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SHORT COMMUNICATION
Year : 2021  |  Volume : 5  |  Issue : 1  |  Page : 28-30

Therapeutic response of patients with progressive macular hypomelanosis to narrowband ultraviolet B phototherapy at dermatology department, Tripoli Central Hospital, Tripoli, Libya (2008–2018)


1 Department of Dermatology, Tripoli Central Hospital; Department of Medical, Tripoli University, Tripoli, Libya
2 Department of Dermatology, Tripoli Central Hospital, Tripoli, Libya

Date of Submission14-Oct-2020
Date of Acceptance17-Jan-2021
Date of Web Publication10-Apr-2021

Correspondence Address:
Dr. Halima Arebi El-Megei
Department of Dermatology, Tripoli Central Hospital, Tripoli; Department of Medical, Tripoli University, Tripoli
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_91_20

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  Abstract 


Background/Aim: Progressive macular hypomelanosis (PMH) is a common skin disorder, predominantly affected young adults, especially women. The aim of the study was to evaluate the therapeutic response of this skin disease to narrowband ultraviolet B (UVB) phototherapy. Methods: A case series study of a total of 100 patients with PMH who were treated in the Phototherapy Unit at Tripoli Central Hospital in the period between January 2008 and December 2018. Results: Out of 100 patients, 82% were female and 18% were male with the mean age of 24.45 ± 4 years. NB-UVB therapy was given three times a week starting with 0.2 J/cm2, with 20% dose increment every session. The maximum cumulative dose was 65.13 J/cm2 with a mean cumulative dose of 20.48 ± 15 J/cm2. The maximum number of sessions was 36 sessions. A satisfactory response was achieved without any complications in most of the patients (89%) after a mean of 17.21 ± 7.2 treatments. Conclusion: PMH occurs mainly in adolescence and young adults with female predominance mainly with skin types IV and V. NB-UVB phototherapy seems to be effective, well-tolerated, safe, and easily administered treatment for progressive PMH.

Keywords: Narrowband-ultraviolet B phototherapy, progressive macular hypomelanosis, skin therapy, Libya


How to cite this article:
El-Megei HA, El-Houni NO, Ezeddin SS. Therapeutic response of patients with progressive macular hypomelanosis to narrowband ultraviolet B phototherapy at dermatology department, Tripoli Central Hospital, Tripoli, Libya (2008–2018). Libyan J Med Sci 2021;5:28-30

How to cite this URL:
El-Megei HA, El-Houni NO, Ezeddin SS. Therapeutic response of patients with progressive macular hypomelanosis to narrowband ultraviolet B phototherapy at dermatology department, Tripoli Central Hospital, Tripoli, Libya (2008–2018). Libyan J Med Sci [serial online] 2021 [cited 2021 Jun 21];5:28-30. Available from: https://www.ljmsonline.com/text.asp?2021/5/1/28/313530




  Introduction Top


Progressive macular hypomelanosis (PMH) is an acquired disorder of skin pigmentation of uncertain etiology.[1],[2] Although it is common, particularly in Fitzpatrick skin types IV–VI, this condition is frequently misdiagnosed and treated inadequately with antifungal or topical steroids.[3] PMH is more common in tropical and subtropical regions[4] and it is characterized by ill-defined nummular, nonscaly hypopigmented spots on the trunk, often confluent in and around the midline.[5] Involvement of the face in PMH has not been commonly reported in the literature;[6] some authors have asserted that the lesions tend to stabilize and undergo spontaneous regression over a period of 2–5 years.[7] Many treatment modalities have been proposed, but none are universally effective.[8] Narrowband ultraviolet B (NB-UVB) is the treatment of choice for PMH in many centers.[4] Other treatment modalities include benzoyl peroxide, oral tetracyclines, and isotretinoin.[9] The speculative mode of action for the efficacy of NB-UVB phototherapy includes stimulation of melanogenesis and antimicrobial effects.[4],[10] Although PMH appears to be not a rare disease in Libya, we think that it is commonly misdiagnosed and underreported by treating doctors, we have treated all patients who presented to us with this condition with NB-UVB phototherapy as monotherapy.

This study aims to evaluate the therapeutic response to NB-UVB (311 nm) treatment among our patients with progressive PMH.


  Methods Top


Study population and setting

The present case series study included all medical records ( n = 100) of patients with progressive PMH attended the Phototherapy Clinic in Dermatology Department, Tripoli Central Hospital, Tripoli, Libya, for treatment from January 2008 to December 2018.

Medical records with missed data and patients with other diseases causing hypopigmentation such as pityriasis alba, pityriasis versicolor, vitiligo, and postinflammatory hypopigmentation, were excluded clinically, by potassium hydroxide examination, and/or Wood's lamp examination. Skin biopsy was performed in some cases like cases were hypopigmented mycosis fungoides. Complete response was defined as repigmentation of the affected skin by 90% or more following the course of phototherapy.

Data management and analysis

Data which obtained from medical records of patients included age and gender of patients, skin type, number of treatment sessions, cumulative dose side effect, and complication. Patients were assessed every 2 weeks clinically for 90% regimentation which was considered as treatment success. The data collected were analyzed with SPSS statistical package version 20 (SPSS, Inc., Chicago, IL, USA). and descriptive statistics included frequency, means, and standard deviation were used.

Ethical consideration

Ethical approval from the head of the Dermatology Department in Tripoli Central Hospital was attained, and consent was obtained from patients to take their photos to be used.


