Ophthal Plast Reconstr Surg, Vol. 32, No. 3, 2016
Unilateral Poliosis of Eyelashes Gabriel Vainstein, M.D.*, and Arie Y. Nemet, M.D.† Abstract: A 68-year-old man presented with significant, asymptomatic, unilateral eyelash poliosis, not associated with any ophthalmic or systemic conditions. He reported that this started about 40 years ago with a few lashes in the central portion of his eyelid and that adjacent eyelashes subsequently became involved over the next 4 to 5 days. He had normal ophthalmologic and neurologic examinations with no other relevant medical history reported. The case might be an unusual presentation of a halo nevus. To the best of the authors’ knowledge, this is the first such case reported regarding the eyelashes. The case and relevant literature are presented.
P
oliosis (polios = gray) is defined as a localized area of hypopigmented hair caused by a reduction or absence of melanin in a group of follicles. In humans, eyelashes are generally the most darkly pigmented hair,1 and in fair-haired individuals, eyebrows and eyelashes are much darker than scalp hair.2 Acquired poliosis of the eyelashes has been described in several ophthalmic conditions, including blepharitis, sarcoidosis, sympathetic ophthalmia, herpes zoster, Vogt-KoyanagiHarada syndrome, vitiligo, tuberous sclerosis,3 postirradiation, with topical administration of prostaglandin F2 analogues,4,5 and halo nevus.6 A case of unilateral poliosis not associated with any of these ophthalmic conditions and with no skin involvement was described. A search of MEDLINE and PubMed failed to discover any similar cases.
CASE PRESENTATION A 68-year-old man was examined routinely by a neurologist. On examination a significant, asymptomatic, unilateral poliosis was observed. On physical examination, a significant color difference between his right and left eyelashes was noted—the right lashes were white, while the left were black. He reported that the color change started about 40 years ago, involving a few lashes on the central part of his eyelid and adjacent eyelashes subsequently became involved over the next 4 to 5 days. Ophthalmologic examinations were normal. His visual acuity was 20/20 in OU, and there were no significant findings in the anterior segment or fundus. Serological tests for autoimmunity (antinuclear antibodies, rheumatoid factor blood test and anticentromere antibodies) were negative. His medical history included ischemic heart disease, hypertension, hyperlipidemia, and percutaneous transluminal coronary angioplasty. There was no associated family history of vitiligo, poliosis, or autoimmune disorders such as Vogt-Koyanagi-Harada syndrome or sarcoidosis.
Case Reports
demonstrates either decreased or absent melanin and/or melanocytes in the hair bulbs of the affected hair follicles.8 The epidermal melanocytes are usually not affected unless there is associated vitiligo.7 Genetic and acquired conditions are associated with poliosis. Several genetic syndromes, such as tuberous sclerosis, piebaldism, Waardenburg syndrome, neurofibromatosis type 1, and Marfan syndrome, have poliosis as one of their characteristic clinical manifestations.3,8 Nongenetic associations, including vitiligo, Vogt-Koyanagi-Harada syndrome, Alezzandrini syndrome, Alopecia areata, sarcoidosis and halo nevus,6 have also been reported. Drug-induced poliosis has been reported with several topical or systemic medications (prostaglandin analogs, imiquimod, and chloramphenicol).9,10 Segmental vitiligo, depigmentation of patches of skin, may present in a similar way. It tends to affect areas of skin associated with dorsal roots from the spine and is most often unilateral.11 In segmental vitiligo, the eyebrow and eyelashes and other hairbearing sites commonly show white hair, and there is also skin involvement. Segmental vitiligo usually spreads within a segment in a short period of time and then tends to stop.7 However, there was no skin involvement in the case reported here. There are only few case reports of poliosis which are not associated with underlying disease. One case of a 5-year-old girl with congenital macular hyperpigmentation on the right side of the nose and congenital color difference between