Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net Letter
ARTICLE IN PRESS
doi:
10.25259/IJDVL_405_2024

Alopecia areata sparing vitiligo: Another Renbök phenomenon

Department of Dermatology, Hangzhou Third People’s Hospital, Westlake Ave 38, Hangzhou, China.

Corresponding author: Dr. Bo Xie, Department of Dermatology, Hangzhou Third People’s Hospital, Westlake Ave 38, Hangzhou, China. wavethanks@163.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Zhang Y-T, Xie B. Alopecia areata sparing vitiligo: Another Renbök phenomenon. Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_405_2024

Dear Editor,

The Renbök phenomenon refers to an area of non-involvement in an otherwise generalised skin disease. Here, we describe a case with coexisting alopecia areata (AA) and vitiligo with retained hair growth localised to the vitiligo lesion. The development of alopecia areata-sparing vitiligo has not been reported previously.

A 50-year-old woman presented with a depigmented patch on the occipital scalp 10 months ago. During the subsequent months, scalp hair loss was observed. She was otherwise healthy, did not take any medications, and had no family history of AA or vitiligo. Remarkably, the symptoms of AA were spared in the white patch, which exhibited pigmented terminal hairs [Figure 1a]. Physical examination revealed extensive hair loss on the occipital skin, including the depigmented patch, but most hairs in the white patch were retained. Dermoscopy revealed black dots, broken hairs, and perifollicular pigmentation [Figure 1b]. We diagnosed this case as vitiligo, accompanied by AA.

Obvious terminal hair growth within a 4 cm well-defined depigmented patch with alopecia areata.
Figure 1a:
Obvious terminal hair growth within a 4 cm well-defined depigmented patch with alopecia areata.
Dermoscopy under polarised light (10×) of the clinically spared area displaying black dots, broken hairs, and perifollicular pigmentation.
Figure 1b:
Dermoscopy under polarised light (10×) of the clinically spared area displaying black dots, broken hairs, and perifollicular pigmentation.

In 1991, Happle et al. first described the Renbök phenomenon in a patient with psoriasis and AA with non-colocalisation.1 In addition to AA, the Renbök phenomenon can spare areas of naevus flammeus, Becker’s naevus, vascular naevus, melanocytic naevus, and scalp sarcoidosis.2 There have also been reports of drug-related eruptions, Stevens‒Johnson syndrome, and contact immunotherapy-induced Renbök phenomenon.3 The duelling cytokines theory is one potential explanation for the complex development of this phenomenon; in this theory, the Renbök phenomenon occurs after inflammatory amplification via the activation of a subset of T helper (Th) cells (Th1, Th2, and Th17). Positive feedback is sustained through the release of related cytokines from Th cells.2

Previous studies of the underlying pathogenesis of both AA and vitiligo have focused on the interferon gamma-driven autoimmune response.4 These specific immune responses target the anagen-stage AA hair follicle bulbs as well as melanocytes in the basal layer of the epidermis in vitiligo, both of which may be caused by abnormal melanocyte autoantigen exposure, the “original perpetrator”.5,6

AA is known to influence pigmented (black or dark brown) hairs and potentially spare white hairs; therefore, we speculated that pigmented hairs in patients are vulnerable to autoantibodies, which preferentially target the melanocytes of the hair follicle. The immune privilege of hair follicles is thought to protect against AA and may be responsible for protecting hair from depigmentation in vitiligo.6 In this case, the vitiligo patch subsequently developed AA, and the existing vitiligo lesion counteracted AA areata progression and retained the hair. We hypothesised that the collapse of immune privilege in hair follicles plays an important role in the interaction between the different autoimmune patterns of the two diseases.

The unique hair residues in vitiligo lesions suggested that the immune pattern of vitiligo could affect the immune privilege of hair follicles under autoimmune attack. We believe that this phenomenon supports a new type of Renbök phenomenon in AA, which helps to elucidate the underlying mechanisms and potential treatment strategies for AA.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Natural Science Foundation of China (NO.82303998).

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

References

  1. , . The Renbök phenomenon: An inverse Köebner reaction observed in alopecia areata. Eur J Dermatol. 1991;2:39-40.
    [Google Scholar]
  2. , , . Renbök phenomenon and contact sensitization in a patient with alopecia universalis. Arch Dermatol. 2010;146:422-5.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  3. , , , . Post-irradiation Renbök phenomenon in erythema multiforme: Report of a case sparing previously irradiated areas. J Eur Acad Dermatol Venereol. 2023;37:85-6.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  4. . Alopecia areata universalis sparing nevus flammeus. Dermatology. 2005;210:227-8.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , . Understanding autoimmunity of vitiligo and alopecia areata. Curr Opin Pediatr. 2016;28:463-9.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  6. , , . Alopecia areata - Vitiligo overlap syndrome: an emerging clinical variant. Indian J Dermatol Venereol Leprol. 2013;79:535-7.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
4,165

PDF downloads
155
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections