pediatrics at the Icahn School of Medicine at Mount Sinai, emphasized that optimal management of pediatric vitiligo extends beyond repigmentation to include vigilant screening for comorbidities, attention to psychosocial health, and preparation for an expanding therapeutic landscape.

Silverberg highlighted thyroid disease as one of the most clinically significant comorbidities in children with vitiligo. Drawing on data from Mount Sinai’s pediatric vitiligo registry and an upcoming systematic review and meta-analysis conducted with colleagues in pediatric endocrinology, she explained that thyroid dysfunction is frequently underrecognized because many children compensate for early disease without obvious symptoms. She described an “iceberg model,” noting that clinically apparent thyroid disease represents only a small portion of the overall burden. Studies incorporating thyroid-stimulating hormone testing alongside thyroid peroxidase and thyroglobulin antibody screening reveal a substantially higher prevalence of thyroid abnormalities, approaching 20% in some cohorts. Even children who remain euthyroid but test positive for thyroid antibodies warrant ongoing monitoring because they carry an increased risk of developing clinically significant thyroid disease within subsequent years.

“We don't necessarily want to wait until the children are not growing, or are falling off the curve, or are losing performance in school,” she noted.

Beyond endocrine disease, Silverberg discussed the importance of evaluating for anemia, another comorbidity that can contribute to fatigue, impaired school performance, and diminished quality of life. She also stressed the profound psychosocial impact of vitiligo in pediatric patients. While approximately half of younger children report being affected by their disease, that figure approaches nearly all adolescents (98%), underscoring the need to integrate mental health support into comprehensive care. Referral to psychologists or psychiatrists, when appropriate, may help patients and families better manage the emotional burden of the disease.

Silverberg also outlined a rapidly evolving treatment pipeline. Ongoing pediatric clinical trials are evaluating topical ruxolitinib in children aged 2 to 11 years, while oral JAK inhibitors are expected to expand therapeutic options for adolescents in the coming years. Established modalities, including narrowband UV-B phototherapy delivered in-office or through increasingly accessible home units, remain important treatment foundations. Investigational approaches targeting IL-15, the CXCL9/10/11-CXCR3 pathway, and additional immune mechanisms may further broaden future options.

"We want patients and parents to know: treatment is available no matter what your age, no matter how many years you've had disease. It is something you can explore, and the opportunities are increasing over time,” Silverberg told Dermatology Times.

Looking ahead, Silverberg described pediatric dermatology as entering an “exciting” era defined by targeted therapies across multiple inflammatory diseases. As treatment options continue to expand, she emphasized that updated clinical guidelines will play a critical role in helping clinicians individualize therapy, improve long-term quality of life, and potentially reduce the burden of disease-associated comorbidities for children with vitiligo.

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