Although this looks like post-inflammatory
hypopigmentation secondary to tinea versicolor, there is no
evidence for the latter at this time. The presentation fits
the description of PMH.
Do you feel this is a real entity? Some consider
this post-inflammatory hypopigmentation secondary to pityriasis
versicolor. Do you think any therapy is of value? UVB?
Reference: Westerhof W et al. Propionibacterium
acnes and the pathogenesis of progressive macular hypomelanosis.
Arch Dermatol. 2004 Feb;140(2):210-4.
Netherlands Institute for Pigment Disorders, and the Department
of Dermatology, Academic Medical Center, University of Amsterdam,
Amsterdam, the Netherlands. w.westerhof@amc.uva.nl
BACKGROUND: Progressive macular hypomelanosis is a common hypopigmentation
mainly on the central parts of the trunk, predominantly in young
adults, especially women. It is often mistaken for pityriasis
versicolor and pityriasis
alba. It occurs in all races and has been described in many
parts of the world. We discovered follicular red fluorescence
restricted to lesional skin. We suspected a relation with a
porphyrin-producing bacteria residing in sebum of
the pilosebaceous duct, and we therefore performed a study in
8 patients.Observation In all biopsy specimens taken from lesional
skin of 8
women, we could demonstrate gram-positive bacteria in the pilosebaceous
duct, and a mild perifollicular lymphocytic infiltrate was seen.
In all but 1 patient, Propionibacterium acnes was yielded from
cultured biopsy specimens taken
from follicular lesional skin. Healthy follicular skin did not
show bacteria in histological sections, and cultures did not
yield anaerobic bacteria.
CONCLUSIONS: There seems to be a relation between the presence
of P acnes and the hypopigmented macules. We propose that a
factor is produced by these strains of P acnes, which interfere
with melanogenesis. Based on these observations, we are undertaking
a clinical trial to find a treatment for this troubling, intractable
disease.
Comments from Members
Doug Johnson MD, Dept of Medicine, University of Hawaii
School of Medicine, Honolulu, HI, USA on Mar 11, 2004
Thanks for including me. I see something similar in Asian teens
with lots of sun exposure and then a lapse because of school
or weather. Usually abdomen and back. I've never been sure what
to call it.
Patrick Condry MD, Rochester, NY, USA on Mar
12, 2004
I have been in practice since 1980 in Dermatology and before
that in Internal Medicine. The author calls this common but
I may have seen it three times in all of this time. Where are
all these "common" cases?
Sunil Dogra MD, Dept. of Dermatology, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
on Mar 13, 2004
I do see many such cases in India, which were simply labeled
as postinflammatory hypopigmentation before description given
by Westerhof. I have tried Narrow band UVB in few and seems
to work.
Abir Saraswat MD, India on Mar 14, 2004
Many cases that were put into the dustbin of "atypical"
or "extensive" pityriasis alba may now be given the
consolation of a brand new diagnosis to call their own. I have
recently seen a child with extensive monomorphic round hypopigmented
macules. The mother stoutly denies any prior inflammatory lesions.
I will do a wood's light exam on her next visit and try topical
clindamycin on a few lesions.
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