Poliosis (Localized Loss of Pigment in Eyelashes & Eyebrows)
Poliosis is a condition characterized by localized loss of pigment in hair, resulting in white or depigmented eyelashes, eyebrows, or other hair. It occurs when melanocytes responsible for producing melanin are reduced, damaged, or dysfunctional.
What Is Poliosis?
Poliosis is a localized absence or reduction of pigment in hair caused by decreased melanin production within affected hair follicles.
The condition most commonly affects eyelashes and eyebrows but may also involve the scalp, beard, or other body hair.
Unlike madarosis, which involves loss of hair, poliosis involves a change in hair color while the hair itself may remain present.
Poliosis may occur as an isolated finding or as part of a systemic, genetic, autoimmune, or inflammatory disorder.
Eyelash & Eyebrow Pigment Anatomy
Hair pigmentation depends on specialized cells within hair follicles that produce melanin.
Melanocytes
Specialized pigment-producing cells responsible for creating melanin.
Melanin Production
The process responsible for determining hair color.
Hair Follicles
Structures containing pigment-producing cells that generate eyelashes and eyebrows.
Hair Shaft
The visible portion of hair containing pigment.
Supporting Periocular Structures
Healthy eyelid and surrounding skin structures support normal eyelash growth and pigmentation.
Eyelashes
Protect the ocular surface and normally contain pigment from melanocytes.
Eyebrows
Help protect the eye from sweat and debris while contributing to facial expression.
Eyelid Margin
Contains eyelashes and important structures involved in eyelid function.
Skin Pigment Cells
Maintain normal pigmentation of surrounding periocular tissues.
Normal Hair Pigmentation vs Poliosis
Hair color depends on normal melanocyte activity within the follicle.
Normal Pigmented Hair
- Healthy melanocyte function
- Normal melanin production
- Uniform hair color
- Normal follicle activity
Poliosis
- Reduced or absent pigment
- White or gray hair appearance
- May affect isolated areas
- May indicate underlying disease
Types of Poliosis
Congenital Poliosis
Present from birth and may be associated with genetic disorders.
Acquired Poliosis
Develops later due to autoimmune disease, inflammation, or other causes.
Localized Poliosis
Pigment loss affecting a specific area of hair.
Segmental Poliosis
Affects a defined region or patch of hair.
Eyelash Poliosis
Loss of pigment specifically affecting eyelashes.
Eyebrow Poliosis
Depigmentation affecting eyebrow hairs.
Scalp-Associated Poliosis
Depigmentation involving scalp hair.
Isolated Poliosis
Occurs without an identifiable associated disorder.
Why Does Poliosis Occur?
Poliosis develops when melanocytes within hair follicles cannot produce normal amounts of pigment.
Melanocyte Dysfunction
Pigment-producing cells may become inactive or impaired.
Loss of Melanin Production
Reduced pigment production causes white or depigmented hair.
Autoimmune Destruction
The immune system may target melanocytes.
Genetic Disorders
Inherited conditions may affect pigment development.
Inflammatory Disease
Inflammation may interfere with melanocyte function.
Medication Effects
Certain treatments may alter pigmentation.
Common Causes & Risk Factors
Vitiligo
Autoimmune loss of pigment affecting skin and hair.
Waardenburg Syndrome
Genetic condition associated with pigment abnormalities.
Vogt-Koyanagi-Harada Disease
Inflammatory disorder affecting melanocyte-containing tissues.
Alopecia Areata
Autoimmune hair disorder that may involve pigment changes.
Ocular Inflammation
Inflammatory eye disease may be associated with pigment changes.
Uveitis
Inflammation involving pigmented ocular tissues.
Trauma
Injury may affect pigment-producing structures.
Medication Effects
Some medications may alter hair pigmentation.
Conditions Associated With Poliosis
Madarosis
Loss of hair may occur alongside pigment changes.
Vitiligo
Autoimmune depigmentation disorder commonly associated with poliosis.
