Chinese Medical Journal 2013;126 (18)

3591

Letter
Progressive macular hypomelanosis with asymmetrically distributed lesions

o the editor: A 28-year-old Chinese woman was referred for the

evaluation of whitish macules. The macules firstly appeared in
left upper back three years ago and then spread to left limb slowly but
steadily in size. After the first gravidity at age of 26 years, the patient
observed a marked acceleration of this process. She was previously
diagnosed with pityriasis versicolor and was treated with ciclopirox
cream and zinc pyrithione shampoo without improvement. There was
no history of itching or dysaesthesia. The patient denied recreational
sun exposure in past five years. When exposed to sunlight, the whitish
macules did not change in the color whereas the non-affected skin
became more tanned, thus the contrast against the whitish macules skin
was remarkably intensified. There is no similar individual in her family.
Skin findings of this patient consisted of scattered, partial confluent,
non-scaly, well-defined, round or oval hypopigmented macules which
asymmetrically distributed on left upper back and left limb (Figure 1A
and 1C), and no similar lesions on the other side of the body (Figure 1B).
No signs of inflammation were present in these macules.
There was no evidence for fungi or other infectious agents in
morphologic and cultural surveys on repeated attempts. A biopsy
from affected skin displayed a reduced amount of melanin in the
basal layer and mild lymphocytes infiltration in the superficial layer
of the dermis, comparing to non-affected skin (Figure 1D). Under
confocal laser scanning microscopy (Lucid, USA) examination, the
lesion showed that its melanin content was decreased compared with
the perilesional normal skin (Figure 1E and 1F). Under Woods lamp
(Waldmann, Germany) examination, the lesions showed punctiform
red fluorescence. And the friction test was negative. A diagnosis of
progressive macular hypomelanosis (PMH) was made.
PMH is an uncommon pigmental skin disease especially among
darker skinned individuals, with the first report in 1988 by Guillet.1
Since the disease began to be reported in other countries, which
showed no association with race. Some other terms like cutis
trunci variata, creole dyschromia, idiopathic multiple large macule

hypomelanosis, and nummular and confluent hypomelanosis of

the trunk were used to describe similar symptoms as in PMH. 2
The classical clinical characteristics are ill-defined nummular,
hypopigmented, non-scaly macules on the trunk region and limb,
mainly with a symmetrically distributed pattern. 3 PMH often
causes diagnostic errors with other hypopigmented diseases
including pityriasis alba, pityriasis versicolor, postinflammatory
hypopigmentation, vitiligo.
To our knowledge, our PMH case reported here is the first one with
asymmetrically distributed lesions, which suggesting the existence of
some other subtypes of PMH.
DOI: 10.3760/cma.j.issn.0366-6999.20131518
WEN Lei-lei, WANG Tao, YANG Chao, YANG Sen, CUI Yong and ZHANG Xue-jun
Institute of Dermatology & Department of Dermatology, First Hospital of Anhui
Medical University, Hefei, Anhui 230032, China (Wen LL, Wang T, Yang C, Yang
S, Cui Y and Zhang XJ)
Correspondence to: CUI Yong, Institute of Dermatology & Department of
Dermatology, First Hospital of Anhui Medical University, Hefei, Anhui 230032,
China (Tel & Fax: 86-551-65138576. Email: wuhucuiyong@gmail.com)
REFERENCES
1.

Guillet G, Helenon R, Gauthier Y, Surleve-Bazeille JE, Plantin P, Sassolas

B. Progressive macular hypomelanosis of the trunk: primary acquired
hypopigmentation. J Cutan Pathol 1988; 15: 286-289.

2.

Relyveld GN, Menke HE, Westerhof W. Progressive Macular

Hypomelanosis: An Overview. Am J Clin Dermatol 2007; 8: 13-19.

3.

Wu XG, Xu AE, Song XZ, Zheng JH, Wang P, Shen H. Clinical, pathologic,
and ultrastructural studies of progressive macular hypomelanosis. Int J
Dermatol 2010; 49: 1127-1132.

(Received June 10, 2013)

Edited by GUO Li-shao

Figure 1. The clinical and pathological features of this case with PMH (colour
photographs printing). A: Hypopigmented macules on the back. B: No lesions
on the right limb. C: Hypopigmented macules on the left limb. D: Biopsy shows
reduced amount of melanin in the basal layer and mild lymphocytes infiltration
in the superficial dermis (H&E staining, light microscopy, original magnification
40). E and F: Confocal laser scanning microscopy examination of the PMH
lesion and the surrounding normal skin. The melanin content (arrows) of lesion
areas (E) was decreased compared with the surrounding normal skin (F).