Patchy Hypopigmentation in a Young Man

presented by David Elpern MD,

Williamstown, Massachusetts, USA

on March 11, 2004

Dermatologist, The Skin Clinic, Williamstown, Massachusetts, USA

S. D., 30-year-old Indian man
7 years
Patchy hypopigmentation on the torso. His sister had similar process.
Physical Examination
Incomplete hypopigmentation on the chest and back

Laboratory Data

KOH negative


Progressive Macular Hypopigmentation (PMH)
Comments and References

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.

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.