28545 A man with halo nevi and premature hair graying
Lyons AB, Awosika O, and Lim HW. 28545 A man with halo nevi and premature hair graying. J Am Acad Dermatol 2021; 85(3):AB197.
J Am Acad Dermatol
Case presentation: A 20-year-old male presented with a 5-month history of asymptomatic depigmented lesions on the trunk and patchy graying of hair. He noted an acute onset of depigmented patches slowly enlarging around nevi on his chest and abdomen. Three months later, he developed similar appearing areas of involvement disassociated from nevi on his chest and back and graying of his scalp hair. He denied any new or changing moles and reported no associated symptoms. Personal and family histories were negative for vitiligo, autoimmune conditions, and skin cancer. On physical examination, there were numerous depigmented macules and patches on the trunk and depigmented patches surrounding symmetric, evenly pigmented, well-demarcated 3-6 mm brown-black macules on the trunk. There was also patchy graying of the scalp hair. Wood’s lamp examination revealed fluorescence of depigmented macules and patches on the trunk. Labs were notable for mild anemia and TSH within normal limits. The patient also had a normal ocular exam by ophthalmology. Betamethasone dipropionate 0.05% ointment BID, gingko biloba (60 mg BID), and alpha lipoic acid (100 mg daily) were started with no improvement at 4 months.
Discussion: Halo nevi may be associated with nonsegmental vitiligo or melanoma-associated leukoderma. In patients with multiple halo nevi, premature hair graying may represent a robust immune response that warrants a search for melanoma as a possible trigger. Melanoma was ruled out in this case with full skin and ocular examinations. This clinical presentation of halo nevi, nonsegmental vitiligo, and premature hair graying represents a rare triad.