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Williams KA, Wondimu B, Ajayi AM, Sokumbi O. Skin of color in dermatopathology: does color matter? Hum Pathol 2023; 140:240-266. [PMID: 37146946 DOI: 10.1016/j.humpath.2023.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
Skin of color (SoC) remains an understudied and under taught area of dermatology despite its rising importance. Race and ethnicity play a particularly important role in dermatology as skin pigmentation can affect the manifestation and presentation of many common dermatoses. With this review, we seek to review pertinent differences in SoC histology, as well as highlight the histopathology of conditions more common in SoC and address inherent bias that may affect accurate dermatopathology sign out.
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Affiliation(s)
- Kyle A Williams
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Bitania Wondimu
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA, 98195, USA
| | - Ayodeji M Ajayi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, 32224, USA; Department of Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL, 32224, USA.
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2
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Paquette GM, Sherman S, Akabane A, Harris JE. Adolescent extra-truncal progressive macular hypomelanosis. Pediatr Dermatol 2023. [PMID: 36744793 DOI: 10.1111/pde.15252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/29/2022] [Indexed: 02/07/2023]
Abstract
Two adolescent females presented to outpatient clinic with isolated, non-scaly, asymptomatic hypopigmented macules and patches on the arm(s). Both cases had Wood's lamp exams notable for extralesional punctiform coral-red perifollicular fluorescence on the back and faint intralesional enhancement. In one case, biopsy was performed and deemed consistent with progressive macular hypomelanosis. The patient had complete response to antimicrobial therapy and sun exposure.
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Affiliation(s)
- Gabriella M Paquette
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States
| | - Shany Sherman
- Division of Dermatology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States
| | - Andressa Akabane
- Division of Dermatology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States
| | - John E Harris
- Division of Dermatology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States
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3
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Rao M, Young K, Jackson-Cowan L, Kourosh A, Theodosakis N. Post-Inflammatory Hypopigmentation: Review of the Etiology, Clinical Manifestations, and Treatment Options. J Clin Med 2023; 12:jcm12031243. [PMID: 36769891 PMCID: PMC9917556 DOI: 10.3390/jcm12031243] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
Post-inflammatory hypopigmentation is a common acquired pigmentary disorder that is more prominent in skin of color, leading to great cosmetic and psychosocial implications. Often, a diagnosis with a pigmentary disorder can negatively impact an individual's health-related quality of life and may result in stigma. Although most cases of post-inflammatory hypopigmentation resolve spontaneously over time, a systematic diagnostic approach can help with identifying the underlying etiology and informing treatment strategies. It can be due to cutaneous inflammation, sequelae of inflammatory or infectious dermatoses, or dermatologic procedures. Therefore, a thorough understanding of the epidemiology, patient history, physical exam findings, and clinical features of post-inflammatory hypopigmentation phenomenon can explain the primary cause to providers and allow for patient education. It is also important to understand the various therapeutic approaches available and the efficacy of these options, which will inform providers to choose the appropriate therapy for patients. Although algorithms exist for classifying acquired disorders of hypopigmentation, there are no established algorithms for the diagnosis and treatment of post-inflammatory hypopigmentation, which warrants further exploration and discourse.
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Affiliation(s)
- Medha Rao
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | | | - Ladonya Jackson-Cowan
- The Medical College of Georgia at Augusta University, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Arianne Kourosh
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nicholas Theodosakis
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- Correspondence: ; Tel.: +617-724-2919
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4
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Blom van Staden A, Kovacs D, Cardinali G, Picardo M, Lebeko M, Khumalo NC, Ray SS, Lall N. Synthesis and characterization of gold nanoparticles biosynthesised from Aspalathus linearis (Burm.f.) R.Dahlgren For progressive macular hypomelanosis. J Herb Med 2021. [DOI: 10.1016/j.hermed.2021.100481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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5
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McDowell A, McLaughlin J, Layton AM. Is Cutibacterium (previously Propionibacterium) acnes a potential pathogenic factor in the aetiology of the skin disease progressive macular hypomelanosis? J Eur Acad Dermatol Venereol 2020; 35:338-344. [PMID: 32603510 DOI: 10.1111/jdv.16789] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/16/2020] [Indexed: 01/23/2023]
Abstract
Progressive macular hypomelanosis (PMH) is a skin condition that normally causes symmetrically distributed hypopigmented macules on the front and back of the trunk, but rarely the face. To date, the pathophysiology of the condition is not well understood, but a role for the anaerobic skin bacterium Cutibacterium (previously Propionibacterium) acnes in the development of the disease has been proposed due to its sole presence within lesional, but not normal peri-lesional, skin. The success of antimicrobials in the treatment of PMH also provides circumstantial evidence that this association may be causal, although this is still to be proven. More recent culture and metagenomic typing studies indicate that strains of C. acnes subsp. elongatum (type III) may be important in the aetiology of the condition, which would help to explain why PMH does not normally affect the face since such strains are rarely present there, and why no association between this condition and acne vulgaris is found; acne appears to primarily involve type IA1 strains from C. acnes subsp. acnes (type I). In this review, we summarize current knowledge on the relationship between C. acnes and PMH, and re-examine previous challenges to the view that the bacterium plays a role in the condition against the backdrop of newly emerged data.