her right and left eyelashes—the right ones black, similar to the hair on other parts of her body—was described. The authors assumed that this was a presentation of a somatic mosaicism for genes affecting pigmentation (Figs. 1 and 2).2 Halo nevi are acquired, compound melanocytic nevi and appear in childhood and early adolescence. It was suggested to be an autoimmune response directed against antigenic changes of dysplastic nevi, or against melanocytes, as occurs in vitiligo.6,12The underlying pathophysiology might be the result of an immune response leading to nevus cell destruction.6 One case of eyelash poliosis as an unusual sign of a halo nevus confirmed histologically was described in a 39-year-old man.6 In this case, only the eyelashes were involved, without the brows or hair. Other reports of halo nevi of the eyelids were accompanied by vitiligo, not poliosis. Some authors suggest an autoimmune response directed against antigenic changes of dysplastic nevi, while others regard it as an autoimmune phenomenon against melanocytes, as occurs in
DISCUSSION Eyelash heterochromia or poliosis implies the growth of eyelash hair of 2 distinct colors in the same individual. Poliosis may affect various regions of the body including the eyelashes, eyebrows, and beard.7,8 On histopathology, it *Department of Neurology, Maccabi Healthcare Services; and †Department of Ophthalmology, Meir Medical Center, Kfar Sava, Israel Accepted for publication June 4, 2014. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Arie Y. Nemet, m.d., Department of Ophthalmology, Meir Medical Center, 59 Tschernihovsky St., Kfar Sava 44281, Israel. E-mail: [email protected] DOI: 10.1097/IOP.0000000000000250
FIG. 1. The patient with eyes closed. A significant color difference between the right and left eyelashes is seen; the right lashes are white, while the left are black. Note the brows on both sides are mixed with black and white hairs.
© 2014 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
e73
Ophthal Plast Reconstr Surg, Vol. 32, No. 3, 2016
Case Reports
REFERENCES
FIG. 2. The patient with eyes open. The lower eyelid lashes present the same heterochromia as the upper eyelids.
vitiligo.6,12 In the presented case, since there is no histologic confirmation of halo nevus, it may be just idiopathic poliosis. In conclusion, a rare case of spontaneous poliosis of the eyelashes is presented, which might represent a rare representation of idiopathic poliosis or a halo nevus with poliosis.
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1. de Barker DAR MA, Sinclair RD. Disorders of hair. In: Burns T, Breathnach S, Cox N, et al., eds. Rook’s Textbook of Dermatology. 7th edn. Oxford: Blackwell Science, 2004:110. 2. Namazi MR. Eyelash heterochromia. Pediatr Dermatol 2008;25:138. 3. Apibal Y, Reakatanan W, Chunharas A. Poliosis as the first clue of tuberous sclerosis. Pediatr Dermatol 2008;25:486–7. 4. Chen CS, Wells J, Craig JE. Topical prostaglandin F(2alpha) analog induced poliosis. Am J Ophthalmol 2004;137:965–6. 5. Moorthy RS, Inomata H, Rao NA. Vogt-Koyanagi-Harada syndrome. Surv Ophthalmol 1995;39:265–92. 6. Kay KM, Kim JH, Lee TS. Poliosis of eyelashes as an unusual sign of a halo nevus. Korean J Ophthalmol 2010;24:237–9. 7. Hann SK, Lee HJ. Segmental vitiligo: clinical findings in 208 patients. J Am Acad Dermatol 1996;35(5 Pt 1):671–4. 8. Dessinioti C, Stratigos AJ, Rigopoulos D, et al. A review of genetic disorders of hypopigmentation: lessons learned from the biology of melanocytes. Exp Dermatol 2009;18:741–9. 9. Rathod DJ, Shuttleworth GN. Anterior uveitis, poliosis, and skin hypopigmentation associated with topical chloramphenicol allergy following ptosis surgery. Ophthal Plast Reconstr Surg 2007;23:318–9. 10. Sleiman R, Kurban M, Succaria F, et al. Poliosis circumscripta: overview and underlying causes. J Am Acad Dermatol 2013;69:625–33. 11. Lotti TM, Berti SF, Hercogova J, et al. Vitiligo: recent insights and new therapeutic approaches. G Ital Dermatol Venereol 2012;147:637–47. 12. Mihara M, Nakayama H, Aki T, et al. Cutaneous nerves in cafe au lait spots with white halos in infants with neurofibromatosis. An electron microscopic study. Arch Dermatol 1992;128:957–61.
