Spontaneous Re-pigmentation of Vitiligo Following Excision of Halo Congenital Melanocytic nevi: An Interesting Case Report

Summary@#Halo nevi (HN) are benign skin lesion that represent melanocytic nevi in which an inflammatory infiltrate develops, resulting in zone of depigmentation around nevus. Although Sutton originally described the lesion in 1916 as leukoderma acquista centrifugum, the lesions were noted earlier as evidenced in the painting by Matthias Grunwald cica 1512-1516. The prevalence of HNs in the general population is 1%, and HNs usually appear in childhood or early adulthood. Up to 26% of patients with HN have vitiligo, but in very few instances is there an association of HN around congenital melanocytic nevi (CMN) and vitiligo. The exact mechanisms responsible for the development of vitiligo and HN and its resolution are unknown. One of the most accepted hypotheses considers that both phenomena are a result of a self-limited immunologic response to pigmented cells, either in the “normal” skin or within the melanocytic lesion. Hereby we present a rare case report of a girl with halo CMN and infraorbital vitiligo. The halo CMN was excised which was followed by spontaneous improvement of vitiligo.

Enfermedades poco frecuentes. Halo nevus. Presentación de un caso clínico / Rare diseases. Halo nevus. Presentation of a clinical case

El Halo Nevus consiste en un área hipopigmentada que rodea un nevus melanocítico preexistente y lo hace desaparecer, dejando una cicatriz hipocrómica en el lugar del nevo. Un 20% puede malignizarse. Se presenta un adolescente con lesiones en sus diferentes estados evolutivos, sin sintomatología adicional, ni antecedentes familiares. Es importante el seguimiento clínico y dermatológico para detectar signos tempranos de malignización con el consiguiente tratamiento oportuno

Summary Halo Nevus consists is an hypopigmented area surrounding a pre-existing melanocytic nevus and make it desappared leaving a hypochromic scar in it place, and 20% may become malignant. We present an adolescent with lesions in their different stages of evolution, without additional symptoms or family history. Clinical and dermatological follow-up is important to detect early signs of malignancy with the following timely treatment

Prepubertal and postpubertal vitiligo: a multivariate comparative study in 375 patients

Abstract: Background: The onset of vitiligo during childhood is common. Limited data exist that compare the clinical associations of prepubertal and postpubertal vitiligo in Arabs. Objective: To compare the clinical profile of pre and postpubertal onset vitiligo. Methods: A cross-sectional observational study was conducted. The Vitiligo European Task Force questionnaire was completed for each patient. Results: A total of 375 patients were included; 199 had postpubertal vitiligo (>12 years), and 176 had prepubertal onset vitiligo (<12years). There were more females in the prepubertal group (49%) than in the postpubertal group (29%), p-value <0.001. The prepubertal group has had more involvement than the postpubertal group (45% vs 30%, p=0.004). Only 8 cases of segmental vitiligo were observed; five were observed in the prepubertal group of patients. Female gender (OR=2.3; 95% CI:1.5, 3.5), presence of halo nevus (OR=2.2; 95% CI:1.1, 4.4) and face involvement (OR=1.9; 95% CI:1.2, 2.9) were positively associated with prepubertal vitiligo. Stress, as an onset factor, was positively associated (OR=0.51; 95% CI:0.3, 0.8) with postpubertal onset vitiligo. Study limitations: A possible selection bias toward more severe vitiligo cases can be a limitation, because the study was conducted in a clinic specialized in vitiligo. Moreover, a likelihood of false recall bias cannot be excluded. Conclusions: Our data present clinical evidence that vitiligo behaves mostly the same way in the prepubertal group as in the postpubertal group. However, female over-representation, more face involvement and more halo nevi were observed in prepubertal vitiligo, while stress was more prevalent as an aggravating factor in postpubertal vitiligo patients.