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Affiliation(s)
- A McDowell
- Northern Ireland Centre for Stratified Medicine, School of Biomedical Sciences, Ulster University, Londonderry, UK
| | - J McLaughlin
- Northern Ireland Centre for Stratified Medicine, School of Biomedical Sciences, Ulster University, Londonderry, UK
| | - A M Layton
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, UK
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6
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Abdelmaksoud A, Lotti T, Anadolu R, Goldust M, Ayhan E, Dave DD, Vestita M, Ebik B, Gupta M. Low dose of isotretinoin: A comprehensive review. Dermatol Ther 2020; 33:e13251. [PMID: 32022958 DOI: 10.1111/dth.13251] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/04/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
Abstract
Isotretinoin is a first-generation retinoid initially approved for the treatment of severe cases of acne vulgaris (nodulocystic acne). Because of its broad anti-inflammatory and immunomodulatory properties, it has been used beyond its initial approval in a myriad of other indications. Adverse effects of isotretinoin vary from xerosis to teratogenicity. Herein, we reviewed the literature, through date-unlimited PubMed search, from inception till December 2019, using the following search terms: "low-dose isotretinoin" and "dermatology," "isotretinoin and safety," "isotretinoin, off-label uses," "isotretinoin and male fertility," "isotretinoin, iPLEDGE system," aiming to deliver a therapeutic update relevant to clinical practice. All English-language articles were considered with no limitation based on the articles' type. Low-dose isotretinoin is not limited to old and novel dermatological conditions, but also showed promising results in the field of infertility and safety in the field of gastroenterology. We also highlight on the safety profile of the drug and experts' recommendations to enhance safety measures to decrease fetal risk while on isotretinoin.
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Affiliation(s)
- Ayman Abdelmaksoud
- Mansoura Dermatology, Venerology and Leprology Hospital, Mansoura, Egypt
| | - Torello Lotti
- Department of Dermatology, University of Rome "G.Marconi", Rome, Italy
| | - Rana Anadolu
- Department of Dermatology, Venerology and Dermatopathology, International Dermatology, Dermatopathology, Esthetics and Anti-aging Academy (IDEA), Istanbul, Turkey.,Dermatology Clinic, Ankara, Turkey.,Faculty of Medicine, Department of Dermatology, Ankara University, Ankara, Turkey
| | - Mohamed Goldust
- University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Erhan Ayhan
- Department of Dermatology, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | | | - Michelangelo Vestita
- Unit of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Berat Ebik
- Division of Gastroenterology Diyarbakir, Dicle University Faculty of Medicine, Kıtılbıl, Turkey
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7
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Abstract
Porphyrins are intermediate metabolites in the biosynthesis of vital molecules, including heme, cobalamin, and chlorophyll. Bacterial porphyrins are known to be proinflammatory, with high levels linked to inflammatory skin diseases. Propionibacterium species are dominant skin commensals and play essential roles in defending against pathogens and in triggering an inflammatory response. To better understand how the inflammatory potential of the skin microbiome may vary depending on its propionibacterial composition, we compared the production levels of porphyrins among Propionibacterium acnes, Propionibacterium granulosum, Propionibacterium avidum, and Propionibacterium humerusii strains. We found that porphyrin production varied among these species, with P. acnes type I strains producing significantly larger amounts of porphyrins than P. acnes type II and III strains and other Propionibacterium species. P. acnes strains that are highly associated with the common skin condition acne vulgaris responded to vitamin B12 supplementation with significantly higher porphyrin production. In contrast, vitamin B12 supplementation had no effect on the porphyrin production of health-associated P. acnes strains and other propionibacteria. We observed low-level porphyrin production in most Propionibacterium strains harboring the deoR repressor gene, with the exception of P. acnes strains belonging to type I clades IB-3 and IC. Our findings shed light on the proinflammatory potential of distinct phylogenetic lineages of P. acnes as well as other resident skin propionibacteria. We demonstrate that the overall species and strain composition is important in determining the metabolic output of the skin microbiome in health and disease.IMPORTANCE Porphyrins are a group of metabolites essential to the biosynthesis of heme, cobalamin, and chlorophyll in living organisms. Bacterial porphyrins can be proinflammatory, with high levels linked to human inflammatory diseases, including the common skin condition acne vulgaris. Propionibacteria are among the most abundant skin bacteria. Variations in propionibacteria composition on the skin may lead to different porphyrin levels and inflammatory potentials. This study characterized porphyrin production in all lineages of Propionibacterium acnes, the most dominant skin Propionibacterium, and other resident skin propionibacteria, including P. granulosum, P. avidum, and P. humerusii We revealed that P. acnes type I strains produced significantly more porphyrins than did type II and III strains and other Propionibacterium species. The findings from this study shed light on the proinflammatory potential of the skin microbiome and can be used to guide the development of effective acne treatments by modulating the skin microbiome and its metabolic activities.
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8
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Maymone MBC, Watchmaker JD, Dubiel M, Wirya SA, Shen LY, Vashi NA. Common Skin Disorders in Pediatric Skin of Color. J Pediatr Health Care 2019; 33:727-737. [PMID: 31655787 DOI: 10.1016/j.pedhc.2019.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 12/12/2022]
Abstract
Children with skin of color represent a large proportion of the pediatric population. There are numerous skin conditions that commonly occur in this population, including but not limited to acne, atopic dermatitis, pityriasis alba, tinea versicolor, progressive macular hypomelanosis, traction alopecia, and confluent and reticulated papillomatosis. This article highlights the clinical presentations of these conditions in skin of color and briefly addresses pathophysiology and treatment modalities.
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9
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Goh BK, Pandya AG. Presentations, Signs of Activity, and Differential Diagnosis of Vitiligo. Dermatol Clin 2017; 35:135-144. [PMID: 28317523 DOI: 10.1016/j.det.2016.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vitiligo has a variety of presentations, including focal, acrofacial, segmental, and generalized forms. Thorough knowledge of these presentations is important to make the correct diagnosis. Signs of activity are important to recognize so that treatment is optimized. Clinical findings of confettilike depigmentation, trichrome and inflammatory vitiligo, and the Koebner phenomenon should alert the clinician that a patient's disease is likely to worsen. These patients may require systemic treatment to stabilize their disease. Many other skin disorders present with hypopigmentation or depigmentation and must be distinguished to determine the right diagnosis, advise the patient on prognosis, and prescribe the correct treatment.
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Affiliation(s)
- Boon-Kee Goh
- Skin Physicians Pte Ltd, 3 Mount Elizabeth, Suite 11-08 Mount Elizabeth Medical Centre, Singapore 228510, Singapore
| | - Amit G Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9069, USA.
