Although the classic halo nevus is a brown nevus with a surrounding rim of depigmentation, i.e. a stage I halo nevus, these nevi can have several clinical stages. The central nevus may lose its pigmentation and appear pink with a surrounding halo (stage II), the central papule may disappear leading to a circular area of depigmentation (stage III) or the depigmented area may repigment (stage IV), leaving no trace of its prior existence. Herein we describe an unusual phenomenon – darkening of the central nevus rather than lightening – following the appearance of the halo phenomenon. An 18-year-old boy who had multiple atypical nevi developed multiple halo nevi beginning at the age of 12 years. Following the appearance of the peripheral halos, 2 of his nevi that were originally solid medium brown in color darkened and the hyperpigmentation had a reticulated pattern with perifollicular sparing. One possible explanation is a postinflammatory hyperpigmentation induced by the infiltrating lymphocytes.

Keywords:
Halo nevus, darkening, Perifollicular hypopigmentation
1.
Barnhill RL, Fitzpatrick TB, Fandrey K, Kenet RO, Mihm MC Jr, Sober AJ: Color Atlas and Synopsis of Pigmented Lesions. New York, McGraw-Hill, 1995, pp 95–99.
2.
Frank SB, Cohen HJ: The halo nevus. Arch Dermatol 1964;89:367–373.
3.
NIH Consensus Development Panel on Early Melanoma: Diagnosis and treatment of early melanoma. JAMA 1992;268:1314–1319.
4.
Luna LG (ed): Manual of Histologic Staining Methods of the Armed Forces Institute of Pathology, ed 3. New York, McGraw-Hill, 1968, pp 104–105.
5.
Stegmaier OC: Natural regression of the melanocytic nevus. J Invest Dermatol 1959;32:413–421.
6.
Ortonne JP, Mosher DB, Fitzpatrick TB: Vitiligo and other hypomelanoses of hair and skin. New York, Plenum Press, 1993, pp 567–611.
7.
Kopf AW, Morrill SD, Silberberg I: Broad spectrum of leukoderma acquisitum centrifugum. Arch Dermatol 1965;92:14–35.
8.
Wayte DM, Helwig EB: Halo nevi. Cancer 1968;22:69–90.
9.
Berman A: Halo nevus with exceptional clinical features: Apparent arrest of nevus cell degeneration and return of pigment to halo. Arch Dermatol 1978;114:1081–1082.
10.
Odom RB, James WD, Berger TG: Andrews’ Diseases of the Skin: Clinical Dermatology, ed 9. Philadelphia, Saunders, 2000, pp 875–876.
11.
Bigler CF: Halo nevus; in Demis DJ, Thiers BH, Burgdorf WHC, Raimer SS (eds): Clinical Dermatology, rev 26. Philadelphia, Lippincott Williams & Wilkins, 1999, vol 2, unit 11–36.
12.
Rhodes AR: Benign neoplasias and hyperplasias of melanocytes; in Freedberg I, Eisen AZ, Wolfe K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB (eds): Fitzpatrick’s Dermatology in General Medicine, ed 5. New York, McGraw-Hill, 1999, pp 1032–1034.
13.
Cockerell CJ, Johnson TM, Swanson NA: Benign melanocytic neoplasms: Congenital and acquired nevi; in Arndt KA, LeBoit PE, Robinson JK, Wintroub BU (eds): Cutaneous Medicine and Surgery. Philadelphia, Saunders, 1996, pp 1566–1567.
14.
Bolognia JL, Shapiro PE: Perifollicular hypopigmentation: A cause of variegate pigmentation and irregular border in melanocytic nevi. Arch Dermatol 1992;128:514–517.
15.
Morishima T, Endo M, Imagawa I, Morioka S: Clinical and histopathological studies on spotted grouped pigmented nevi with special reference to eccrine-centered nevus. Acta Derm Venereol 1976;56:345–351.
16.
Akasu R, From L, Kahn HJ: Characterization of the mononuclear infiltrate involved in regression of halo nevi. J Cutan Pathol 1994;21:302–311.
17.
Fernandez-Herrera J, Fernandez-Ruiz E, Lopez-Cabrera M, Garcia-Diez A, Sanchez-Madrid F, Gonzalez-Amaro R: CD69 expression and tumor necrosis factor α immunoreactivity in the inflammatory cell infiltrate of halo naevi. Br J Dermatol 1996;134:388–393.
18.
Barada L, Torres-Alvarez B, Moncada B, Portales-Perez D, de la Fuente H, Layseca E, Gonzalez-Amaro R: Presence of activated lymphocytes in the peripheral blood of patients with halo nevi. J Am Acad Dermatol 1999;41:567–572.
19.
Le Poole IC, van der Wijngaard RM, Westerhof W, Das PK: Presence of T cells and macrophages in inflammatory vitiligo skin parallels melanocyte disappearance. Am J Pathol 1996;148:1219–1228.
20.
Ogg GS, Dunbar PR, Romero P, Chen J, Cerundolo V: High frequency of skin-homing melanocyte-specific cytotoxic T lymphocytes in autoimmune vitiligo. J Exp Med 1998;188:1203–1208.
21.
Nordlund JJ, Collins CE, Rheins LA: Prostaglandin E2 and D2 but not MSH stimulate the proliferation of pigment cells in the pinnal epidermis of the DBA/2 mouse. J Invest Dermatol 1986;86:433–437.
22.
Ruiz-Maldonado R, Orozco-Covarrubias ML: Postinflammatory hypopigmentation and hyperpigmentation. Semin Cutan Med Surg 1997;16:36–43.
© 2001 S. Karger AG, Basel
2001
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.