Halo Nevus Arising from Congenital Melanocytic Nevus Featuring an Early Onset Vitiligo / 이화의대지

Halo nevus and vitiligo are known to be associated with immunologic defect that result in typical skin lesions. Random shapes and sizes of whitish patches, depending on the type, are featured in vitiligo. Halo, on the other hand, presents by surrounding the previous pigmented lesion leaving a whitish-halo-like appearance. The mechanisms underlying these entities remain to be elucidated. Various immunological responses along with biomechanical activities suggest causal relationship between the two diseases. A 6-year-old male patient was recently presented with multiple whitish patches on the various parts of the body in a Koebner phenomenon manner. A noticeable hairy congenital melanocytic nevus surrounded a well-demarcated halo of depigmentation was also observed. Clinical and pathological findings were conclusive of as halo nevus with multiple concurrent vitiligo. The pathogenic relationship between the two entities must be underlined since the nature of disease progression is associated and the respective management may also be altered accordingly.

A Case of Halo Phenomenon Induced by Molluscum Contagiosum / 대한피부과학회지

Halo nevi (HN), also known as Sutton's nevi or leukoderma acquisitum centrifugum, are nevomelanocytic nevi surrounded by a rim of depigmentation. A 9-year-old female presented with an asymptomatic solitary flesh-colored 0.75-cm-sized papule surrounded by depigmentation on the right cheek 1 month ago. The excisional biopsy demonstrated molluscum contagiosum and decreased basal layer pigmentation on Fontana-Masson stain. The halo phenomenon is often associated with an acquired nevus cell nevus, but has also been associated with a congenital nevus cell nevus, non-neuroectodermal lesions such as angiomas, seborrheic keratoses, lichen planus, sarcoid, psoriasis, involuting flat warts, and histiocytoma. Our patient had an unusual association of molluscum contagiosum with the halo phenomenon. We suppose that the halo phenomenon in this patient might have been provoked by the molluscum contagiosum virus. A halo nevus-like appearance suggests the possibility of disease other than nevus. In such cases, skin biopsy is required for confirmation.

Early Involvement of Hair Melanocytes Prior to Epidermal Melanocytes in the Progress of Halo Nevus / 대한피부과학회지

No abstract available.

Vulvar vitiligo-like depigmentation and multiple halos of hypomelanosis at the trunk following treatment with imiquimod 5% cream for vulvar condylomata: casual or related events?

A 25-year-old Caucasian female with multiple genital warts involving the vulvar area was treated with imiquimod 5% cream. During follow-up the patient developed areas of hypopigmentation at the site of application of imiquimod cream and areas of hypomelanosis around multiple preexisting nevi of the trunk. At 18 months follow-up genital depigmentation persisted and halo nevi of the trunk were still present. Different mechanisms of imiquimod-induced depigmentation have been reported. Halo nevi are considered expression of an autoimmune response. In the case presented here, it might be conceivable that both vitiligo-like depigmentation at the site of application and halo of hypomelanosis around melanocytic nevi have been induced by the same immunologic mechanism elicited by topical application of imiquimod.

Criterios dermatoscópicos de halo nevo y halo melanoma / Dermoscopy criteria of halo nevi and halo melanoma

El fenómeno halo es más común en lesiones melanocíticas benignas. Se han reportado casos de halo nevo en individuos con antecedentes personales o familiares de melanoma como también melanomas con halo lo que ha suscitado preocupaciones acerca del diagnóstico y manejo de estas lesiones. El halo nevo pertenece al grupo de los simuladores de melanoma. A través de una técnica no invasiva como es la dermatoscopia se puede diferenciar las características dermatoscópicas del halo nevo y halo melanoma

Halo phenomenon appears more often in benign melanocytic lesions. There have been reports of halo nevi in individuals with personal or family history of melanoma as well as melanomas with halo, raising concerns about the diagnosis and management of these lesions. Halo nevus belongs to the group of melanoma simulators. Dermoscopic features of halo nevus and melanoma can be differentiated through a noninvasive technique such as dermoscopy.

Halo Congenital Nevus Followed by Periocular Vitiligo / 대한피부과학회지

Halo nevus is a pigmented nevus surrounded by acquired round depigmentation. Depigmentation appears mostly around several types of pigmented lesions, such as acquired nevus, congenital nevus, blue nevus and Spitz nevus. In contrast, it is rare that depigmentation develops around a congenital nevus. While the precise etiology of halo nevus and vitiligo remains uncertain, several theories suggest that both phenomena result from an immunologic reaction to melanocytes by CD8 + T cell. We report a case of halo congenital nevus in the arm, which is followed by periocular vitiligo. This is the third case in Korean dermatological literature.

