Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2025;15(3):5235 1 Bilateral Eyelash Poliosis with Raccoon Erythema and Hypopigmentation-Contact Follicular Leukoderma Shreya K Gowda1, Ritika Dhakad1, Somesh Gupta1 1 Department of Dermatology and Venereology, All India Institute of Medical Sciences, Delhi, India Key words: Follicular vitiligo, Contact follicular leukoderma, Contact poliosis, Eyelash poliosis, Contact leukoderma Citation: Gowda SK, Dhakad R, Gupta S, et al. Bilateral Eyelash Poliosis with Raccoon Erythema and Hypopigmentation-Contact Follicular Leukoderma. Dermatol Pract Concept. 2025;15(3):5235. DOI: https://doi.org/10.5826/dpc.1503a5235 Accepted: February 24, 2025; Published: July 2025 Copyright: ©2025 Gowda et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. SK and SG had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis and were responsible for the study concept and design. SK and SG drafted the manuscript. RD and SG contributed to the critical revision of the manuscript for important intellectual content and supervised the study. All authors contributed to the acquisition, analysis, and interpretation of data. Corresponding Author: Dr. Somesh Gupta, Professor, Department of Dermatology and Venereology, All India Institute of Medical Sciences, Delhi, India-11029. Orcid ID: 0000-0003-3015-8602. E-mail: someshgupta@aiims.edu Introduction Contact chemical leukoderma is an acquired hypopigmentation-to-depigmentation disorder due to re- peated exposure to chemical agents which are toxic to mela- nocytes in genetically susceptible individuals [1]. Case Presentation A 36-year-old male patient presented with whitish discolor- ation of eyelashes and periorbital pruritus for 10 months. The patient had a history of ankylosing spondylitis with uve- itis and had used topical medications, including olopatadine and tobramycin for two months, followed by azelastine and cyclosporine for three months, along with topical steroids for eight months. Most of these topical agents contained pre- servatives such as benzalkonium chloride and cetrimide. The patient had no history of auditory or neurological symptoms. Examination revealed eyelash poliosis sparing eyebrows. Bilateral periocular areas showed diffuse hypopigmented macule with perilesional erythema, telangiectasia, and fine scaling (Figure 1). A possible diagnosis of follicular vitiligo, and Vogt-Koyanagi-Harada (VKH) syndrome was con- sidered for uveitis and poliosis. Fundoscopy did not reveal any optic disc pallor, retinal depigmentation, or scarring. As late-onset poliosis and fundoscopy did not show features of sunset glow, the possibility of VKH syndrome was discarded (Figure 2A and 2B). Later we performed a patch test with the suspected eyedrops and preservative cetrimide, which was negative on readings on days 2, 4, and 7. Periocular features 2 Research Letter | Dermatol Pract Concept. 2025;15(3):5235 of erythema, scaling, and pruritus with temporal association with topical therapy led us to speculate contact leukoderma or steroid-induced hypopigmentation despite a negative patch test. Diagnosing contact leukoderma requires three of four cri- teria: acquired vitiligo-like depigmented macules, patterned lesions at exposure sites, confetti lesions, or prior chemical exposure [1,2]. Inflammation (itching, irritation) before leu- koderma onset supported this diagnosis over vitiligo. Con- tact leukoderma has been described mostly secondary to phenol, benzol, and catechol derivatives (monobenzylether of hydroquinone in tannery workers, rubber, plastic, leather, and dye industries; benzyl alcohol hair dye and rinses, and azo dyes) which have selective melanocytotoxicity [3,4]. In most cases, there is no linear or temporal correlation between exposure and leukoderma, while there is dose-de- pendent melanocyte destruction [4]. There are reports of contact leukoderma or hypopigmentation secondary to cor- ticosteroids at the site of application and the local spread of chemical leukoderma along the lymphatics beyond the site of contact [5]. We could not clarify whether the chemical leuko- derma was due to corticosteroid or any other component of eyedrops used for uveitis which led to melanocyte apoptosis or inflammation. VKH syndrome is a rare multisystem disease of unknown etiology and is characterized by bilateral panuveitis, white forelock, and auditory and neurological manifestation [6]. Conclusion Follicular vitiligo is characterized by leukotrichia with or without interfollicular minimal hypo-to-depigmentation. In non-segmental vitiligo the interfollicular skin is affected with intact hair pigment in the early stages, while the re- verse is seen in follicular vitiligo. Differentiating vitiligo from contact leukoderma can be challenging, as initial contact leukoderma may trigger an autoimmune response leading to vitiligo, and pre-existing vitiligo could be mistaken for chemical-induced depigmentation. We hereby report a rare case of contact follicular leukoderma secondary to topical eyedrops in a patient with uveitis mimicking VKH syndrome. Further research is required to know the exact pathomech- anism involved and the etiological agent in eye drops which led to unusual presentations.Figure 1. Bilateral eyelash poliosis with periocular erythematous hypopigmented fine scaly macule. Figure 2. Fundoscopy demonstrates both eye cup disc ratios 0.4:1, healthy neuroretinal rim, sharp fove- olar reflex. and arteriovenous ratio 2:3 suggestive of normal fundus (A and B). Research Letter | Dermatol Pract Concept. 2025;15(3):5235 3 References 1. Takeuchi A, Egawa G, Nomura T, Kabashima K. Contact leuko- derma induced by rotigotine transdermal patch (Neupro®). Eur J Dermatol. 2019;29(2):215-217. DOI:10.1684/ejd.2019.3500 2. Oliver EA, Schwartz L, Warren LH. Occupational leukoderma: preliminary report. JAMA. 1939;113(11):927-928. DOI:10.1001 /jama.1965.03090220021006. 3. Pandhi RK, Kumar AS. 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