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10
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Pflederer RT, Wuennenberg JP, Foote C, Aires D, Rajpara A. Use of Wood's lamp to diagnose progressive macular hypomelanosis. J Am Acad Dermatol 2017; 77:e99-e100. [DOI: 10.1016/j.jaad.2017.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/05/2017] [Indexed: 10/18/2022]
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11
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Petersen RLW, Scholz CFP, Jensen A, Brüggemann H, Lomholt HB. Propionibacterium Acnes Phylogenetic Type III is Associated with Progressive Macular Hypomelanosis. Eur J Microbiol Immunol (Bp) 2017; 7:37-45. [PMID: 28386469 PMCID: PMC5372479 DOI: 10.1556/1886.2016.00040] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 12/21/2016] [Indexed: 01/16/2023] Open
Abstract
Progressive macular hypomelanosis (PMH) is a skin disorder that is characterized by hypopigmented macules and usually seen in young adults. The skin microbiota, in particular the bacterium Propionibacterium acnes, is suggested to play a role. Here, we compared the P. acnes population of 24 PMH lesions from eight patients with corresponding nonlesional skin of the patients and matching control samples from eight healthy individuals using an unbiased, culture-independent next-generation sequencing approach. We also compared the P. acnes population before and after treatment with a combination of lymecycline and benzoylperoxide. We found an association of one subtype of P. acnes, type III, with PMH. This type was predominant in all PMH lesions (73.9% of reads in average) but only detected as a minor proportion in matching control samples of healthy individuals (14.2% of reads in average). Strikingly, successful PMH treatment is able to alter the composition of the P. acnes population by substantially diminishing the proportion of P. acnes type III. Our study suggests that P. acnes type III may play a role in the formation of PMH. Furthermore, it sheds light on substantial differences in the P. acnes phylotype distribution between the upper and lower back and abdomen in healthy individuals.
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Affiliation(s)
| | | | - Anders Jensen
- Department of Biomedicine, Aarhus University , Aarhus, Denmark
| | | | - Hans B Lomholt
- Department of Biomedicine, Aarhus University , Aarhus, Denmark
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12
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13
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Strains of the Propionibacterium acnes type III lineage are associated with the skin condition progressive macular hypomelanosis. Sci Rep 2016; 6:31968. [PMID: 27555369 PMCID: PMC4995408 DOI: 10.1038/srep31968] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/22/2016] [Indexed: 12/21/2022] Open
Abstract
Progressive macular hypomelanosis (PMH) is a common skin disorder that causes hypopigmentation in a variety of skin types. Although the underlying aetiology of this condition is unclear, there is circumstantial evidence that links the skin bacterium Propionibacterium acnes to the condition. We now describe the first detailed population genetic analysis of P. acnes isolates recovered from paired lesional and non-lesional skin of PMH patients. Our results demonstrate a strong statistical association between strains from the type III phylogenetic lineage and PMH lesions (P = 0.0019), but not those representing other phylogroups, including those associated with acne (type IA1). We also demonstrate, based on in silico 16S rDNA analysis, that PMH isolates previously recovered from patients in Europe are also consistent with the type III lineage. Using comparative genome analysis, we identified multiple genomic regions that are specific for, or absent from, type III strains compared to other phylogroups. In the former case, these include open reading frames with putative functions in metabolism, transport and transcriptional regulation, as well as predicted proteins of unknown function. Further study of these genomic elements, along with transcriptional and functional analyses, may help to explain why type III strains are associated with PMH.
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14
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Barka EA, Vatsa P, Sanchez L, Gaveau-Vaillant N, Jacquard C, Meier-Kolthoff JP, Klenk HP, Clément C, Ouhdouch Y, van Wezel GP. Taxonomy, Physiology, and Natural Products of Actinobacteria. Microbiol Mol Biol Rev 2016; 80:1-43. [PMID: 26609051 PMCID: PMC4711186 DOI: 10.1128/mmbr.00019-15] [Citation(s) in RCA: 947] [Impact Index Per Article: 118.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Actinobacteria are Gram-positive bacteria with high G+C DNA content that constitute one of the largest bacterial phyla, and they are ubiquitously distributed in both aquatic and terrestrial ecosystems. Many Actinobacteria have a mycelial lifestyle and undergo complex morphological differentiation. They also have an extensive secondary metabolism and produce about two-thirds of all naturally derived antibiotics in current clinical use, as well as many anticancer, anthelmintic, and antifungal compounds. Consequently, these bacteria are of major importance for biotechnology, medicine, and agriculture. Actinobacteria play diverse roles in their associations with various higher organisms, since their members have adopted different lifestyles, and the phylum includes pathogens (notably, species of Corynebacterium, Mycobacterium, Nocardia, Propionibacterium, and Tropheryma), soil inhabitants (e.g., Micromonospora and Streptomyces species), plant commensals (e.g., Frankia spp.), and gastrointestinal commensals (Bifidobacterium spp.). Actinobacteria also play an important role as symbionts and as pathogens in plant-associated microbial communities. This review presents an update on the biology of this important bacterial phylum.
