halonaevus vitiligo mc dr elke janig austria

Elke Janig

Halo Naevi – is it vitiligo?

Department of Dermatology und Venerology

Medical University Vienna

Austria

Our patient

• Healthy 17 years, male• No other diseases, no medication• Family: no Halo naevi, vitiligo or

autoimmune disorders

• 10 Halo Naevi / face and trunk• Vitiligo / face and genital• Hyperpigmented areas / trunk

History of Halo Naevi

• 1512-1516: Matthias Grünewald – painted „the Temptation of St. Anthony“

• 1874: Hebra and Kaposi– perinaevic depigmentation

• 1916: Sutton– Leucodermia acquisita centrifugum

Halo Naevi

• Melanocytic naevus surrounded by a depigmented zone

• Average age of onset ~ 15 years

• 1-5 cm

• Solitary or multiple

• Benign, asymptomatic

• Cosmetic significance

Associated diseases

• Turner`s syndrome

• Vitiligo

• Halo naevi-associated leucoderma

Pathogenesis

• (Postinflammatory) autoimmune reaction against melanocytes or melanoma cells

• Infiltrate:– CD 4 + and CD 8 + T cells– Langerhans cells– Melanophages

Life cycle of a Halo Naevus

• Benign naevus

• Start of depigmentation

• Involution of the naevus

• Depigmented macula

• Repigmentation

Similar Naevi

• Meyerson Nevus: eczematous halo around a pigmented nevus

• Cockade Nevus: central dark nevus surrounded by concentric circles of light and dark pigmentation

• Attention: – Melanoma with regression

Treatment Options

• Information

• Excision

• Topical tacrolimus

• Excimer Laser

• Tattooing

• Excision of the central naevus combined with epidermal grafting or UVB 311nm

Halo Naevi and Vitiligo

• Acquired leucodermas

• No change of skin surface

• Unknown aetiology

• Coincidence 1%-47%

Halo Naevi and Vitiligo

Features Halo Naevus Vitiligo

Wood light White Bluish/ yellowish fluorescence

H2O2Normal levels Elevated levels

Distribution Non-symmetrical Often symmetrical

Progression Limited Progressive

Associated diseases

Rare Autoimmune diseases

Thank you!

Univ.-Prof. Dr. Adrian Tanew