Narrowband UVB treatment of progressive macular hypomelanosis

Department of Dermatology, Pusan National University, School of Medicine, Busan, Korea.
Journal of the American Academy of Dermatology (Impact Factor: 4.45). 10/2011; 66(4):598-605. DOI: 10.1016/j.jaad.2011.04.010
Source: PubMed


Little information is available on effective treatments for progressive macular hypomelanosis (PMH). To our knowledge, only one case of narrowband ultraviolet B (NB-UVB) therapy as an efficient treatment for patients with PMH has been reported in the recent literature.
We aimed to investigate the clinical features of PMH in Koreans and to determine the therapeutic efficacy of NB-UVB therapy in the management of PMH.
We performed an uncontrolled prospective study designed to evaluate the usefulness of NB-UVB therapy in PMH. A total of 23 patients with PMH were enrolled in the study. Of these, 17 patients underwent treatment with NB-UVB therapy once or twice weekly and were eligible for analysis. The remaining 6 patients were lost to follow-up before completion of the treatment. Repigmentation was evaluated by two dermatologists using photographic documentation.
In our trial, NB-UVB therapy was used successfully in 9 of 16 patients (56.2%), who showed more than 90% repigmentation. We found that 13 of 16 patients (81.3%) experienced at least 50% repigmentation. The repigmented sites showed an excellent color match. No signs of recurrence have been detected in 11 of these 16 patients (68.7%) up to the present time (13.2 ± 8.2 months of follow-up).
Our study includes a small number of subjects examined, and it was an uncontrolled and non-double-blind study.
The findings of this study suggest that NB-UVB therapy is an effective and safe method for use in the treatment of PMH.

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    ABSTRACT: Background Progressive macular hypomelanosis (PMH) is a cosmetically disturbing skin disorder that is poorly understood with indefinite treatment. The aim of the present study was to clinically outline PMH and study its pathogenesis. Based upon the literature suggesting improvement of PMH with antibiotic therapy to decrease Propionibacterium acnes (P. acnes) colonization, different treatment modalities were tried to reach the best treatment option. Patients and methods This study included 12 newly diagnosed PMH selected patients who attended Tanta University Hospital outpatient clinic of Dermatology and Venereology from June 2009 to March 2010. Patient's lesions were subjected to wood's lamp and potassium hydroxide (KOH) examination as well as biopsies used in histological, immunohistochemical, bacteriological and electron microscopic examination. A randomized clinical trial with different treatment modalities was applied. Results The patient's mean age was 25 ± 10.8 with significant female predominance (P = 0.0001). Reduction of epidermal melanosomes and tyrosine activity together with difference in distribution of S100 proteins in hypopigmented skin was demonstrated. Abnormal distribution of tonofilaments was noticed inside keratinocytes with increased apoptosis. P. acnes were detected in hair follicles of 83.3% hypopigmented lesions. Administration of local and systemic antimicrobial treatment with narrow band ultraviolet B (NBUVB) phototherapy for 3 months was the best treatment modalities. Conclusion The etiology of PMH is multifactorial where genetic predisposition, the presence of P. acnes and hormonal imbalance play the main role. Administration of local and systemic antimicrobial treatment with NBUVB phototherapy for 3 months is an effective treatment regimen for PMH.
    12/2014; 2(4). DOI:10.1016/j.jmau.2014.09.001
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    ABSTRACT: Background: Progressive macular hypomelanosis, a disease of uncertain etiology, was first described by Guillet et al. in 1988. It is characterized by asymptomatic hypopigmented macules and patches that appear on the trunk and upper extremities. It is a relatively recently described disorder and more case reports are needed. Objective: The purpose of the study was to document the clinicopathologic and ultrastructural features of progressive macular hypomelanosis in Korean patients. Methods: Patients who presented to our hospital and were diagnosed with progressive macular hypomelanosis from July 2009 to June 2014 were enrolled in this study. Skin scrapings were taken for fungal tests, and skin biopsy specimens from lesional and normal skin were obtained. Sections of the skin biopsies were stained with hematoxylin and eosin, Brown and Brenn Gram stain, and Fontana-Masson stain, and they were incubated with a panel of immunohistochemical reagents used to identify melanocytes, namely, gp-100, melan-A, and microphthalmia- Associated transcription factor. The tissues from two patients were also examined using electron microscopy. Results: Over the course of 5 years, 16 patients presented with ill-defined hypopigmented macules on their trunks and ; upper extremities. The mean age of the patients was 28.4±9.0 years and the male to female ratio was about 1 : 4. Histopathologically, lesional skin showed a reduced level of pigmentation, while the number of melanocytes was preserved. None of the patients showed bacterial colonization of the pilosebaceous units. Electron microscopy demonstrated smaller and less melanized melanosomes in the lesional keratinocytes. Conclusion: Progressive macular hypomelanosis is a hypopigmentary disorder that is characterized by a loss of melanosomes without damage to the melanocytes. Although there are several reports that describe a possible relationship between Propionibacterium acnes and progressive macular hypomelanosis, it remains unclear.
    Korean Journal of Dermatology 02/2015; 53(2):113-118.

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