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Affiliation(s)
- Essaid Ait Barka
- Laboratoire de Stress, Défenses et Reproduction des Plantes, Unité de Recherche Vignes et Vins de Champagne, UFR Sciences, UPRES EA 4707, Université de Reims Champagne-Ardenne, Reims, France
| | - Parul Vatsa
- Laboratoire de Stress, Défenses et Reproduction des Plantes, Unité de Recherche Vignes et Vins de Champagne, UFR Sciences, UPRES EA 4707, Université de Reims Champagne-Ardenne, Reims, France
| | - Lisa Sanchez
- Laboratoire de Stress, Défenses et Reproduction des Plantes, Unité de Recherche Vignes et Vins de Champagne, UFR Sciences, UPRES EA 4707, Université de Reims Champagne-Ardenne, Reims, France
| | - Nathalie Gaveau-Vaillant
- Laboratoire de Stress, Défenses et Reproduction des Plantes, Unité de Recherche Vignes et Vins de Champagne, UFR Sciences, UPRES EA 4707, Université de Reims Champagne-Ardenne, Reims, France
| | - Cedric Jacquard
- Laboratoire de Stress, Défenses et Reproduction des Plantes, Unité de Recherche Vignes et Vins de Champagne, UFR Sciences, UPRES EA 4707, Université de Reims Champagne-Ardenne, Reims, France
| | | | - Hans-Peter Klenk
- School of Biology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Christophe Clément
- Laboratoire de Stress, Défenses et Reproduction des Plantes, Unité de Recherche Vignes et Vins de Champagne, UFR Sciences, UPRES EA 4707, Université de Reims Champagne-Ardenne, Reims, France
| | - Yder Ouhdouch
- Faculté de Sciences Semlalia, Université Cadi Ayyad, Laboratoire de Biologie et de Biotechnologie des Microorganismes, Marrakesh, Morocco
| | - Gilles P van Wezel
- Molecular Biotechnology, Institute of Biology, Sylvius Laboratories, Leiden University, Leiden, The Netherlands
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Klatte JL, van der Beek N, Kemperman PMJH. 100 years of Wood's lamp revised. J Eur Acad Dermatol Venereol 2014; 29:842-7. [PMID: 25428804 DOI: 10.1111/jdv.12860] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/20/2014] [Indexed: 11/30/2022]
Abstract
The Wood's lamp is a diagnostic tool in dermatology. Unfortunately, this useful tool is often overlooked in the busy and hectic outdoor dermatology clinic. To emphasize its value in modern dermatology, we present an updated review of the principles and applications and shed new light on its proper place in our practice.
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Affiliation(s)
- J L Klatte
- Department of Dermatology, Waterland Hospital, Purmerend, The Netherlands
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16
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Progressive macular hypomelanosis pathogenesis and treatment: a randomized clinical trial. J Microsc Ultrastruct 2014. [DOI: 10.1016/j.jmau.2014.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Lo Schiavo A, Gambardella A, Caccavale S. The possible role of antiretroviral drugs in the pathogenesis of progressive macular hypomelanosis. Int J Dermatol 2013; 53:759-60. [DOI: 10.1111/j.1365-4632.2012.05660.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Martínez Martínez M, Azaña Defez J, López Villaescusa M, Gómez Sánchez M. Máculas hipopigmentadas en un adolescente resistentes a tratamiento antifúngico. Semergen 2012; 38:405-7. [DOI: 10.1016/j.semerg.2011.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 09/29/2011] [Accepted: 10/01/2011] [Indexed: 10/28/2022]
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Martínez-Martínez ML, Azaña-Defez JM, Rodríguez-Vázquez M, Faura-Berruga C, Escario-Travesedo E. Progressive macular hypomelanosis. Pediatr Dermatol 2012; 29:460-2. [PMID: 21995551 DOI: 10.1111/j.1525-1470.2011.01506.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Progressive macular hypomelanosis (PMH) is a condition of unknown etiology characterized by asymptomatic, hypopigmented macules located predominantly on the trunk. We recorded 12 adolescents with PMH over a 6-month period. Ten were female, and the mean age was 16.6 years. The average time from the patients first noticing pigment change to diagnosis was 15 months. PMH is probably an underdiagnosed condition.
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Kim YJ, Lee DY, Lee JY, Yoon TY. Progressive macular hypomelanosis showing excellent response to oral isotretinoin. J Dermatol 2012; 39:937-8. [PMID: 22724575 DOI: 10.1111/j.1346-8138.2012.01605.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Cavalcanti SMDM, de França ER, Lins AK, Magalhães M, de Alencar ERB, Magalhães V. Investigation of Propionibacterium acnes in progressive macular hypomelanosis using real-time PCR and culture. Int J Dermatol 2012; 50:1347-1352. [PMID: 22004486 DOI: 10.1111/j.1365-4632.2011.04978.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Progressive macular hypomelanosis (PMH) is a dermatosis of unknown etiology. It has been concluded that it involves the presence of Propionibacterium acnes, a saprophyte of the pilosebaceous follicles. In our study, we investigated the presence of P. acnes in lesional and non-lesional skin of patients with PMH through quantitative real-time polymerase chain reaction (PCR) and bacterial culture from a skin fragment. MATERIALS AND METHODS An observational, exploratory study, with laboratory comparison of lesional (study group) and non-lesional skin (comparison group), in patients with PMH, was carried out with 36 patients, seen in the dermatology outpatient setting at the Oswaldo Cruz University Hospital (OCUH), Recife, Pernambuco, Brazil, between March and May 2008. All patients were submitted to a Wood's lamp examination, mycological research, and biopsies of lesional and non-lesional skin from the back. Skin fragments were submitted to a histopathology test, bacterial culture, and a quantitative real-time PCR test. The program Statistical Package for Social Sciences, version 12.0, was employed for relationship analysis with the Wilcoxon and McNemar tests. RESULTS There was a significant predominance of P. acnes on lesional skin, in comparison to non-lesional skin (P<0.001), as demonstrated by culture and quantitative real-time PCR. CONCLUSION Although P. acnes is a saprophyte, the hypothesis may be raised that this microorganism participates in the development of PMH.
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Cavalcanti SMDM, Querino MCD, Magalhães V, França ERD, Magalhães M, Alencar E. The use of lymecycline and benzoyl peroxide for the treatment of progressive macular hypomelanosis: a prospective study. An Bras Dermatol 2012; 86:813-4. [PMID: 21987158 DOI: 10.1590/s0365-05962011000400034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 06/17/2010] [Indexed: 11/22/2022] Open
Abstract
Progressive macular hypomelanosis is a dermatosis of uncertain etiology. The participation of Propionibacterium acnes has been suggested in view of the response achieved following therapy with drugs that are active against this bacterium. This report describes a series of thirteen patients with progressive macular hypomelanosis who were treated with an association of lymecycline and benzoyl peroxide over a three-month period. Response to treatment was excellent and the positive results were maintained during the entire follow up period.