© 2014 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
Unilateral Poliosis of Eyelashes Gabriel Vainstein, M.D.*, and Arie Y. Nemet, M.D.† Abstract: A 68-year-old man presented with significant, asymptomatic, unilateral eyelash poliosis, not associated with any ophthalmic or systemic conditions. He reported that this started about 40 years ago with a few lashes in the central portion of his eyelid and that adjacent eyelashes subsequently became involved over the next 4 to 5 days. He had normal ophthalmologic and neurologic examinations with no other relevant medical history reported. The case might be an unusual presentation of a halo nevus. To the best of the authors’ knowledge, this is the first such case reported regarding the eyelashes. The case and relevant literature are presented.
P
oliosis (polios = gray) is defined as a localized area of hypopigmented hair caused by a reduction or absence of melanin in a group of follicles. In humans, eyelashes are generally the most darkly pigmented hair,1 and in fair-haired individuals, eyebrows and eyelashes are much darker than scalp hair.2 Acquired poliosis of the eyelashes has been described in several ophthalmic conditions, including blepharitis, sarcoidosis, sympathetic ophthalmia, herpes zoster, Vogt-KoyanagiHarada syndrome, vitiligo, tuberous sclerosis,3 postirradiation, with topical administration of prostaglandin F2 analogues,4,5 and halo nevus.6 A case of unilateral poliosis not associated with any of these ophthalmic conditions and with no skin involvement was described. A search of MEDLINE and PubMed failed to discover any similar cases.
CASE PRESENTATION A 68-year-old man was examined routinely by a neurologist. On examination a significant, asymptomatic, unilateral poliosis was observed. On physical examination, a significant color difference between his right and left eyelashes was noted—the right lashes were white, while the left were black. He reported that the color change started about 40 years ago, involving a few lashes on the central part of his eyelid and adjacent eyelashes subsequently became involved over the next 4 to 5 days. Ophthalmologic examinations were normal. His visual acuity was 20/20 in OU, and there were no significant findings in the anterior segment or fundus. Serological tests for autoimmunity (antinuclear antibodies, rheumatoid factor blood test and anticentromere antibodies) were negative. His medical history included ischemic heart disease, hypertension, hyperlipidemia, and percutaneous transluminal coronary angioplasty. There was no associated family history of vitiligo, poliosis, or autoimmune disorders such as Vogt-Koyanagi-Harada syndrome or sarcoidosis.
Case Reports
demonstrates either decreased or absent melanin and/or melanocytes in the hair bulbs of the affected hair follicles.8 The epidermal melanocytes are usually not affected unless there is associated vitiligo.7 Genetic and acquired conditions are associated with poliosis. Several genetic syndromes, such as tuberous sclerosis, piebaldism, Waardenburg syndrome, neurofibromatosis type 1, and Marfan syndrome, have poliosis as one of their characteristic clinical manifestations.3,8 Nongenetic associations, including vitiligo, Vogt-Koyanagi-Harada syndrome, Alezzandrini syndrome, Alopecia areata, sarcoidosis and halo nevus,6 have also been reported. Drug-induced poliosis has been reported with several topical or systemic medications (prostaglandin analogs, imiquimod, and chloramphenicol).9,10 Segmental vitiligo, depigmentation of patches of skin, may present in a similar way. It tends to affect areas of skin associated with dorsal roots from the spine and is most often unilateral.11 In segmental vitiligo, the eyebrow and eyelashes and other hairbearing sites commonly show white hair, and there is also skin involvement. Segmental vitiligo usually spreads within a segment in a short period of time and then tends to stop.7 However, there was no skin involvement in the case reported here. There are only few case reports of poliosis which are not associated with underlying disease. One case of a 5-year-old girl with congenital macular hyperpigmentation on the right side of the nose and congenital color difference between