A Lagging Lock: Hair Cycle Abnormalities in Follicular Vitiligo?

A 32‐year‐old Indian lady presented with a history of localized short white hair over the scalp for the past 3 months and scalp depigmentation for the past 1 month. There was no history of loss of hair over the area or family history of premature canities. On examination, a well circumscribed 5 cm × 1.7 cm area of depigmentation with a lock of coarse white hair [Figures 1 and 2a] was seen over the frontal region. Patchy hypopigmented macules and few spared black hairs were also present in the depigmented area. Some white hairs showed an abrupt transition to pigmented black hair in the distal shaft [Figure 2b]. Isolated short white hairs without scalp depigmentation were noticed over the vertex [Figure 3]. Hair pull test was negative. Biopsy from the frontal area revealed hair follicles with preserved follicular density, normal anagen:telogen ratio and absence of hair follicle melanocytes. The patient was treated with a combination of topical tacrolimus, topical steroids, and narrow band ultraviolet B phototherapy for depigmented skin and intralesional steroids for depigmented hair.