Uveitis
Inflammatory eye disease involving pigmented structures.
Autoimmune Disease
Immune disorders may affect melanocyte function.
Alopecia Areata
May cause localized hair and pigment abnormalities.
Ocular Inflammation
Inflammation may affect periocular pigmentation.
Symptoms & Clinical Signs
Poliosis itself is usually painless and does not directly affect vision. However, the presence of white eyelashes or eyebrows may indicate an underlying ocular, dermatologic, autoimmune, or genetic condition.
Common Symptoms
- White eyelashes
- White eyebrows
- Patchy hair depigmentation
- Change in facial appearance
- Cosmetic concerns
- Associated skin color changes
- Possible eye discomfort from underlying disease
Clinical Signs
- Depigmented hair shafts
- Normal hair density
- Localized white hair patches
- Skin depigmentation
- Eyelid pigment changes
- Associated ocular inflammation
Clinical Findings in Poliosis
The characteristic finding of poliosis is a localized area of white or gray hair caused by reduced melanin production.
Depigmented Hair Shafts
Affected eyelashes or eyebrows appear white due to reduced melanin content.
Normal Hair Density
Unlike madarosis, the number of hairs may remain normal.
Localized Pigment Loss
Only specific areas of hair may lose pigmentation.
Associated Skin Changes
Nearby skin may demonstrate depigmentation in disorders such as vitiligo.
Poliosis vs Madarosis
Although both conditions affect eyelashes and eyebrows, they represent different processes.
Poliosis
- Hair is present
- Pigment is reduced or absent
- Hair appears white
- Follicles may remain healthy
Madarosis
- Hair is missing or reduced
- May involve follicle damage
- Can cause lash or brow thinning
- May be scarring or non-scarring
Clinical Examination of Poliosis
Evaluation focuses on identifying pigment changes and determining whether an associated ocular or systemic disorder is present.
Eyelid Examination
Assesses eyelashes, eyelid margins, inflammation, and structural abnormalities.
Eyebrow Evaluation
Determines distribution and extent of pigment loss.
Slit Lamp Examination
Evaluates ocular structures for inflammatory disease.
Eyelid Examination
A detailed eyelid evaluation helps differentiate isolated poliosis from conditions affecting eyelid health.
Eyelash Color Assessment
Determines the extent and pattern of lash depigmentation.
Eyelid Margin Evaluation
Checks for inflammation, scarring, or associated blepharitis.
Hair Distribution
Determines whether pigment loss is localized or widespread.
Eyebrow Evaluation
The eyebrow examination provides clues about possible systemic or dermatologic conditions.
Pattern of Depigmentation
Determines whether pigment loss follows a specific pattern.
Associated Skin Changes
Looks for areas of vitiligo or other pigment disorders.
Symmetry
Helps distinguish isolated findings from systemic conditions.
Slit Lamp Examination
Slit lamp evaluation is important when poliosis is associated with ocular inflammation.
Anterior Segment Evaluation
Examines the eye for signs of inflammation.
Iris Evaluation
Assesses pigment changes associated with inflammatory disorders.
Anterior Chamber
Evaluates for cells and flare suggesting uveitis.
Ocular Surface
Assesses associated dryness or irritation.
Wood’s Lamp Examination
Wood’s lamp evaluation may help identify areas of skin depigmentation, particularly in suspected vitiligo.
Vitiligo Assessment
Depigmented areas may become more visible under ultraviolet light.
Skin Pigment Evaluation
Helps determine whether pigment loss extends beyond hair.
Evaluation for Ocular Inflammation
Poliosis associated with inflammation requires assessment for diseases involving pigment-containing ocular tissues.
Uveitis Evaluation
Checks for inflammatory cells within the eye.
VKH Disease Assessment
Evaluates for inflammatory findings associated with melanocyte disorders.
Retinal Evaluation
Assesses posterior segment involvement when indicated.
Assessing Severity of Poliosis
Severity is based on the amount of pigment loss, affected hair structures, and presence of associated disease.
