Tattooing with electrocauterization: A cosmetically acceptable therapeutic modality for a single halo naevus

Introduction

Halo naevus also known as Sutton′s naevus or perinaevoid vitiligo or leucoderma acquisitum centrifugum, is characterized by a pigmented naevus with a surrounding depigmented zone. The naevus is usually intradermal with a central area of depigmentation having a regular sharply demarcated border. It may be single or multiple and develops mostly in teenage groups.[1] Usually treatment of halo naevus is not indicated as it is believed that repigmentation will take place eventually. We hereby report two cases of single lesion halo naevus on exposed areas being treated for cosmetic reasons with tattooing in combination with electrocauterization, thereby giving cosmetically acceptable results.

Case Report

Case 1. A 16 - year - old male presented with a halo naevus on right side of cheek in front of tragus. It progressed slowly to the present size of about 2 x 1.5cm in diameter. It was stationary for the last 6 months without any progression or reggression. Examination revealed a single, oval-shaped, depigmented zone of about 2x1.5cm surrounding pigmented naevus of about 0.7x0.6cm was present with a clear demarcation of margins over right cheek in front of tragus

[Figure - 1]. Routine investigations like Hb, TLC, DLC, BT, CT urinalysis FB.S., elisa for H.I.V I and II were done and were found to be within normal limits. As the patient insisted that any

colour other than white is welcome for cosmetic reasons, tattooing was done in depigmented area [Figure - 2] followed by electrocauterization after one month in the naevus part. He was followed up regularly for one year and had shown significant cosmetic acceptance.

Case 2. A 6 - year -old female child presented with a single halo naevus on right side of neck for last one year. It was stationary for the last 6 months without any progression or involution. Examination revealed a single halo naevus with depigmented zone of about 1x0.5 cm surrounding a pigmented naevus of about 0.1 x 0.2 cm. in diameter on anteromedial side of neck in front of right sternocleidomastoid muscle. Routine investigations like Hb, TLC, DLC, BT, CT, FB.S., elisa for H.I.V I and II, urinalysis were done and found to be within normal limits. Here also tattooing in depigmented zone followed by electrocauterization after one month on naevus part was done for cosmetic reasons on parent′s insistence. This was followed up regularly for 6 months and had shown significant cosmetic acceptability

Discussion

Tattooing or micropigmentation is one of the surgical methods used to treat stable vitiligo by permanent camouflage. Tattooing is defined as uniform implantation of minute inert pigment granules into dermis, so as to artistically create a permanent cosmetic camouflage.[2] On the medical front, Galena used tattooing to improve defects of colouration as early as the second century. Pauli[3] performed medical tattooing to colour naevi and grafts in1835. Over the years, tattooing has been advocated to camouflage corneal leukomata, naevi and to reconstruct eyebrows,[4] areola and nipple.[5]

In our reporting, both the cases of halo naevus were single, asymptomatic and stationary for the last 6 months. Specific treatment modality is neither available nor indicated because of their spontaneous repigmentation. But in our reporting, these were treated with tattooing followed by electrocauterization for cosmetic reasons only. These results showed significant cosmetic acceptability to the patient. So, these cosmetically acceptable therapeutic modality can be considered as one of the options for treatment in cases of single halo naevus.