|Year : 2021 | Volume
| Issue : 4 | Page : 381-384
Halo nevus and halo phenomenon in dermatology
Manjyot Gautam, Reeya Patel
Department of Dermatology, Venereology and Leprosy, Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India
|Date of Submission||02-May-2021|
|Date of Decision||10-Jul-2021|
|Date of Acceptance||08-Aug-2021|
|Date of Web Publication||01-Oct-2021|
B-404 Harbour View, Sector 19A-Nerul, Navi Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gautam M, Patel R. Halo nevus and halo phenomenon in dermatology. Indian J Paediatr Dermatol 2021;22:381-4
| What is Halo Phenomenon in Dermatology?|| |
The term “Halo phenomenon” refers to a ring or zone of depigmentation occurring around several types of melanocytic or nonmelanocytic lesions, with halo being the prototype of a halo lesion.
Halo nevi, along with vitiligo and melanoma-associated hypopigmentation, belongs to a group of dermatoses called “immunological leukodermas.”
| What Are the Synonyms for Halo Nevus?|| |
Leukoderma acquisitum centrifugum, nevus depigmentosa centrifugum, leukopigmentary nevus, perinevoid vitiligo, perinevoid leukoderma, and Grunewald nevus are the synonyms of halo nevus.
| Describe the Historical Aspects of Halo Nevus?|| |
Hebra originally described halo nevus (HN). Sutton described HN as leukoderma acquisitum centrifugum in 1916. Happle termed it as “Grunewald nevus” to honor the artist Mathias Grunewald who depicted a bull-like monster with multiple halo lesions in his altarpiece Wandelalter (1512–1516).
| What are the Factors That can Trigger the Onset of a Halo Phenomenon?|| |
Halo phenomenon most often occurs spontaneously, but it can be triggered following exposure to sunlight, exogenous depigmenting agents, local trauma (scratching, friction), or psychosocial stress, which causes the nevus to be recognized by the immune system as foreign and thereby mounting an immune response against it.
| What is the Etiology of a Halo Phenomenon?|| |
The exact etiology is not fully understood, but the halo phenomenon is believed to be immunologically mediated against the melanocytes. The depigmentation is due to a mononuclear cell infiltrate composed predominantly of cytotoxic CD8+ T-lymphocytes surrounding the degenerating nevus/tumor cells leading to the destruction of the nevus cells/tumor cells as well as the adjacent epidermal melanocytes that express the same antigens. IgM or IgG autoantibodies against melanocytes have been found in the serum of patients with halo nevi, suggesting the role of humoral immunity in the development of the halo phenomenon. However, recent studies have failed to demonstrate a temporal relation between the appearance of circulating antibodies and the regression of the central nevus. It is now believed that antibody production follows destruction of the nevus cells by cytotoxic T-cells and subsequent release of antigens.
| What Are the Epidemiological Features of a Halo Nevus?|| |
HN is seen in 1% of the general population. There is no sex predilection. It is more often seen in children and young adults. Back is the most common site for HN. Halo nevi may be solitary or multiple (20%–50%).
An increased incidence of halo nevi has been reported in patients with Turner syndrome.
| What Are the Stages in the Evolution of a Halo Nevus?|| |
Studies have shown that the halo nevi may persist for more than a decade. However, a major subgroup evolves through various stages to finally regress completely. Up to 50% of the HN undergo spontaneous resolution over 8 years on an average.
The stages in the evolution of HN are as follows:
- Stage I: Contains a central pigmented nevus/tumor outlined by a circular or oval hypo- or depigmented area;
- Stage II: The central nevus/tumor loses its color resulting in a pink-colored papule surrounded by the halo;
- Stage III: The central papule disappears and the depigmentation remains;
- Stage IV: Shows a partial or complete re-pigmentation of the skin.
| What Are the Conditions in Dermatology Associated with Halo Phenomenon?|| |
Dermatological conditions associated with the halo phenomenon can be classified as melanocytic and nonmelanocytic, as shown in [Table 1] [Figure 2] and [Figure 3].