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Santos JB, Almeida OLS, Silva LMD, Barreto ERM. Efficacy of topical combination of benzoyl peroxide 5% and clindamycin 1% for the treatment of progressive macular hypomelanosis: a randomized, doubleblind, placebo-controlled trial. An Bras Dermatol 2012; 86:50-4. [PMID: 21437522 DOI: 10.1590/s0365-05962011000100006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 12/15/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Progressive macular hypomelanosis is a dermatosis without definite etiology. There is no consensus or first-line therapy in the treatment of progressive macular hypomelanosis, and the treatment options used are very little effective. OBJECTIVE To evaluate the therapeutic efficacy of the topical combination of benzoyl peroxide 5% and clindamycin 1% associated with sun exposure for the treatment of progressive macular hypomelanosis. MATERIALS AND METHODS This is a randomized, double-blind, placebo-controlled study in which patients were divided into two groups. Group A used the topical combination of benzoyl peroxide 5% and clindamycin 1% and Group B used gel cream as a placebo. Patients were advised to expose themselves to the sun on a daily basis and were systematically evaluated and photographed. The collected data were entered and analyzed using Epi Info. A p value < 0.05 was considered statistically significant. RESULTS Out of the 23 patients included in the study, 13 were in group A and 10 in group B. Eleven patients (85%) in group A had significant clinical improvement and only two patients (20%) in group B showed an equivalent clinical improvement (p = 0.003). Side effects were more frequent in group A (p = 0.003). CONCLUSION The topical combination of benzoyl peroxide 5% and clindamycin 1% is effective in the treatment of progressive macular hypomelanosis.
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Kim MB, Kim GW, Cho HH, Park HJ, Kim HS, Kim SH, Kim BS, Ko HC. Narrowband UVB treatment of progressive macular hypomelanosis. J Am Acad Dermatol 2011; 66:598-605. [PMID: 22005073 DOI: 10.1016/j.jaad.2011.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 03/28/2011] [Accepted: 04/06/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND 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. OBJECTIVE 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. METHODS 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. RESULTS 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). LIMITATIONS Our study includes a small number of subjects examined, and it was an uncontrolled and non-double-blind study. CONCLUSIONS 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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Affiliation(s)
- Moon-Bum Kim
- Department of Dermatology, Pusan National University, School of Medicine, Busan, Korea
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de Morais Cavalcanti SM, de França ER, Magalhães M, Lins AK, Brandão LC, Magalhães V. A quantitative analysis of Propionibacterium acnes in lesional and non-lesional skin of patients with progressive macular hypomelanosis by real-time polymerase chain reaction. Braz J Microbiol 2011; 42:423-9. [PMID: 24031649 PMCID: PMC3769848 DOI: 10.1590/s1517-83822011000200002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 08/02/2010] [Accepted: 11/04/2010] [Indexed: 11/22/2022] Open
Abstract
Little is known about the etiology of progressive macular hypomelanosis, although it has been suggested that Propionibacterium acnes plays an important role. While microbiological culture is commonly employed to identify Propionibacterium acnes, new identification methods have been under investigation, amongst them polymerase chain reaction. To determine the cut-off point for the number of genome copies of Propionibacterium acnes in the lesional skin of patients with progressive macular hypomelanosis as a positive marker, employing quantitative real-time polymerase chain reaction and anaerobic culture, considered gold standard. An observational study with a comparison group, included 35 patients with dermatosis, attended at the Oswaldo Cruz University Hospital, Pernambuco, Brazil, between March and May 2008. Lesional skin was compared to non-lesional skin through positive testing with real-time polymerase chain reaction and culture. The Statistical Package for Social Sciences, version 12.0, was employed for the association analysis with the McNemar test, and the cut-off point with the ROC curve for maximum values. Propionibacterium acnes was most frequently encountered in lesional areas (p<0,025). The cut-off point of Propionibacterium acnes in lesional skin was 1,333 genome copies, with a sensitivity of 87,9% and a specificity of 100,0%. Since Propionibacterium acnes is a saprophyte, identifying the cut-off point may assist in determining its positivity in lesional skin in patients suffering with this dermatosis.
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Sim JH, Lee DJ, Lee JS, Kim YC. Comparison of the clinical efficacy of NBUVB and NBUVB with benzoyl peroxide/clindamycin in progressive macular hypomelanosis. J Eur Acad Dermatol Venereol 2011; 25:1318-23. [PMID: 21349111 DOI: 10.1111/j.1468-3083.2011.03980.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Progressive macular hypomelanosis (PMH) is a skin disorder characterized by multiple hypopigmented patches symmetrically distributed on the trunk. Several treatment modalities have been attempted; however, a standard treatment modality has not been agreed to. OBJECTIVES The aim of this study was to compare the effectiveness of antimicrobial therapy combined with narrow band ultraviolet B (NBUVB) with NBUVB monotherapy. METHODS A randomized left-right comparison study was conducted in a total of 10 patients. Patients received NBUVB therapy with daily application of antimicrobial gel on one side of the trunk (comb-NBUVB) and without it (mono-NBUVB) for 8 weeks. The clinical efficacy was determined by objective measurements using a colour analyser and subjective assessment by evaluating pictures taken with a digital camera at baseline, at the time of treatment cessation and 6 months after treatment. RESULTS Significant repigmentation was observed in all 10 patients during the 8 weeks of treatment. The mean difference in L values between lesional and non-lesional skin was reduced in the comb-NBUVB area (from 4.52 ± 1.65 to 0.94 ± 0.65), and in the mono-NBUVB area, (from 4.34 ± 1.39 to 1.18 ± 0.94). There was no significant difference between treated sites at both of the evaluation points in time. At 6 months after treatment, 7 of 10 patients completed the clinical trial, and some degree of clinical improvement remained in four of seven patients; recurrence occurred in the other patients. CONCLUSIONS Although recurrence occurred in some patients, NBUVB treatment appears to be a safe and useful modality for the treatment of PMH.
