Yonago Acta medica 2012;55:81–82

Wart with Depigmented Halo and Generalized Vitiligo
Takamichi Ito,*† Yuichi Yoshida,* Koji Adachi,* Masutaka Furue† and Osamu
Yamamoto**Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan and †Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Depigmented haloes sometimes appear around melanocytic tumors or non-melanocytic tumors, but coexistence of warts and depigmented haloes is extremely rare. We report here anunusual case of warts accompanied by depigmented haloes and subsequently-triggered generalized vitiligo. A 55-year-old Japanese man presented with a 3-year history of brown nodules
on the back, upper eyelid and dorsum of the left hand. Depigmented haloes appeared aroundthe noldules and then gradually spread over a wide area, resulting in the development of generalized vitiligo. He had no history of antecedent treatment for these lesions before consultation. Histopathologically, the lesion showed papillomatosis and hyperkeratosis with lymphocytic exocytosis into the epidermis, which compatible to warts. Based on these clinical and histopathologic findings, a diagnosis of warts with depigmented halo and subsequently-triggered
generalized vitiligo was made. None of the warts had resolved spontaneously after the appearance of haloes, and the depigmented haloes and generalized vitiligo remain unchanged.
Key words: depigmented halo; verruca; vitiligo; wart

on the left upper eyelid. It was 7 mm in size andthe surface was papillomatous (Fig. 1). Results ofroutine laboratory studies were unremarkable. Dermoscopic examination revealed exophytic papillary
structures with hyperkeratosis and dotted vessels in
the tops of dermal papillae. Similar nodules wereobserved on the left face, upper part of the back anddorsum of the left hand. Most of the nodules wereaccompanied by depigmented haloes. Generalized
vitiligo was also seen (Fig. 2). He underwent skinbiopsy of the verrucous nodule with a depigmented
halo on the dorsum of the left hand as a representative lesion. Histopathologically, the lesion showedpapillomatosis and hyperkeratosis with lymphocytic
exocytoses into the epidermis. In addition, there
were superficial lymphocytic infiltrate in the dermis. Based on these clinical and histopathologic
findings, a diagnosis of warts with depigmented
halo and subsequently-triggered generalized vitiligo
was made. None of the warts had resolved spontaneously after the appearance of haloes. ResidualDepigmented haloes sometimes appear aroundmelanocytic tumors such as melanocytic nevi andmalignant melanomas. Although there have beensporadic patient reports on this phenomenon in nonmelanocytic lesions, coexistence of warts and depigmented haloes is extremely rare. We report here
an unusual case of warts accompanied by depigmented haloes and subsequently-triggered generalized vitiligo.
Patient Report
A 55-year-old Japanese man presented with a 3-year
history of brown nodules. He had felt pruritus in
the nodules 3 weeks before consultation. Depigmented haloes appeared around the noldules andthen gradually spread over a wide area, resulting
in the development of generalized vitiligo. He hadno history of autoimmune diseases and family history of vitiligo. Physical examination revealed a
relatively elevated, flat-topped verrucous nodule81

T. Ito et al.

warts were treated with cryotherapy, and most ofthem consequently showed involution. However, thedepigmented haloes and generalized vitiligo remainunchanged during follow-up period of 6 months.
Discussion
Some non-melanotic lesions are known to be associated with depigmented haloes, but warts with haloes are extremely rare (Berman, 1977); there havebeen only 2 cases in a previous literature. Berman
reported that depigmented haloes developed around
involuting flat warts in 2 patients whose warts weretreated with a 6% salicylic acid-propylene glycol gel
formulation (Berman, 1977). In those patients, allof the warts disappeared soon after the appearanceof depigmented haloes, but generalized vitiligo was
not found.
There are 2 different points between our patient and previous ones (Berman, 1977); the presence of antecedent treatment and generalized vitiligo. Berman used salicylic acid-propylene glycol
gel for treatment of the warts. Some topical agents,
such as imiquimod and diphenylcyclopropenone,
have been reported to induce depigmented vitiligo(Serrão et al., 2008; Oh et al., 2012). These agentsare thought to activate host immune reactions. Although Berman confirmed that the gel did not in-Fig. 1. A verrucous nodule with a depigmented halo on
the left upper eyelid.

duce depigmentation in some healthy people, there
remains the possibility of an association between
the gel and depigmentation. However, no antecedent
topical agent was used in our patient.
Pathogenesis of the halo phenomenon is still
unclear. However, it seems that vitiligo lesion on theback in our patient is composed of multiple depigmented haloes. Because a large number of lymphocytes had infiltrated into the verrucous lesion in ourbiopsied specimen, both depigmented haloes andgeneralized vitiligo might have been elicited by hostreaction, leading to the decrease of melanocytes. It
is of interest that our patient had generalized vitiligo
that spread after inflammation of warts.
References
1 Berman A. Depigmented haloes associated with the involution of flat warts. Brit J Dermatol 1977;97:263–265.
2 Oh YJ, Shin MK, Lee MH. Narrow-band ultraviolet B
treatment for dyphenylcyclopropenone-induced vitiliginous lesions. Acta Derm Venereol 2012;92:102–103.
3 Serrão VV, Páris FR, Feio AB. Genital vitiligo-likedepigmentation following use of imiquimod 5% cream.
Eur J Dermatol 2008;18:342–343.
Received October 25, 2012; accepted October 29, 2012

Fig. 2. Many verrucous nodules with depigmented haloes
and generalized vitiligo on the upper part of the back (arrows).

Corresponding author: Takamichi Ito, MD82