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eyelash_poliosis [2025/09/18 20:36] – Scott Larsoneyelash_poliosis [2026/05/26 19:12] (current) – [Eyelash Poliosis] Scott Larson
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 ====== Eyelash Poliosis ====== ====== Eyelash Poliosis ======
-FIXME 
-Idiopathic poliosis is a diagnosis of exclusion when no underlying cause is found. Vitiligo is a common acquired pigmentary disorder that can present with poliosis of the eyelashes, often accompanied by depigmented skin patches; it is frequently associated with other autoimmune conditions. Chronic blepharitis may rarely cause poliosis due to chronic inflammation of the eyelid margin. Post-inflammatory change from atopic or contact dermatitis can result in localized poliosis, especially if there is a history of eczema or dermatitis involving the periocular region. Drug-induced poliosis is most commonly seen with topical prostaglandin F(2α) analogues used for glaucoma, which can cause reversible poliosis of the eyelashes. Halo nevus or other benign nevus-associated poliosis may present as localized whitening of lashes adjacent to a melanocytic nevus. Phthisis bulbi or chronic uveitis–related poliosis can occur in the context of longstanding ocular inflammation.[1-5] 
-Most Important Not to Miss Diagnoses: 
-Vogt–Koyanagi–Harada (VKH) disease is a multisystem autoimmune disorder that can present with eyelash poliosis, often accompanied by bilateral granulomatous uveitis, auditory symptoms, and meningeal signs. Diagnosis relies on clinical findings and multimodal imaging, with indocyanine green angiography and enhanced depth imaging OCT being key tools. Sympathetic ophthalmia is a bilateral granulomatous uveitis following ocular trauma or surgery, and may present with poliosis; early recognition and prompt systemic immunosuppression are critical. Cutaneous/ocular malignant melanoma may rarely present with poliosis due to destruction of melanocytes adjacent to a melanoma; biopsy is required for diagnosis, as recommended by the American Academy of Dermatology.[6-8] 
-Key Additional History and Follow-up Tests: 
-• History of autoimmune disease, ocular trauma, surgery, or topical medication use. 
-• Associated skin depigmentation, hearing changes, or neurologic symptoms. 
-• Slit-lamp examination for uveitis. 
-• Skin and eyelid examination for vitiligo, nevi, or dermatitis. 
-• Consider biopsy of suspicious lesions. 
-• Imaging (OCT, ICGA) if VKH or sympathetic ophthalmia is suspected. 
-• Thyroid and autoimmune panel if systemic disease is suspected. 
-Would you like me to summarize the latest diagnostic criteria and recommended workup for Vogt–Koyanagi–Harada (VKH) disease, given its importance as a "not to miss" cause of eyelash poliosis? 
  
-1. 
-Vitiligo: A Comprehensive Overview Part I. Introduction, Epidemiology, Quality of Life, Diagnosis, Differential Diagnosis, Associations, Histopathology, Etiology, and Work-Up. 
-Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. 
  
-Journal of the American Academy of Dermatology. 2011;65(3):473-491. doi:10.1016/j.jaad.2010.11.061.+====Causes==== 
 +  * Idiopathic- diagnosis of exclusion 
 +  * Vitiligo 
 +    * acquired pigmentary disorder of skin and hair with depigmented skin patches 
 +    * frequently associated with other autoimmune conditions.  
 +  * Chronic blepharitis 
 +  * Post-inflammatory change from atopic or contact dermatitis especially if there is a history of eczema or dermatitis involving the periocular region.  
 +  * Drug-induced  
 +    * topical prostaglandin F(2α) analogues used for glaucoma, usually reversible poliosis  
 +  * Skin lesions 
 +    * Cutaneous/ocular malignant melanoma may rarely present with poliosis due to destruction of melanocytes adjacent to a melanoma; biopsy is required for diagnosis 
 +    * Halo nevus or other benign nevus-associated poliosis  
 +      * localized whitening of lashes adjacent to a melanocytic nevus.  
 +  * Uveitis associated poliosis  
 +    * Phthisis bulbi 
 +    * Vogt–Koyanagi–Harada (VKH) disease  
 +      * a multisystem autoimmune disorder  
 +      * bilateral granulomatous uveitis, auditory symptoms, and meningeal signs. 
 +    * Sympathetic ophthalmia is a bilateral granulomatous uveitis
  