Amount of Pigment Loss
Determines whether only a few hairs or a larger area is involved.
Number of Hair Involved
Assesses the extent of eyelash or eyebrow depigmentation.
Associated Skin Disease
Presence of vitiligo or other pigment disorders affects evaluation.
Ocular Involvement
Inflammatory eye disease may increase clinical significance.
Differential Diagnosis
Several conditions may resemble poliosis and should be distinguished during evaluation.
Madarosis
Loss of eyelashes or eyebrows rather than loss of pigment.
Premature Graying
Generalized age-related or early hair depigmentation.
Alopecia Areata
Autoimmune hair loss that may include pigment changes.
Vitiligo
Autoimmune depigmentation of skin and sometimes hair.
Chemical Bleaching
External products may alter hair color.
Associated Conditions
Vitiligo
Common autoimmune pigment disorder associated with poliosis.
Waardenburg Syndrome
Genetic disorder associated with pigment abnormalities.
Vogt-Koyanagi-Harada Disease
Inflammatory disorder affecting melanocyte-containing tissues.
Alopecia Areata
Autoimmune disorder affecting hair follicles.
Autoimmune Disorders
Immune-mediated conditions may affect melanocyte function.
Key Clinical Questions
When Did Pigment Loss Begin?
Helps differentiate congenital from acquired causes.
Is Skin Depigmentation Present?
May suggest vitiligo or pigment disorders.
Are There Eye Symptoms?
May indicate associated ocular inflammation.
Treatment Options for Poliosis
Treatment of poliosis depends on the underlying cause, presence of associated disease, and whether pigment-producing melanocytes can recover.
Observation
Isolated and stable poliosis without associated disease may only require monitoring.
Treat Underlying Cause
Management focuses on controlling autoimmune, inflammatory, or genetic conditions.
Cosmetic Management
Used when pigment changes affect appearance or quality of life.
Observation and Monitoring
Some cases of poliosis remain stable and do not require active treatment.
Isolated Poliosis
Patients without symptoms or associated disease may be monitored periodically.
Monitor Progression
Follow-up helps identify new pigment loss or development of systemic disease.
Ocular Screening
Patients with ocular symptoms may require evaluation for inflammation.
Treating the Underlying Cause
Because poliosis is often a sign of another condition, identifying and treating the cause is the primary goal.
Autoimmune Disease Management
Treatment focuses on reducing immune activity affecting melanocytes.
Inflammatory Disease Treatment
Controlling inflammation may prevent further pigment changes.
Vitiligo Management
Treatment may include therapies aimed at restoring or stabilizing pigment.
Uveitis Treatment
Inflammatory eye disease requires appropriate ocular therapy.
Autoimmune-Related Poliosis Treatment
Autoimmune disorders may cause melanocyte dysfunction or destruction.
Corticosteroids
May reduce autoimmune inflammation in selected conditions.
Immunomodulatory Therapy
Used when immune activity contributes to pigment loss.
Systemic Evaluation
Assessment may be needed to identify associated autoimmune disorders.
Vitiligo-Associated Poliosis Management
When poliosis occurs with vitiligo, treatment focuses on controlling pigment loss and improving appearance.
Topical Corticosteroids
May help stimulate repigmentation in selected areas.
Topical Immunomodulators
May regulate immune activity affecting melanocytes.
Phototherapy
Ultraviolet-based treatments may promote repigmentation in some patients.
Uveitis-Associated Poliosis Treatment
Poliosis associated with ocular inflammation requires evaluation and treatment of the inflammatory disease.
Anti-Inflammatory Therapy
Controls inflammation affecting ocular tissues.
Ocular Monitoring
Regular examinations monitor disease activity.
Vision Protection
Early management reduces risk of inflammatory complications.
Medical Treatment Options
Specific therapy depends on the cause and extent of pigment loss.
Corticosteroids
Used for inflammatory and autoimmune conditions when appropriate.
