Prognostic value and clinical significance of halo naevi regarding vitiligo

Background: Vitiligo and halo naevi can present together or separately. Whether they are different entities remains unclear.

Objectives: To assess the clinical significance of halo naevi, both with respect to the future development of vitiligo, and to the clinical profile and course of vitiligo.

Methods: In total, 291 patients were included in this study: patients with only halo naevi (group 1; n=40), patients with generalized vitiligo without halo naevi (group 2; n=173) and patients with generalized vitiligo with halo naevi (group 3; n=78).

Results: Patients with only halo naevi (group 1) reported significantly less associated autoimmune disease (P=0·001), were less likely to have a family history of vitiligo (P=0·013) and were less likely to have presence of Koebner phenomenon (P<0·001) compared with patients with generalized vitiligo (groups 2+3). Multiple halo naevi (≥3) were significantly more frequently observed (P=0·002) in patients from group 1 compared with patients from group 3. In group 3, halo naevi were reported prior to the development of vitiligo in 61% (mean±SD time interval of 33·7±5·17months). No significant correlation was observed between the presence of halo naevi and the extent, activity or subtype of vitiligo. However, halo naevi in patients with vitiligo significantly reduced the risk for associated autoimmune diseases, and age at onset of vitiligo was significantly lower compared with patients with vitiligo without halo naevi (P<0·001).

Conclusions: Our results support the hypothesis that halo naevi can represent a distinct condition. In a subset of patients, the occurrence of halo naevi may be an initiating factor in the pathogenesis of vitiligo.