- +====Resources==== 
-2. +  - [[https://pubmed.ncbi.nlm.nih.gov/21839315|Vitiligo: A Comprehensive Overview Part I. Introduction, Epidemiology, Quality of Life, Diagnosis, Differential Diagnosis, Associations, Histopathology, Etiology, and Work-Up. Alikhan A, Felsten LM, Daly M, Petronic-Rosic V.Journal of the American Academy of Dermatology. 2011;65(3):473-491.]] 
-Interventions for Chronic Blepharitis. +  - [[https://www.nejm.org/doi/full/10.1056/NEJMra2023911|Atopic Dermatitis.Ständer S. The New England Journal of Medicine. 2021;384(12):1136-1143.]] 
-Lindsley K, Matsumura S, Hatef E, Akpek EK. +  - [[https://pubmed.ncbi.nlm.nih.gov/15126178/|Topical Prostaglandin F(2alpha) Analog Induced Poliosis. Chen CS, Wells J, Craig JE. American Journal of Ophthalmology. 2004;137(5):965-6.]] 
- +  - [[https://pubmed.ncbi.nlm.nih.gov/23850259/|Poliosis Circumscripta: Overview and Underlying Causes. Sleiman R, Kurban M, Succaria F, Abbas O. Journal of the American Academy of Dermatology. 2013;69(4):625-33.]] 
-The Cochrane Database of Systematic Reviews. 2012;(5):CD005556. doi:10.1002/14651858.CD005556.pub2. +  - [[https://pubmed.ncbi.nlm.nih.gov/34145419/|Precise, Simplified Diagnostic Criteria and Optimised Management of Initial-Onset Vogt-Koyanagi-Harada Disease: An Updated Review. Herbort CP, Tugal-Tutkun I, Abu-El-Asrar A, et al. Eye (London, England). 2022;36(1):29-43.]] 
- +  - [[https://pubmed.ncbi.nlm.nih.gov/34494974/|Recent Advances in Diagnosis and Management of Sympathetic Ophthalmia. Fromal OV, Swaminathan V, Soares RR, Ho AC. Current Opinion in Ophthalmology. 2021;32(6):555-560.]] 
- +  - [[https://pubmed.ncbi.nlm.nih.gov/30392755/|Guidelines of Care for the Management of Primary Cutaneous Melanoma. Swetter SM, et al. Journal of the American Academy of Dermatology. 2019;80(1):208-250.]]
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-3. +
-Atopic Dermatitis. +
-Ständer S. +
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-The New England Journal of Medicine. 2021;384(12):1136-1143. doi:10.1056/NEJMra2023911. +
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- Leading Journal  +
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-4. +
-Topical Prostaglandin F(2alpha) Analog Induced Poliosis. +
-Chen CS, Wells J, Craig JE. +
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-American Journal of Ophthalmology. 2004;137(5):965-6. doi:10.1016/j.ajo.2003.11.020. +
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-5. +
-Poliosis Circumscripta: Overview and Underlying Causes. +
-Sleiman R, Kurban M, Succaria F, Abbas O. +
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-Journal of the American Academy of Dermatology. 2013;69(4):625-33. doi:10.1016/j.jaad.2013.05.022. +
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-6. +
-Precise, Simplified Diagnostic Criteria and Optimised Management of Initial-Onset Vogt-Koyanagi-Harada Disease: An Updated Review. +
-Herbort CP, Tugal-Tutkun I, Abu-El-Asrar A, et al. +
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-Eye (London, England). 2022;36(1):29-43. doi:10.1038/s41433-021-01573-3. +
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-7. +
-Recent Advances in Diagnosis and Management of Sympathetic Ophthalmia. +
-Fromal OV, Swaminathan V, Soares RR, Ho AC. +
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-Current Opinion in Ophthalmology. 2021;32(6):555-560. doi:10.1097/ICU.0000000000000803. +
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-8. +
-Guidelines of Care for the Management of Primary Cutaneous Melanoma. +
-Swetter SM, Tsao H, Bichakjian CK, et al. +
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-Journal of the American Academy of Dermatology. 2019;80(1):208-250. doi:10.1016/j.jaad.2018.08.055. +
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-Practice Guideline+
  
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