Segmental vitiligo of the lid margin with leukotrichia of lashes in a child

A 5-year-old child was brought by the parents with complaints of graying of lashes. Poliosis of the left medial upper lid lashes (Figure 1A) and segmental vitiligo of the underlying lid margin (Figure 1B) were noted on examination. No signs of uveitis or infection were seen. No other areas of hypopigmentation were observed. The child was diagnosed with “Segmental vitiligo with leukotrichia”. After appropriate laboratory workups and referrals, tacrolimus 0.1% ointment was started for 6 weeks, and the child is currently under follow-up. Vitiligo is an autoimmune disease that progressively destroys skin melanocytes⁽¹⁾ and secondarily involves the hair follicles, which causes leukotrichia. Follicular vitiligo of the lashes is a differential diagnosis that primarily affects the melanocytic reservoir of the hair follicle⁽²⁾ inducing primary depigmentation of the follicle without initial involvement of the surrounding skin. Topical calcineurin inhibitors, Janus Kinase inhibitors, steroids, and surgical modalities such as follicular unit extraction have been attempted with limited success.

Figure 1. External photograph of the medial part of the upper lid of the left eye: (A) Leukotrichia of the lashes (arrow). (B) Lid margin segment (underlying the gray lashes) with segmental vitiligo (solid arrow) without the involvement of the overlying lid skin.

REFERENCES

1. Chang WL, Lee WR, Kuo YC, Huang YH. Vitiligo: an autoimmune skin disease and its immunomodulatory therapeutic intervention. Front Cell Dev Biol [Internet] 2021[cited 2022 June 21];9:797026. Available from: Vitiligo: An Autoimmune Skin Disease and its Immunomodulatory Therapeutic Intervention - PMC (nih.gov)

2. Cabrera R, Reculé F, Hojman L, Larrondo J. Follicular vitiligo: dermatoscopic features of a new subtype of vitiligo. An Bras Dermatol [Internet]. 2019[cited 2023 Jan 24];94(1):120-1. Available from: Follicular vitiligo: dermatoscopic features of a new subtype of vitiligo - ScienceDirect

Submitted for publication: March 27, 2023.
Accepted for publication: April 25, 2023.

Funding: This study received no specific financial support.

Disclosure of potential conflicts of interest: None of the authors has any potential conflicts of interest to disclose.