|Figure 2: Neurofibromatosis.1 with halo neurofibroma with vitiligo vulgaris|
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|Figure 3: Halo around an atypical melanocytic nevus (outlined with a marker). Biopsy was suggestive of melanoma. The background shows multiple benign naevi on the trunk (courtesy Dr Tanumay Raychaudhury)|
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It is most commonly associated with acquired melanocytic nevi of junctional, compound, and intradermal variants. It is rarely seen in congenital melanocytic nevi (CMN) where it is generally associated with regression of the nevus. However, on rare occasions, it could indicate the development of a melanoma within the CMN.
| What Are the Microscopic Criteria Required for the Diagnosis of a Halo Phenomenon?|| |
The microscopic criteria for the halo phenomenon included the obligate presence of a band-like lymphohistiocytic infiltrate and a diminution or absence of melanin pigment at the dermoepidermal junction at the periphery of the nevus. This depletion of melanin results in the development of a zone of depigmentation around the nevus/tumor.
| What are the Histologic Forms of Halo Nevus?|| |
There are four histologic forms of HN:
Inflammatory, noninflammatory, HN without halo diagnosed by histopathology, and halo dermatitis around a melanocytic nevus.
The inflammatory HN in its early stage shows nests of nevus cells embedded in a dense inflammatory infiltrate, in the upper dermis, and at the dermoepidermal junction. Later, scattered nevus cells predominate over the nests. Cells show evidence of damage to their nucleus and cytoplasm and apoptotic nevus cells are commonly observed. In both inflammatory and noninflammatory HN, the epidermis of the halo first shows a reduction in the amount of melanin, ultimately resulting in absence of melanin and also a negative DOPA (Dihydroxyphenylalanine) reaction. In the early lesions, lymphocytes may be seen rosetting around damaged melanocytes in the halo.
| What Are the Dermoscopic Findings of a Halo Nevus?|| |
The dermoscopic findings include the uniform globular pattern with blue pepper-like granules and/or white-scar areas.
| Enumerate the Differential Diagnoses of Halo Nevus|| |
- Dysplastic nevus
- Spitz nevus
- Basal cell carcinoma.
| What is Inverse Halo Phenomenon?|| |
When the depigmentation commences within the center of a melanocytic nevus, it is termed as the inverse halo phenomenon.
| What is Pseudo Halo Nevus?|| |
Development of a hypopigmented zone around a melanocytic nevus secondary to overuse of sunscreen on and around the nevus is termed as pseudo HN.
| What are the Risk Factors Associated with the Development of Vitiligo in Patients with Halo Nevi?|| |
Halo nevi are not associated with segmental vitiligo. Approximately 20% of individuals with halo nevi have nonsegmental vitiligo [Figure 1]. The risk factors include multiple halo nevi, koebnerization, or family history of vitiligo. It is believed that the dermal lymphocytic infiltrate in HN leads to an oxygen burst with the generation of oxidants like H2O2. This oxidative stress may trigger the onset of vitiligo in these patients.
| Will the Surgical Excision of a halo Nevus Reduce the Risk of Developing Vitiligo?|| |
Many dermatologists advise surgical excision of the HN as they believe that this would halt the abnormal immunological mechanism targeting the melanocytes and thereby reduce the risk of development of vitiligo. However, there is no evidence in the literature to support this concept.
| Is There an Association Between a Halo Nevus and Melanoma?|| |
Majority of the halo nevi are benign. A HN can indicate the presence of melanoma on rare occasions, especially in older adults and when the HN has atypical features like an irregular shape and variegated color. A complete examination of the skin and eyes for melanoma is recommended in these patients. Dermoscopy may be helpful. However, a recent study by Haynes et al. concluded that adult-onset HN was associated with a 1% risk of primary cutaneous melanoma development in the year following HN diagnosis, with no cases of primary noncutaneous or metastatic melanoma.
Interestingly, vitiligo and halo nevi have been linked to treatment success in melanoma patients treated with immunotherapy.
| What are the Features that Differentiate a Halo Nevus from the Halo Phenomenon in a Melanoma?|| |
The features that differentiate Halo Nevus from the halo phenomenon in melanoma are given in [Table 2].
|Table 2: Differentiating features between a halo nevus from a halo phenomenon in melanoma|
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| How Do You Treat a Halo Nevus?|| |
Majority of the halo nevi are benign and no treatment is necessary, particularly in children and adolescents. However, if the HN has atypical features such as an irregular shape, variegated color, and if present in the elderly, the nevus should be surgically excised and sent for histopathological examination to rule out a melanoma.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]