her right and left eyelashes—the right ones black, similar to the hair on other parts of her body—was described. The authors assumed that this was a presentation of a somatic mosaicism for genes affecting pigmentation (Figs. 1 and 2).2 Halo nevi are acquired, compound melanocytic nevi and appear in childhood and early adolescence. It was suggested to be an autoimmune response directed against antigenic changes of dysplastic nevi, or against melanocytes, as occurs in vitiligo.6,12The underlying pathophysiology might be the result of an immune response leading to nevus cell destruction.6 One case of eyelash poliosis as an unusual sign of a halo nevus confirmed histologically was described in a 39-year-old man.6 In this case, only the eyelashes were involved, without the brows or hair. Other reports of halo nevi of the eyelids were accompanied by vitiligo, not poliosis. Some authors suggest an autoimmune response directed against antigenic changes of dysplastic nevi, while others regard it as an autoimmune phenomenon against melanocytes, as occurs in
DISCUSSION Eyelash heterochromia or poliosis implies the growth of eyelash hair of 2 distinct colors in the same individual. Poliosis may affect various regions of the body including the eyelashes, eyebrows, and beard.7,8 On histopathology, it *Department of Neurology, Maccabi Healthcare Services; and †Department of Ophthalmology, Meir Medical Center, Kfar Sava, Israel Accepted for publication June 4, 2014. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Arie Y. Nemet, m.d., Department of Ophthalmology, Meir Medical Center, 59 Tschernihovsky St., Kfar Sava 44281, Israel. E-mail: [email protected] DOI: 10.1097/IOP.0000000000000250
FIG. 1. The patient with eyes closed. A significant color difference between the right and left eyelashes is seen; the right lashes are white, while the left are black. Note the brows on both sides are mixed with black and white hairs.
© 2014 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
e73
Ophthal Plast Reconstr Surg, Vol. 32, No. 3, 2016
Case Reports
REFERENCES
FIG. 2. The patient with eyes open. The lower eyelid lashes present the same heterochromia as the upper eyelids.
vitiligo.6,12 In the presented case, since there is no histologic confirmation of halo nevus, it may be just idiopathic poliosis. In conclusion, a rare case of spontaneous poliosis of the eyelashes is presented, which might represent a rare representation of idiopathic poliosis or a halo nevus with poliosis.
e74
1. de Barker DAR MA, Sinclair RD. Disorders of hair. In: Burns T, Breathnach S, Cox N, et al., eds. Rook’s Textbook of Dermatology. 7th edn. Oxford: Blackwell Science, 2004:110. 2. Namazi MR. Eyelash heterochromia. Pediatr Dermatol 2008;25:138. 3. Apibal Y, Reakatanan W, Chunharas A. Poliosis as the first clue of tuberous sclerosis. Pediatr Dermatol 2008;25:486–7. 4. Chen CS, Wells J, Craig JE. Topical prostaglandin F(2alpha) analog induced poliosis. Am J Ophthalmol 2004;137:965–6. 5. Moorthy RS, Inomata H, Rao NA. Vogt-Koyanagi-Harada syndrome. Surv Ophthalmol 1995;39:265–92. 6. Kay KM, Kim JH, Lee TS. Poliosis of eyelashes as an unusual sign of a halo nevus. Korean J Ophthalmol 2010;24:237–9. 7. Hann SK, Lee HJ. Segmental vitiligo: clinical findings in 208 patients. J Am Acad Dermatol 1996;35(5 Pt 1):671–4. 8. Dessinioti C, Stratigos AJ, Rigopoulos D, et al. A review of genetic disorders of hypopigmentation: lessons learned from the biology of melanocytes. Exp Dermatol 2009;18:741–9. 9. Rathod DJ, Shuttleworth GN. Anterior uveitis, poliosis, and skin hypopigmentation associated with topical chloramphenicol allergy following ptosis surgery. Ophthal Plast Reconstr Surg 2007;23:318–9. 10. Sleiman R, Kurban M, Succaria F, et al. Poliosis circumscripta: overview and underlying causes. J Am Acad Dermatol 2013;69:625–33. 11. Lotti TM, Berti SF, Hercogova J, et al. Vitiligo: recent insights and new therapeutic approaches. G Ital Dermatol Venereol 2012;147:637–47. 12. Mihara M, Nakayama H, Aki T, et al. Cutaneous nerves in cafe au lait spots with white halos in infants with neurofibromatosis. An electron microscopic study. Arch Dermatol 1992;128:957–61.
© 2014 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
