What Is Poliosis (Poliosis Circumscripta)?

Poliosis (poliosis circumscripta) is when a person is born with or develops a patch of white hair but maintains their natural hair color otherwise. It occurs due to a lack of melanin (a substance that produces pigmentation in your hair, skin, and eyes) in certain hair follicles, causing the hair growing from those follicles to be white.

Poliosis can affect any hair on the body, including the scalp, eyebrows, and eyelashes. Though poliosis itself is harmless, sometimes it is a sign of an underlying health issue.

Treatment options for poliosis are primarily cosmetic and focus on camouflaging the white hair patch, such as using hair dyes or colored cosmetic products. Poliosis can affect both children and adults, though exactly how many people have it is unclear. 

Types

There are two main types of poliosis: acquired poliosis and genetic poliosis. Types are based on the underlying cause. 

Acquired Poliosis 

Required poliosis is when external factors lead to the depigmentation of a patch of hair. Common causes include certain medications, inflammatory or autoimmune disorders, and melanoma (a type of skin cancer).

Genetic Poliosis 

Genetic poliosis is linked to inherited factors, meaning it is passed down from parent to child. With this type, the white patch of depigmented hair is generally present at birth or develops in early childhood. Genetic poliosis is associated with rare genetic conditions such as:

• Piebaldism: This is a condition characterized by the absence of melanocytes, or cells that produce melanin, in the skin and/or hair.
• Waardenburg syndrome: This is the term for a group of genetic conditions that may cause hearing loss and/or pigmentation changes in your hair, skin, or eyes.
• Tuberous sclerosis: This is a rare genetic disease that causes non-cancerous (benign) tumors in the brain and/or several other areas of the body, such as the nerves, eyes, spinal cord, skin, and some internal organs.

Poliosis Symptoms 

Poliosis is characterized by a distinct patch or patches of white hair surrounded by normally pigmented hair. Patches of hair absent of color can occur anywhere there is hair on the body, such as:

• The scalp (a white patch of hair on the head is commonly referred to as "white forelock") 
• Eyebrows
• Eyelashes 
  

Poliosis on its own is not serious and does not cause other symptoms. Talk to a healthcare provider if you have poliosis and other symptoms or changes to your skin and hair. Sometimes poliosis is a sign of an underlying condition or reaction to medication that may require medical care.

What Causes Poliosis? 

Poliosis occurs when the affected hair follicles have very little to no melanin. A lack of melanin is usually due to a decrease or absence of melanocytes—the skin cells responsible for producing melanin. 

Several factors can disrupt melanin production and lead to poliosis, including:

• Inherited genetic disorders, such as piebaldism, Wardenburg syndrome, and tuberous sclerosis 
• Medications, such as Chloramphenicol (topical antibiotic), Acitretin (oral retinoid to treat psoriasis), cetuximab (chemotherapy drug)
• Melanoma 
• Injury to the affected hair follicles
• Herpes zoster (shingles) 
• Exposure to radiation therapy 
• Blepharitis (eyelid inflammation)

Certain inflammatory or autoimmune conditions can also lead to poliosis, including

• Vitiligo: A skin disorder characterized by the loss of skin pigment in patches.
• Alopecia areata: An autoimmune disorder that leads to hair loss, often in patches. 
• Vogt-Koyanagi-Harada (VKH) disease: A rare autoimmune disorder that affects various body systems, including the eyes, ears, nervous system, and skin, causing depigmentation in the hair and skin.
  

Risk Factors 

Poliosis can affect people of any age and sex. Some disorders associated with poliosis may be hereditary, increasing the risk for people with a family history of these conditions. But even people with no family history of poliosis can develop white patches in their hair. More research is needed to understand the risk factors of poliosis better. 

Diagnosis

Healthcare providers can usually diagnose poliosis by looking at the affected hair. To determine the cause of poliosis, your healthcare provider will review your medical history, including medication use, and ask if you have a family history of conditions linked to poliosis.  

Diagnostic tests can help your healthcare provider confirm the diagnosis and identify the underlying cause. Depending on your symptoms and medical history, these tests may include:

• Wood's lamp examination: A Wood's lamp emits black light on the scalp and skin to detect certain pigments, including the presence or absence of melanin.
• Blood tests: Blood tests can help look for underlying genetic disorders or medical conditions associated with poliosis.
• Skin biopsy: A small sample of skin tissue is collected from the affected area and examined under a microscope to look for melanin in the hair follicles. A biopsy can help determine whether the depigmented hair is caused by conditions linked to poliosis, such as alopecia or vitiligo.

Treatments for Poliosis  

There are no known treatments to add color to depigmented hair permanently. Some people with poliosis leave the white hair as it is, and others may choose to use cosmetic products, such as hair dye, mascara, or eyebrow pencils, to blend the depigmented hair patch with the surrounding hair. 

Treating certain conditions linked to poliosis may help restore hair pigmentation. For example, skin grafting followed by light therapy may help restore melanin-producing cells and stimulate the pigmentation process, helping reverse poliosis in people with vitiligo.

Prevention

Poliosis is typically a result of factors beyond control, making it difficult to prevent. Taking precautions to avoid damage or injury to the hair follicles may help reduce the risk of depigmentation. 

Treating certain conditions associated with the development of poliosis may help prevent poliosis. Research shows that immunomodulatory therapy combined with corticosteroids may help prevent poliosis in people with Vogt-Koyanagi-Harada syndrome.

Related Conditions 

While poliosis can sometimes occur due to medication use or damage (trauma) to the hair follicles, it is often associated with an underlying condition. People with the following genetic, autoimmune, or inflammatory disorders are more likely to develop poliosis:

• Vitiligo
• Alopecia areata
• Rheumatoid arthritis
• Piebaldism
• Tuberous sclerosis
• Waardenburg syndrome
• Vogt-Koyanagi-Harada (VKH) disease

Living With Poliosis

While poliosis poses no health risks, its visible nature can have emotional and psychological impacts. Some people with poliosis choose to leave their hair as is, but others may not feel comfortable with the visible difference. If you feel uncomfortable with depigmented hair on your scalp, eyebrows, or eyelashes, cosmetic camouflage techniques (e.g., hair dye, mascara, eyebrow pencils) can help the depigmented hair patch match your natural hair color. 

If an underlying condition causes poliosis, it is important to work closely with a healthcare provider to manage and treat the underlying condition effectively.