Association between congenital melanocytic nevi and vitiligo

Summary: Congenital melanocytic nevus (CMN) is a neural crest derived hamartoma that are usually present at birth. Spontaneous involution of CMN with vitiligo can occur in rare cases. Herein, we present a case report about a unique case of onset of vitiligo following changes in a medium sized CMN in a pediatric patient. A 5-year-old female with significant history of a medium size congenital melanocytic nevus present at birth, located on right posterior leg, presented to the dermatology clinic with white macules localized around the mouth, nose, and left knee that have been present for 6-9 months. Upon further questioning, parents reported that the mentioned birthmark had also changed in size and color, developing also, a depigmented macule around it. Per patient’s mother, the affected areas were asymptomatic, with no pain, itching, or bleeding. On physical exam, well defined depigmented patches on face and lower extremities were noted, as well as 7.5 x 5 cm brown plaque with hypertrichosis and an adjacent 3.5 x 2.4 cm depigmented patch on the posterior right leg. Patient was started on hydrocortisone 2.5% cream for these depigmented areas. The patient presented a month later for a follow-up. At this time, the mother stated that she has been applying the cream, but lesions appear to be the same. Patient was then started on fluticasone propionate 0.05% cream. This case brings clinical evidence of an association of congenital melanocytic nevus and early vitiligo, especially to understand the prognosis of this autoimmune disorder. Although a benign condition, it is vital that dermatologist monitor the CMN due to its association with melanoma. Knowing the potential association can guide dermatologist to recognize the cause of early vitiligo in young children with CMN. Diego Ramos-Briceño¹, Alyssa Hansen², Aeyzel Munoz Gozalez², Bernard Gibson² 1. Universidad Central de Venezuela Escuela de Medicina Luis Razetti, Caracas, Dto. Capital, Venezuela, Bolivarian Republic of. 2. Dermatology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States. Adaptive and Auto-Immunity