Key clinical message:
Vogt-Koyanagi-Harada Disease (VKHD) is a systemic autoimmune condition that affects melanocyte-rich tissues, leading to ocular, auditory, and skin-related complications. While hair loss, vitiligo, and poliosis are recognized features of VKHD, the emergence of vellus hair on the normally hairless skin of the distal thumb is an unusual and previously undocumented occurrence. This case emphasizes the possibility of immune system dysregulation in VKHD contributing to hair follicle activation in unexpected areas, broadening our knowledge of its dermatological effects.