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Affiliation(s)
- J H Sim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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Duarte I, Nina BID, Gordiano MC, Buense R, Lazzarini R. Hipomelanose macular progressiva: estudo epidemiológico e resposta terapêutica à fototerapia. An Bras Dermatol 2010; 85:621-4. [DOI: 10.1590/s0365-05962010000500004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 03/19/2010] [Indexed: 11/22/2022] Open
Abstract
FUNDAMENTOS: A hipomelanose macular progressiva é uma dermatose comum em diferentes continentes. Sua causa é desconhecida e os tratamentos propostos são pouco eficazes. OBJETIVOS: Determinar aspectos epidemiológicos da hipomelanose macular progressiva em pacientes atendidos num setor de fototerapia, no período de 1997 a 2008, e avaliar a resposta terapêutica com PUVA ou UVBNB. MÉTODOS: Foram avaliados 84 pacientes com Hipomelanose Macular Progressiva. Após 16 sessões de fototerapia, a resposta terapêutica foi definida: I=inalterado, MD=melhora discreta(< 50% de repigmentação), MM=melhora moderada(50-79%), MI=melhora intensa(80-99%) e C=cura(100%). Após um tempo mínimo de três meses, pacientes com cura ou MI foram contatados por telefone para avaliar a manutenção do resultado terapêutico. RESULTADOS: Predominaram mulheres (79%) e a cor branca. A idade mínima de aparecimento da Hipomelanose Macular Progressiva foi de 13 anos e a máxima de 36 anos. Fototerapia com PUVA foi indicada em 27 pacientes e UVBNB em 57. Estatisticamente, não houve diferença significante entre o tratamento com PUVA e UVBNB (teste de Fisher P>0.05). A maioria (81%) dos pacientes obteve 50% ou mais de repigmentação e 65% tiveram cura ou MI. Entretanto, 72% apresentaram recorrência das lesões. CONCLUSÃO: A ausência de pacientes, com mais de 40 anos, sugere que a Hipomelanose Macular Progressiva seja uma doença autolimitada. Tanto PUVA como UVB NB são opções terapêuticas, porém não impedem a recidiva da doença.
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Affiliation(s)
- Ida Duarte
- Santa Casa de Misericórdia de São Paulo, Brasil
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Erpolat S, Gorpelioglu C, Sarifakioglu E. A case of progressive macular hypomelanosis treated with 1% topical clindamycin lotion and narrow-band ultraviolet B. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2010; 26:277-8. [PMID: 20831700 DOI: 10.1111/j.1600-0781.2010.00528.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Echeverría B, Botella-Estrada R, Escutia B, Guillén C. Hipomelanosis macular progresiva resuelta con peróxido de benzoilo y clindamicina tópicos. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Wu XG, Xu AE, Luo XY, Song XZ. A case of progressive macular hypomelanosis successfully treated with benzoyl peroxide plus narrow-band UVB. J DERMATOL TREAT 2010; 21:367-8. [DOI: 10.3109/09546630903403336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kwah YC, Chong WS, Thiam-Seng Theng C, Goh BK. Treatment of progressive macular hypomelanosis with narrow-band ultraviolet B phototherapy. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2010; 26:153-5. [DOI: 10.1111/j.1600-0781.2010.00504.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Progressive and Confluent Macular Hypomelanosis. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70628-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rodríguez-Lojo R, Verea M, Velasco D, Barja J. Hipomelanosis macular progresiva y confluente. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2009.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Relyveld GN, Westerhof W, Woudenberg J, Kingswijk M, Langenberg M, Vandenbroucke-Grauls CM, Bos JD, Savelkoul PHM. Progressive macular hypomelanosis is associated with a putative Propionibacterium species. J Invest Dermatol 2009; 130:1182-4. [PMID: 20043017 DOI: 10.1038/jid.2009.388] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hwang SW, Hong SK, Kim SH, Park JH, Seo JK, Sung HS, Lee D. Progressive macular hypomelanosis in korean patients: a clinicopathologic study. Ann Dermatol 2009; 21:261-7. [PMID: 20523800 PMCID: PMC2861224 DOI: 10.5021/ad.2009.21.3.261] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 01/09/2009] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Progressive macular hypomelanosis is characterized by ill-defined, non-scaly, hypopigmented macules primarily on the trunk of the body. Although numerous cases of progressive macular hypomelanosis have been reported, there have been no clinicopathologic studies of progressive macular hypomelanosis in Korean patients. OBJECTIVE In this study we examined the clinical characteristics, histologic findings, and treatment methods for progressive macular hypomelanosis in a Korean population. METHODS Between 1996 and 2005, 20 patients presented to the Department of Dermatology at Busan Paik Hospital with acquired, non-scaly, confluent, hypopigmented macules on the trunk, and with no history of inflammation or infection. The medical records, clinical photographs, and pathologic findings for each patient were examined. RESULTS The patients included 5 men and 15 women. The mean age of onset was 21.05+/-3.47 years. The back was the most common site of involvement. All KOH examinations were negative. A Wood's lamp examination showed hypopigmented lesions compared with the adjacent normal skin. A microscopic examination showed a reduction in the number of melanin granules in the lesions compared with the adjacent normal skin, although S-100 immunohistochemical staining did not reveal significant differences in the number of melanocytes. Among the 20 patients, 7 received topical drug therapy, 6 were treated with narrow-band ultraviolet B phototherapy, 4 received oral minocycline, and 3 did not receive any treatment. CONCLUSION Most of the patients with progressive macular hypomelanosis had asymptomatic ill-defined, non-scaly, and symmetric hypopigmented macules, especially on the back and abdomen. Histologically, the number of melanocytes did not differ significantly between the hypopigmented macules and the normal perilesional skin. No effective treatment is known for progressive macular hypomelanosis; however, narrow-band ultraviolet B phototherapy may be a useful treatment modality.
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Affiliation(s)
- Seon Wook Hwang
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Soon Kwon Hong
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Hyun Kim
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jeong Hoon Park
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jong Keun Seo
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ho Suk Sung
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Deborah Lee
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Progressive macular hypomelanosis: a rarely diagnosed hypopigmentation in Caucasians. Dermatol Res Pract 2009; 2009:607682. [PMID: 20585481 PMCID: PMC2879604 DOI: 10.1155/2009/607682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 04/24/2009] [Indexed: 11/18/2022] Open
Abstract
A 35-year-old woman who developed whitish macules on trunk and limbs at 12 years of age and observed a remarkable increase of the hypopigmentated lesions after her pregnancies at ages 29 and 32 years. Because of the highly characteristic clinical aspect and the light- and electron-microscopic histopathologic findings, we diagnosed progressive macular hypomelanosis (PMH). It is a nonscaly disorder with hypopigmented macules mainly on the trunk and is more often seen in young women. In contrast to some authors assuming the presence of Propionibacterium spp. as a matter of principle in PMH, we report a case with no evidence for Propionibacterium spp.
