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Wiete Westerhof, MD, PhD; Germaine N. Relyveld, MD; Melanie M. Kingswijk; Peter de Man, MD, PhD; Henk E. Menke, MD, PhD

Arch Dermatol. 2004;140:210-214.

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.

From the Netherlands Institute for Pigment Disorders (Drs Westerhof, Relyveld, and Menke and Ms Kingswijk), and the Department of Dermatology, Academic Medical Center, University of Amsterdam (Dr Westerhof), Amsterdam, the Netherlands; and the Departments of Bacteriology (Dr de Man) and Dermatology (Dr Menke), Sint Franciscus Gasthuis, Rotterdam, the Netherlands. The authors have no relevant financial interest in this article.

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