Immunomodulators
Help regulate abnormal immune responses.
Phototherapy
May assist repigmentation in certain pigment disorders.
Supportive Care
Protects skin and ocular health while monitoring progression.
Cosmetic Management of Poliosis
When pigment loss is permanent or primarily cosmetic, several options may improve appearance.
Eyebrow Makeup
Cosmetic products can restore the appearance of eyebrow color.
Eyelash Tinting
May temporarily improve eyelash appearance.
Cosmetic Camouflage
Specialized cosmetic techniques may reduce visible pigment differences.
Microblading
Creates the appearance of eyebrow pigmentation.
Eyelash Restoration Considerations
Patients with permanent cosmetic concerns may consider restorative options after the underlying condition is controlled.
Potential Options
- Eyelash tinting
- Cosmetic enhancement
- Eyelash transplantation
Important Considerations
- Active inflammation should be controlled
- Underlying disease should be evaluated
- Results vary between patients
Eyebrow Restoration
Eyebrow restoration may be considered when poliosis causes persistent cosmetic concerns.
Microblading
Creates the appearance of natural eyebrow hairs.
Eyebrow Transplantation
Uses transplanted follicles to restore eyebrow density.
Cosmetic Products
Temporary solutions for color enhancement.
Hair Transplantation Considerations
Hair transplantation may be considered in selected patients with stable, permanent pigment or hair changes.
Candidate Selection
Patients should have stable disease and healthy donor follicles.
Benefits
May improve cosmetic appearance.
Limitations
Does not treat the underlying cause of pigment loss.
Post-Treatment Care
Follow-up is important to monitor pigment changes and associated conditions.
Follow-Up Visits
Monitor progression and treatment response.
Monitor Ocular Disease
Patients with inflammatory conditions require ongoing eye evaluations.
Skin Protection
Sun protection is important in areas with pigment loss.
Complications of Poliosis Treatment
Recurrence
Pigment loss may return if the underlying disease remains active.
Skin Irritation
Topical treatments may cause redness or irritation.
Incomplete Pigment Recovery
Damaged melanocytes may not fully recover.
Preventing Progression of Poliosis
Early Evaluation
Identifying associated disease early improves management.
Control Inflammation
Managing inflammatory disorders helps prevent progression.
Routine Eye Care
Regular examinations monitor ocular involvement.
Complications of Poliosis
Poliosis itself is usually a cosmetic finding; however, complications may arise from associated autoimmune, inflammatory, or genetic disorders.
Ocular Complications
- Associated uveitis
- Chronic ocular inflammation
- Ocular surface irritation
- Vision-threatening inflammatory disease
- Need for long-term eye monitoring
Systemic & Cosmetic Effects
- Progressive pigment loss
- Association with autoimmune disease
- Changes in facial appearance
- Psychological impact
- Reduced self-confidence
Associated Autoimmune Disease
Poliosis may be a visible sign of autoimmune activity affecting melanocytes, which are pigment-producing cells.
Vitiligo
Autoimmune destruction of melanocytes causing loss of pigment in skin and hair.
Alopecia Areata
Immune-mediated hair follicle disorder that may cause pigment changes.
Vogt-Koyanagi-Harada Disease
Inflammatory disorder targeting melanocyte-containing tissues.
Autoimmune Screening
Patients may require evaluation for additional autoimmune findings.
Ocular Inflammation Associated With Poliosis
When poliosis occurs with eye inflammation, evaluation is necessary because some inflammatory diseases can affect vision.
Uveitis
Inflammation inside the eye that may be associated with pigment disorders.
Anterior Segment Inflammation
May cause redness, pain, and light sensitivity.
Posterior Segment Disease
Inflammation affecting the retina or choroid requires monitoring.
Cosmetic Impact of Poliosis
White eyelashes or eyebrows may be noticeable and may affect appearance, especially when involving the facial region.