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Menke H, Relyveld G, Westerhof W. Comment on the letter by Chungetal. about progressive macular hypomelanosis1. J Eur Acad Dermatol Venereol 2008; 22:1029-30. [DOI: 10.1111/j.1468-3083.2008.02838.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Relyveld GN, Dingemans KP, Menke HE, Bos JD, Westerhof W. Ultrastructural findings in progressive macular hypomelanosis indicate decreased melanin production. J Eur Acad Dermatol Venereol 2008; 22:568-74. [PMID: 18266692 DOI: 10.1111/j.1468-3083.2007.02515.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The pathogenesis of progressive macular hypomelanosis (PMH) is unknown. Recently, Westerhof et al. (Arch Dermatol 2004; 140: 210-214) hypothesized that Propionibacterium acnes produces a depigmenting factor that interferes with melanogenesis in the skin, resulting in hypopigmented spots. The purpose of the study is to gain an insight into the pathogenesis of PMH. MATERIALS AND METHODS We took a biopsy of 2-mm diameter from normal and lesional skin in eight PMH patients. Using electron microscopy, we compared melanization of melanosomes, melanosome transfer and amount of epidermal melanin in normal and lesional skin. RESULT Compared to non-lesional skin, we observed a decrease of epidermal melanin and less melanized melanosomes in lesional skin of all patients. When comparing normal and lesional skin of patients with skin type V and VI, we observed a difference in melanosome size and maturation and a switch of transferred melanosomes from single stage IV transferred melanosomes to aggregated stage I, II and III transferred melanosomes, as seen in healthy skin of skin type I to IV. CONCLUSION Hypopigmentation in PMH seems to be the result of an altered melanogenesis based on a decrease in melanin formation and a change in the distribution of melanosomes. In lesional skin of PMH patients with skin type V and VI less melanized, aggregated melanosomes in stead of single, mature melanosomes are transferred from melanocytes to keratinocytes. This results in a decrease of epidermal melanin. Further investigations are needed to determine the precise role of Propionibacterium acnes in this alteration of melanogenesis.
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Affiliation(s)
- G N Relyveld
- Netherlands Institute for Pigment Disorders, and Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Abstract
Progressive macular hypomelanosis of the trunk is a disease of unclear etiology that often goes unrecognized in the clinical setting. We present a Caucasian adolescent girl with hypopigmented macules coalescing into patches on her trunk, initially diagnosed as tinea versicolor. Upon further evaluation, the patient was found to have progressive macular hypomelanosis that demonstrated improvement with sunlight exposure and doxycycline. We report this patient to make physicians more aware of this entity and discuss the literature.
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Affiliation(s)
- Marissa Perman
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio 45229, USA
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Mollet I, Ongenae K, Naeyaert JM. Origin, clinical presentation, and diagnosis of hypomelanotic skin disorders. Dermatol Clin 2007; 25:363-71, ix. [PMID: 17662902 DOI: 10.1016/j.det.2007.04.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hypomelanotic skin disorders are cutaneous pigmentary disorders characterized by a reduced melanin content in the skin that results in a lightening of the skin. Establishing the correct diagnosis for hypomelanotic skin disorders requires a good history, a detailed physical examination, the use of special lighting techniques, such as Wood's light, and sometimes a biopsy of the abnormally pigmented skin and the normally pigmented skin. This article focuses on the origin, clinical presentation, and diagnosis of acquired hypomelanotic skin disorders. An algorithm for the diagnostic approach to these hypomelanoses is given.
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Affiliation(s)
- Ilse Mollet
- Department of Dermatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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Abstract
Pigmentary disorders with hypopigmentation/depigmentation or hyperpigmentation may have special manifestations in Latin America. Most pigmentary disorders are commonly observed in all areas of Latin America, but a few are particularly seen in tropical and subtropical regions. In most pigmentary disorder ailments described, multiple factors involved in their pathogenesis are known, but etiology remains elusive. Some pigmentary disorders have peculiar clinical expressions and, in spite of being restricted to certain geographical areas, they may be observed in other world areas because of frequent traveling of affected patients. Therapy of most of these ailments is difficult or remains unknown.
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Affiliation(s)
- Rafael Falabella
- Department of Dermatology, Universidad del Valle and Hospital Universitario del Valle, Calle 5 #36-08, Cali, Colombia.
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42
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Abstract
Progressive macular hypomelanosis (PMH) is a common skin disorder that is often misdiagnosed. Various authors have written about similar skin disorders, referring to them by different names, but we believe that all these similar disorders are part of the same entity.PMH is characterized by ill-defined nummular, non-scaly hypopigmented spots on the trunk, often confluent in and around the midline, and rarely extending to the proximal extremities and neck/head region. There is no itch, pain, or preceding inflammation. PMH has a worldwide distribution; however, it is more often identified in Black people living in or originating from tropical countries. It is also more often seen in young females. The natural history of PMH is stable disease or perhaps slow progression over decades, with spontaneous disappearance after mid-life. Extensive pityriasis alba is probably identical with PMH and we suggest discontinuation of use of the former term on the grounds that extensive pityriasis alba is histologically and clinically different from classical pityriasis alba, which is basically an eczematous type of disorder.PMH is characterized histologically by diminished pigment in the epidermis and a normal-looking dermis. Electron microscopy shows a shift from large melanosomes in normal-looking skin to small aggregated, membrane-bound melanosomes in hypopigmented skin. PMH should be differentiated from other disorders with hypopigmentation on the trunk such as pityriasis versicolor. We propose that Propionibacterium acnes bacteria living in hair follicles are the cause of PMH as a result of production of a hypothetical depigmenting factor. This hypothesis is based on: (i) the presence of a red follicular fluorescence in the hypopigmented spots and the absence of this phenomenon in normal skin when examined under a Wood's light in a dark room; (ii) cultivation of P. acnes from the follicles in the hypopigmented spots but not from follicles in normal-looking skin; and (iii) improvement of the disorder after elimination of these micro-organisms with topical antimicrobial treatment in combination with UVA light.Currently, the treatment of choice of PMH is application of 1% clindamycin lotion during the daytime, 5% benzoyl peroxide gel at night-time, and UVA light irradiation three times a week for a period of 12 weeks. There is insufficient information available as yet to comment on the recurrence rate after therapy.