Association of giant congenital melanocytic nevus, halo nevus and vitiligo in a 75-year-old patient / Associação de nevo melanocítico congênito gigante, nevo halo e vitiligo. Relato de caso em paciente de 75 anos

A giant congenital melanocytic nevus represents a rare condition. The halo phenomenon may be seen in congenital or acquired melanocytic nevi. In the literature, association of halo nevus and giant congenital melanocytic nevus is rare and the association of both with vitiligo even more rare. A 75-yearold woman at first consultation complained of a hyperchromic bluish-brown hairy macula on the lower back, buttocks and thighs present since birth and an achromic halo of onset three years ago. The histological features were consistent with congenital melanocytic nevus and halo nevus, respectively. After two years the patient developed achromic areas in normal skin, histologically consistent with vitiligo. The authors emphasize the rarity of this triple combination, the patient's age and the absence of malignant degeneration to date.

Nevo melanocitico congênito gigante constitui uma condição rara. O fenômeno halo pode ser observado em nevos melanocíticos congênitos ou adquiridos. Na literatura a associação nevo halo e nevo melanocítico congênito gigante é rara e a associação de ambos com vitiligo ainda mais rara. Mulher de 75 anos que à primeira consulta apresentava mácula hipercrômica castanho-azulada pilosa na região lombar, nádegas e coxas desde o nascimento e halo acrômico de aparecimento há 3 anos. Os histológicos foram compatíveis com nevo melanocítico congênito e nevo halo respectivamente. Após dois anos evoluiu com áreas de acromia à distância, com histológico de vitiligo. Os autores ressaltam a raridade desta tripla associação; a idade da paciente e a ausência de degeneração maligna até o presente momento.

Halo Nevi and Vitiligo in Turner's Syndrome / 대한피부과학회지

Turner's syndrome (TS) is a genetic disorder caused by numeric and/or structural abnormalities of the X chromosome. It is characterized by a short stature, gonadal dysgenesis, and frequently by webbed neck, cubitus valgus, lymphedema, broad chest with wide spaced nipples, micrognathia, and brachimetacarpalia. Several cutaneous manifestations are associated with TS, including melanocytic nevi, hypertrophic scarring, and vitiligo. Rarely reported findings include hemangiomas, angiokeratomas, and halo nevi. We present a case of halo nevi and vitiligo in a 13-year-old girl with TS. To the best of our knowledge, halo nevi and vitiligo in TS has not been reported in the Korean literature.

Halo Congenital Nevus Associated with Extralesional Vitiligo / 대한피부과학회지

Halo nevus is a pigmented nevus surrounded by a round or oval depigmentation. Of patients with halo nevus, 18 to 26% patients have vitiligo, either involving the nevus or at a distant site. While the exact etiology of halo formation and vitiligo is unknown, several theories suggest that common immunologic mechanisms are involved in the destruction of melanocytes of both phenomena. Unlike common melanocytic nevus, congenital nevus associated with both halo formation and concurrent extralesional vitiligo is very uncommon and only one case has been reported in the Korean dermatological literature. A 19-year-old female presented with surrounding depigmentation around a congenital hairy nevus on the left forearm. Simultaneously, vitiligo appeared on the lowerabdomen and surrounding regions of both areola. The halo depigmented lesion around congenital nevus and the periareolar vitiliginous lesion shared some histological and immunohistochemical features. These findings further support common immunological mechanisms of pigment destruction in both phenomena.

Poliosis of Eyelashes as an Unusual Sign of a Halo Nevus

A 39-year-old man with poliosis of his lower eyelid lashes visited our clinic. He reported that his symptoms began with a few central lashes and then spread along the adjacent lashes during the ensuing 2 weeks. A pigmented nevus, approximately 4 mm in diameter, was identified just above the white lashes without surrounding skin depigmentation. No specific findings were identified with regard to the patient's general health or serologic and radiologic testing. Excisional biopsy of the pigmented nevus was performed. On histopathologic examination, infiltration of the dermis by numerous lymphocytes and melanophages was observed. The poliosis was ultimately diagnosed as a presenting sign of the halo phenomenon in the regressive stage of a melanocytic nevus.

