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Table of Contents
Year : 2019  |  Volume : 37  |  Issue : 3  |  Page : 176-177

Alopecia totalis sparing congenital melanocytic nevus: Renbök phenomenon

1 Department of Dermatology, Fukushima Medical University, Fukushima, Japan
2 Dermatology Clinic, Hoshi General Hospital, Koriyama, Japan

Date of Web Publication24-May-2019

Correspondence Address:
Prof. Toshiyuki Yamamoto
Department of Dermatology, Fukushima Medical University, Hikarigaoka 1, Fukushima 960-1295
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ds.ds_38_18

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How to cite this article:
Yamamoto T, Okabe H, Hoshi M. Alopecia totalis sparing congenital melanocytic nevus: Renbök phenomenon. Dermatol Sin 2019;37:176-7

How to cite this URL:
Yamamoto T, Okabe H, Hoshi M. Alopecia totalis sparing congenital melanocytic nevus: Renbök phenomenon. Dermatol Sin [serial online] 2019 [cited 2023 Jan 27];37:176-7. Available from: https://www.dermsinica.org/text.asp?2019/37/3/176/259103

Dear Editor,

The Renbök phenomenon (reverse or inverse Köbner phenomenon) was first described by Happle et al.[1] They reported four cases with alopecia areata and concomitant psoriasis or seborrheic dermatitis of the scalp, in which the lesions of these inflammatory skin diseases matched with unaffected areas by alopecia. Herein, we report a case in which alopecia involved the entire scalp, sparing a congenital melanocytic nevus.

A 40-year-old female was referred to our hospital, for the treatment of diffuse alopecia of the scalp. She developed alopecia areata on the parietal scalp 6 years previously, which once improved by treatment with topical corticosteroid (betamethasone butyrate propionate) and carpronium chloride solution; however, 5 years later, her alopecia relapsed, and the affected areas were enlarged. Before the referral, she was treated with excimer light therapy and methylprednisolone pulse therapy at another hospital, which, however, were not effective. After obtaining informed consent, topical application of squaric acid dibutylester (SADBE) solution was started with an initial concentration of 0.001%. Six months later, due to a move, she was referred to our hospital for the continuation of the treatment. Physical examination revealed total alopecia on the scalp, but normal hair growth was observed in the congenital melanocytic nevus [Figure 1]. Neither eyebrows nor eyelashes were involved. Laboratory examination showed normal liver and renal function. Anti-nuclear antibody was negative, and thyroid disease was denied. She is currently treated with 0.01% SADBE by which hair growth is observed in the occipital region.
Figure 1: Total scalp alopecia sparing a congenital melanocytic nevus

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To date, only several cases exhibiting the Renbök phenomenon have been reported in overlapping inflammatory diseases,[2],[3],[4],[5],[6] which have shown that some inflammatory processes such as alopecia is inhibited by psoriasis, or alopecia prevented the induction of psoriasis. Thereafter, this term was extended to include conditions with the mosaic phenomenon. The mechanism is explained by the interaction between different conditions mediated by Th1, Th2, and Th17 cells between psoriasis and alopecia, which exert exclusive effects mutually. In the present case, alopecia diffusely and totally involved the scalp, sparing a hairy melanocytic nevus. To date, a few similar cases have been reported.[7],[8],[9] The first case was a 13-year-old girl with universal alopecia, including the eyebrows and lashes, who developed an alopecia-resistant pigmented congenital nevocellular nevus on the scalp.[7] In the second case, alopecia areata spared a congenital melanocytic nevus on the eyebrow of a 16-year-old boy.[8] The third case was a 30-year-old man with alopecia areata universalis, which spared a large nevus flammeus on the left parietal scalp.[9] These cases may suggest that a congenital nevus is genetically unsusceptible to alopecia. The phenomenon is explained by genetic mosaicism, which reflects a distinct microenvironment and may protect a hairy congenital nevus from hair loss.[8] This is contrary to the immunologic phenomenon seen in the halo nevus, in which depigmentation surrounding the melanocytic nevus is induced by infiltrating T-cells. Further studies of the mechanism in which congenital melanocytic nevus escapes from the local immune control of alopecia are necessary.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Happle R, van der Steen PH, Perret CM. The Renbök phenomenon: An inverse Köbner reaction observed in alopecia areata. Eur J Dermatol 1991;1:228-30.  Back to cited text no. 1
Criado PR, Valente NY, Michalany NS, Martins JE, Romiti R, Aoki V, et al. An unusual association between scalp psoriasis and ophiasic alopecia areata: The Renbök phenomenon. Clin Exp Dermatol 2007;32:320-1.  Back to cited text no. 2
Ito T, Hashizume H, Takigawa M. Contact immunotherapy-induced Renbök phenomenon in a patient with alopecia areata and psoriasis vulgaris. Eur J Dermatol 2010;20:126-7.  Back to cited text no. 3
Harris JE, Seykora JT, Lee RA. Renbok phenomenon and contact sensitization in a patient with alopecia universalis. Arch Dermatol 2010;146:422-5.  Back to cited text no. 4
Garnacho-Saucedo GM, Salido-Vallejo R, Alvarez-López MÁ, Casas de la Asunción E, Ruano-Ruiz J, García-Nieto AV, et al. Renbök phenomenon in a patient with alopecia areata universalis. Arch Dermatol 2012;148:964-5.  Back to cited text no. 5
Oiso N, Kawada A. Renbök phenomenon in a patient with alopecia areata universalis and psoriasis. J Dermatol 2012;39:288-9.  Back to cited text no. 6
Ruiz-Maldonado R, Tamayo L, Durán C. Hairy pigmented congenital naevocellular naevus in a patient with alopecia universalis. Clin Exp Dermatol 1993;18:162-3.  Back to cited text no. 7
Bon AM, Happle R, Itin PH; The Swiss Trichology Study Group. Renbök phenomenon in alopecia areata. Dermatology 2000;201:49-50.  Back to cited text no. 8
Chen W. Alopecia areata universalis sparing nevus flammeus. Dermatology 2005;210:227-8.  Back to cited text no. 9


  [Figure 1]

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