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Affiliation(s)
- Germaine N Relyveld
- The Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Relyveld GN, Kingswijk MM, Reitsma JB, Menke HE, Bos JD, Westerhof W. Benzoyl peroxide/clindamycin/UVA is more effective than fluticasone/UVA in progressive macular hypomelanosis: A randomized study. J Am Acad Dermatol 2006; 55:836-43. [PMID: 17052490 DOI: 10.1016/j.jaad.2006.03.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Revised: 03/14/2006] [Accepted: 03/20/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is no effective treatment for progressive macular hypomelanosis. Recent findings indicate that Propionibacterium acnes may play a role in the pathogenesis. OBJECTIVES We sought to compare the effectiveness of antimicrobial therapy with anti-inflammatory therapy in patients with progressive macular hypomelanosis. METHODS A total of 45 patients were randomized to a within-patient left-right comparison study of benzoyl peroxide 5% hydrogel/clindamycin 1% lotion in combination with UVA irradiation versus fluticasone 0.05% cream in combination with UVA irradiation. Repigmentation was determined by photometric measurements of changes in skin color and by patient and dermatologist assessment using before and after photographs. RESULTS Benzoyl peroxide 5% hydrogel, clindamycin 1% lotion, and UVA led to better repigmentation than fluticasone 0.05% cream in combination with UVA irradiation in all measurements. (Photometric measurements P = .007, patient assessment P < .0001, and dermatologist assessment P < .0001.) LIMITATIONS There was difficult objective color measurement. Therefore, subjective assessment has important additional value. Right-left comparisons have certain inherent limitations. CONCLUSION Antimicrobial therapy in conjunction with light was more effective in repigmentation in patients with progressive macular hypomelanosis than a combination of anti-inflammatory therapy and light.
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Relyveld G, Menke H, Westerhof W. Progressive and extensive hypomelanosis and extensive pityriasis alba: same disease, different names? J Eur Acad Dermatol Venereol 2006; 20:1363-4. [PMID: 17062079 DOI: 10.1111/j.1468-3083.2006.01719.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kumarasinghe SPW, Tan SH, Thng S, Thamboo TP, Liang S, Lee YS. Progressive macular hypomelanosis in Singapore: a clinico-pathological study. Int J Dermatol 2006; 45:737-42. [PMID: 16796639 DOI: 10.1111/j.1365-4632.2006.02755.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Progressive macular hypomelanosis (PMH), a condition of uncertain etiology, is characterized by asymptomatic hypopigmented macules predominantly located on the trunk. To date, there are no reports from South-East Asia concerning this condition. We sought to record the clinical features of PMH in Asian patients, identify etiologic factors, and study the structural and ultrastructural features of melanocytes in this disorder. METHODS Patients who presented to the National Skin Center with acquired, hypopigmented macules on the trunk, without a history of inflammation or infection, were recruited. Erythrocyte sedimentation rate (ESR), complete blood count, fasting blood glucose, liver function tests, skin scrapings for fungi, and skin biopsy specimens (from lesional and normal skin) were obtained. Biopsies were stained with hematoxylin and eosin (H&E), Fontana Masson, an immunohistochemical panel for identification of melanocyte differentiation antibodies (HMB 45, Melan A, and S100) and CD 68. Electron microscopy (EM) was also performed. The patients were evaluated every 3 months. RESULTS During a 9 month period, eight patients (all Chinese) presented with hypopigmented, ill-defined, confluent macules involving the lower aspect of the trunk. There were four men and four women, and the mean age was 25.9 years (range 19-45 years). Skin scrapings were negative for fungi and laboratory tests were normal. Microscopic evaluation of skin biopsy specimens showed reduced pigmentation of lesional as compared with normal appearing skin, but H&E-stained sections revealed only minimal histologic differences between lesional and normal skin. EM demonstrated a statistically significant (P = 0.047, Wilcoxon Signed Rank Test, Wilcoxon 95% CI 0.02-0.62) higher ratio of stage IV and late stage III (dark) melanosomes in normal vs. lesional skin. CONCLUSIONS PMH may occur among young adults in Singapore. Its etiology is uncertain. The melanin content of lesional skin appears to be less than that in normal sites. EM shows a higher ratio of immature melanosomes in lesional vs. normal skin.
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Affiliation(s)
- Sujith Prasad W Kumarasinghe
- National Skin Center, Singapore, Department of Pathology, Faculty of Medicine, National University of Singapore, Singapore.
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Brüggemann H. Insights in the Pathogenic Potential of Propionibacterium acnes From Its Complete Genome. ACTA ACUST UNITED AC 2005; 24:67-72. [PMID: 16092793 DOI: 10.1016/j.sder.2005.03.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One of the long-lasting open questions in understanding acne is the role of the skin bacterium Propionibacterium acnes. Opinions within the scientific community diverge regarding the importance of this Gram-positive bacterium not only in acne but also in other P. acnes-associated diseases. The recently decoded genome gives us some clues with respect to its pathogenic potential and its strategies to survive in the harsh environment of human skin. This review focuses on the major findings of the genome sequence. Special attention has been drawn to the cell surface composition of P. acnes, its antigenic potential, and to enzymes that are potentially involved in degrading skin-derived substances.
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Affiliation(s)
- Holger Brüggemann
- Göttingen Genomics Laboratory, Institute of Microbiology and Genetics, University of Göttingen, Göttingen, Germany.
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