ABSTRACT
La hipomelanosis macular progresiva es un trastorno adquirido de la pigmentación que aparece con más frecuencia en mujeres, adolescentes y adultas jóvenes. Se caracteriza por máculas hipopigmentadas asintomáticas, mal delimitadas, no descamativas, simétricas y de predominio en región lumbar. El estudio histopatológico evidencia disminución del contenido de melanina en la epidermis afectada, con número y distribución de los melanocitos conservados. En su etiopatogenia interviene el Cutibacterium acnes tipo III, bacteria responsable de la característica fluorescencia rojiza de distribución folicular que se observa con la lámpara de Wood. Por este motivo, los tratamientos propuestos incluyen el uso de tetraciclinas por vía oral y tratamientos tópicos como el peróxido de benzoílo, asociados a fototerapia UVA o UVB de banda angosta. Se presenta una paciente con hipomelanosis macular progresiva del tronco que respondió satisfactoriamente al tratamiento con doxiciclina vía oral
Progressive macular hypomelanosis is an acquired pigmentation disorder that occurs mostly in adolescent and young women. It is characterized by asymptomatic, poorly defined, non-scaly, symmetrical hypopigmented macules localized predominantly in the lumbar area. Histopathology shows a decrease in melanin content with preserved number and distribution of melanocytes in the affected epidermis. Cutibacterium acnes type III appears to be the responsible for the dermatosis and for the characteristic reddish fluorescence of follicular distribution observed with Wood´s lamp. Treatment include oral tetracyclines and topical benzoyl peroxide associated with UVA or narrow band UVB phototherapy. We present a patient with progressive macular hypomelanosis of the trunk with excellent response to treatment with oral doxycycline
Subject(s)
Humans , Female , Adult , Phototherapy , Tetracycline/therapeutic use , Administration, Oral , Hypopigmentation/therapy , Doxycycline/therapeutic use , Diagnosis, Differential , Melanosis/therapyABSTRACT
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 por cento de repigmentação), MM=melhora moderada(50-79 por cento), MI=melhora intensa(80-99 por cento) e C=cura(100 por cento). 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 por cento) 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 por cento) dos pacientes obteve 50 por cento ou mais de repigmentação e 65 por cento tiveram cura ou MI. Entretanto, 72 por cento 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.
BACKGROUND: Progressive macular hypomelanosis is a common dermatosis in various continents. Its cause is unknown and proposed treatments have had little effect. OBJECTIVES: To determine epidemiological aspects of progressive macular hypomelanosis in patients referred to a phototherapy clinic between 1997 and 2008 and to evaluate therapeutic response to PUVA (psoralen + UVA) photochemotherapy or narrowband UVB phototherapy. METHODS: Eighty-four patients with progressive macular hypomelanosis were evaluated. After 16 phototherapy sessions, therapeutic response was classified as: unchanged, slightly improved (<50 percent of repigmentation), moderately improved (50-79 percent of repigmentation), much improved (80-99 percent) or cured (100 percent). After a minimum of three months, patients whose response was classified as cured or much improved were contacted by telephone to evaluate the persistence of the therapeutic response. RESULTS: Most of the patients were women (79 percent) and white (85 percent). Age at onset of progressive macular hypomelanosis ranged from 13 to 36 years. PUVA was prescribed for 27 patients and narrowband UVB phototherapy for 57. No significant difference was found between the outcomes obtained with PUVA and those obtained with narrowband UVB phototherapy (Fisher's exact test; p<0.05). The majority of patients (81 percent) had 50 percent or more repigmentation, with 65 percent being classified as cured or much improved. Nevertheless, there was a recurrence of the lesions in 72 percent of patients. CONCLUSIONS: The fact that no patients were over 40 years of age suggests that progressive macular hypomelanosis is a self-limiting disease. Both PUVA and narrowband UVB are effective therapeutic options; however, they do not prevent recurrence of the disease.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Hypopigmentation/therapy , Ultraviolet Therapy/methods , Hypopigmentation/epidemiology , PUVA Therapy/methods , Recurrence , Retrospective Studies , Treatment OutcomeABSTRACT
Se presenta una paciente de sexo femenino, mestiza, de 23 años de edad, con historia de 10 años de aparición de máculas hipopigmentadas en el dorso del tronco, asintomática, que había recibido múltiples tratamientos sin mejoría. Los hallazgos en el examen físico, sumados a los estudios de hongos e histopatológico, permitieron hacer el diagnóstico de hipomelanosis macular progresiva del tronco. Recibió tratamiento tópico con una combinación de peróxido de benzoilo y eritromicina, y presentó resolución de las lesiones. Se presenta el caso como ejemplo de una alternativa terapéutica en el manejo de esta entidad.
Subject(s)
Erythromycin , Gram-Positive Bacterial Infections , Hypopigmentation/therapy , Propionibacterium acnes , Benzoyl Peroxide/therapeutic useABSTRACT
To compare the efficacy and safety of topical tacrolimus 0.03% with superoxide dismutase and catalase in vitiligo. This hospital based quasi-experimental study was carried out in out patients department of Dermatology Unit-II, Mayo Hospital Lahore in year 2006-2007. Patients were selected by non-probability purposive sampling method after obtaining an informed consent. Both sexes [above S years] were included with head and neck vitiligo. They were randomly divided into 2 groups; group 1: superoxide dismutase and catalase; group 2: tacrolimus by using random number table. There were 34[56.7%] females and 26[43.3%] males. Age of the patients ranged from 5 to 60 years with the mean age of 20.52 +/- 14.34 years. Overall 31[62%] patients showed repigmentation of varied grades. Repigmentation was shown by 14[46.6%] patients in superoxide dismutase and catalase group and 17[56.6%] patients in tacrolimus group. Topical superoxide dismutase and catalase and tacrolimus are effective treatment modalities in patients with vitiligo. There is no significant difference regarding efficacy and safety between both forms of treatment