Common Concerns
- Visible white lashes or brows
- Changes in facial appearance
- Difficulty matching cosmetic appearance
- Concern about underlying disease
Management Options
- Cosmetic camouflage
- Eyebrow enhancement
- Eyelash tinting
- Restorative procedures
Psychological Effects
Visible pigment changes may affect emotional well-being, especially when the condition develops suddenly.
Self-Image Concerns
Patients may feel concerned about changes in appearance.
Social Impact
Cosmetic differences may affect confidence in social situations.
Patient Support
Education and reassurance help patients understand the condition.
Progressive Pigment Loss
Some patients may experience progression if the underlying inflammatory or autoimmune process remains active.
Localized Progression
Pigment loss may expand to nearby hairs.
Generalized Pigment Changes
Some systemic disorders may cause widespread depigmentation.
Monitoring
Follow-up helps detect changes early.
Prognosis
The prognosis of poliosis depends on the underlying cause and whether melanocytes remain functional.
Isolated Poliosis
Often remains stable and does not affect vision.
Autoimmune-Related Poliosis
Course depends on control of the underlying immune condition.
Genetic Poliosis
Usually remains stable but may be associated with other findings.
Clinical Pearls
- Poliosis is loss of pigment, not loss of hair.
- White eyelashes with normal lash density suggest poliosis rather than madarosis.
- Vitiligo is one of the most common acquired associations.
- Sudden-onset poliosis may require evaluation for autoimmune or inflammatory disease.
- Always evaluate for ocular inflammation when poliosis is associated with eye symptoms.
- Poliosis may occur with Vogt-Koyanagi-Harada disease and other melanocyte disorders.
- Treatment focuses on the underlying condition rather than the pigment change alone.
- Cosmetic treatments may improve appearance when pigment recovery is limited.
Common ICD-10 Codes
| Code | Description |
|---|---|
| L81.9 | Disorder of pigmentation, unspecified |
| L80 | Vitiligo |
| H20.9 | Unspecified iridocyclitis (uveitis) |
| H44.89 | Other disorders of eye |
| L63.9 | Alopecia areata, unspecified |
Patient Education: Living With Poliosis
Monitor Changes
Report new pigment loss or changes in other body areas.
Protect Skin
Use sun protection in areas with reduced pigment.
Maintain Eye Exams
Regular eye evaluations are important when associated with inflammation.
Address Cosmetic Concerns
Safe cosmetic options can improve appearance.
Frequently Asked Questions
What is poliosis?
Poliosis is localized loss of pigment causing white or depigmented hair, commonly affecting eyelashes or eyebrows.
Is poliosis the same as madarosis?
No. Poliosis affects hair color, while madarosis involves loss of eyelashes or eyebrows.
Can poliosis go away?
Some cases may remain stable, while others may improve if the underlying cause is treated.
Does poliosis affect vision?
Poliosis itself does not usually affect vision, but associated inflammatory conditions may.
Should patients with poliosis see an eye doctor?
Evaluation is recommended if poliosis is new, progressive, or associated with eye symptoms.
Related Eye Conditions
Madarosis
Loss of eyelashes or eyebrows rather than pigment change.
Vitiligo
Autoimmune depigmentation disorder associated with poliosis.
Alopecia Areata
Autoimmune hair disorder that may involve eyelashes.
Uveitis
Inflammatory eye disease associated with pigment disorders.
Vogt-Koyanagi-Harada Disease
Inflammatory disorder affecting melanocyte-containing tissues.
Blepharitis
Chronic eyelid inflammation affecting periocular structures.
Ocular Melanoma
Tumor involving pigment-producing cells of the eye.
Medical Disclaimer
The information provided by Kardia Vision is intended for educational purposes only and should not replace professional medical advice, diagnosis, or treatment.
New pigment changes, eye pain, redness, light sensitivity, or vision changes should be evaluated by a qualified eye care professional.
Kardia Vision is dedicated to providing accurate, evidence-based eye health education for patients, students, and healthcare professionals.