Development of Halo Nevus Around Nevus Spilus as a Central Nevus, and the Concurrent Vitiligo

Halo nevus is a benign melanocytic nevus that is surrounded by a hypopigmented zone. The most frequent association with halo nevus is vitiligo, and this also appears in nearby regions, as well as at other remote sites. Although the mechanism for developing the depigmentation around nevus spilus is uncertain an immunologic process may be responsible for the finding of inflammatory infiltrates of the upper dermis in the depigmented lesions. We report here on a 13-year-old boy who showed a depigmented zone around a nevus spilus on the right side of his neck with simultaneous vitiligo lesions on the face.

Qual é a profundidade da pigmentação do nevus piloso gigante que acomete o dorso? / Congenital giant nevocellular nevus of the back with worsening deep extension to the fat and fascia?

A presença de pigmentação profunda no nevus piloso gigante dificulta sua ressecção completa e deve ser levada em consideração no plano de tratamento. Um caso clínico no qual a pigmentação foi encontrada atingindo a fáscia muscular levou-nos a avaliar as possibilidades terapêuticas disponíveis. A lesão foi removida cirurgicamente, com comprovação patológica de remoção completa de toda sua extensão na profundidade, com resultado estético-funcional favorável através da utilização de expansores de tecido. Técnicas atuais para a reconstrução cirúrgica após a remoção dos nevos pilosos incluem excisão seriada, enxertia de pele parcial, enxertia de pele total e retalhos cutâneos pré-expandidos. Qualquer que seja o método, a remoção completa do nevus piloso gigante que acomete o dorso é muitas vezes impossível sem mutilação, casos em que a melhor opção é a ressecção parcial da lesão seguida de acompanhamento clínico rigoroso. O avanço nas indicações de alguns tipos de laser tem possibilitado novas perspectivas no tratamento dessas lesões, mas o laser não remove os melanócitos sob a camada dérmica profunda e podem dificultar o monitoramento de malignizações. Atualmente, a cirurgia ainda permanece a forma mais segura de tratamento para o nevus piloso gigante que acomete o dorso.

Giant congenital nevi are melanocytic lesions that cover large areas of the body and are associated with the development of malignant melanoma. Recent numbers showed that the risk of malignancy is lower than previously reported, making the treatment based merely on oncologic anticipation no longer suitable. The presence of deep pigmentation makes certain treatment options not as effective as surgical ablation. A clinical case is presented here to raise treatment options when the deeper location of the pigmentation may alter the surgeon’s approach. The presence of deep pigmentation in a Giant Congenital Nevus makes its complete removal very difficult and should be taken into consideration when planning for treatment. A clinical case in which the pigmented lesion was found to extend deep into the muscle fascia is described. The lesion was surgically removed with an acceptable functional and aesthetic result through the utilization of tissue expansion. Modern techniques for surgical reconstruction after removal of the giant nevus include serial excision, partial skin graft, full- thickness skin graft and the utilization of previously expanded skin flaps. Whatever the method of treatment employed, complete removal might de impossible without mutilation, situation in which it is preferable partial removal followed by close clinical follow-up. The indications for utilization of lasers have opened a horizon of possibilities; however, the laser treatment does not remove pigmented cells located at the level of the deep dermis, and they may difficult the follow- up. The presence of deep pigmentation makes certain treatment options not as effective as surgical ablation.

Poliosis Circumscripta Associated with Halo Nevus of the Scalp / 대한피부과학회지

Poliosis circumscripta describes a localized patch of white hair due to deficiency of melanin in the hair follicles. It is a feature of various conditions such as piebaldism, Vogt-Koyanagi-Harada syndrome, tuberous sclerosis, vitiligo, recent herpes zoster infection, or overlying a scalp neurofibroma. We report a rare case of poliosis circumscripta associated with halo nevus of the scalp. A 24-year-old woman presented with a 10 year history of an asymptomatic, pinkish nodule on the scalp which had overlying poliosis. On histopathological examination, dermal nevus cells were observed and the hair follicles of the depigmented patch were found to be devoid of pigment.