  Results Top


A total of 100 patients diagnosed with PMH were treated in our phototherapy clinic with NB-UVB as a monotherapy. There were 82 (82%) females and 18 (18%) males. Their mean age was 24.45 ± 4 years (range 15–35 years) and majority (77%) of the patients were within the age group of 21–30 years at the year of diagnosis [Figure 1]. Most of the patients (93%) had skin type IV, and 2%, 4%, and 1% of the patients had skin types III, V, and VI, respectively [Table 1].
Figure 1: Distribution of the patients according to the age (years)

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Table 1: The distribution of patients according to skin type

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The maximum number of sessions of NB-UVB received by all patients was 36 sessions with a mean number of 17.21 ± 7.2 sessions and the maximum cumulative dose was 65.13 J/cm with a mean cumulative dose of 20.48 ± 15 J/cm. A complete response (90% repigmentation) was achieved in most of the cases (74%) after completed at least 6 weeks of treatments (18 sessions) with NB-UVB. They received mean number of 23 ± 4.7 sessions of NB-UVB with the mean cumulative dose of 32.5 ± 13 J/cm2. No adverse effects were reported in most of the patients (89%). The remaining (11%) of the patient had some complications like itching (6%), erythema (4%), and acneiform rash (folliculitis) (1%) [Table 2].
Table 2: Number of narrowband ultraviolet B treatments with treatment dose and complications

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  Discussion Top


In the present study, we found that PMH is a disorder of adolescents and young adults as it occurs all over the world in young adults of all races.[11] The mean age of our patients was 24.45 ± 4, which is similar to the results recorded in previous studies in Egypt,[5] Korea,[12] and Brazil;[13] this suggests that PMH may be a self-limiting disease as has already been reported in other studies.[10],[15] Two studies, one from Egypt[5] and the other from Nigeria,[7] have reported younger age of 7 years and older age of 55 years. Our study show strong female preponderance (82%), with a male: female ratio of 1: 4.6 as previously reported in many studies from different geographical areas like that of Ida Duarte et al. from Brazil,[14] and that of Selim et al. from Egypt,[5] and that from Korea.[13] The female predominance may be related to the fact that women are known to seek medical advice more for cosmetic reasons, especially at the age of marriage.[11] Majority (93%) of patients were skin type IV; this is because skin type IV is the most common skin type in our population and is consistent with the studies which have shown that PMH can occur in any skin type but more frequently on Fitzpatrick skin types IV–VI.[7] There is no widely accepted first-line treatment for PMH.[14] Phototherapy alone has been attempted for the treatment of PMH with variable results.[4] In a previous study, NB-UVB phototherapy was shown to promote melanocyte proliferation and migration and to diminish the activation of interleukin-6 and tumor necrosis factor-α, which suppress melanin synthesis. This resulted in repigmentation of the hypopigmented lesions.[4] In the present study, all the patients received the same starting doses of NB-UVB irrespective to their skin type, three times per week with the mean number of sessions (17.21 ± 7.2) and mean cumulative dose of (20.48 ± 15 J/cm2), responded well to the treatment with more than 90% repigmentation. Those patients received mean number of 23 ± 4.7 sessions of NB-UVB with the mean cumulative dose of 32.5 ± 13 J/cm2. Our results are approximately the same as the results of the study done by Thng et al.[15] Where for the patients who had 80% repigmentation, a mean of treatments received was 22 ± 3 with the mean cumulative dose of 25.40 J/cm2. Most of our patients (89%) completed their treatment without any major adverse effects or complications except for 6% of the patients complained of itching during treatment, 4% patients had mild erythema, and 1% had acneiform rash; all these complications were treated locally and stopping the treatment was not required.


  Conclusion Top


PMH occurs mainly in adolescence and young adults with female predominance mainly with skin types IV and V. NB-UVB phototherapy seems to be an effective, well-tolerated, safe, and easily administered treatment for patients with progressive PMH.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Keen MA. Progressive macular hypomelanosis: A report of three cases. J Pak Associ Dermatol 2015;25:227-9.  Back to cited text no. 1
    
2.
Martínez-Martínez ML, Azaña-Defez JM, Rodríguez-Vázquez M, Faura-Berruga C, Escario-Travesedo E. Progressive macular hypomelanosis. Pediatr Dermatol 2012;29:460-2.  Back to cited text no. 2
    
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Elmariah SB, Kundu RV. Progressive macular hypomelanosis. J Drugs Dermatol 2011;10:502-6.  Back to cited text no. 3
    
4.
Desai SR, Owen JL. Progressive macular hypomelanosis: An update. Pigment Int 2014;1:52-5.  Back to cited text no. 4
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5.
Kim MB, Kim GW, Cho HH, Park HJ, Kim HS, Kim SH, et al. Narrowband UVB treatment of progressive macular hypomelanosis. J Am Acad Dermatol 2012;66:598-605.  Back to cited text no. 5
    
6.
Selim MK, Ahmed el-SF, Abdelgawad MM, El-Kamel MF. Progressive macular hypomelanosis among Egyptian patients: A clinicopathological study. Dermatol Pract Concept 2011;1:5-11.  Back to cited text no. 6
    
7.
Wang K, Nassef Y, Sahu J, Hermes H, Schwartz LR. Facial involvement in progressive macular hypomelanosis. Cutis 2018;101:297-300.  Back to cited text no. 7
    
8.
Ukonu BA, Ibekwe P, Otokpa, GA. Retrospective analysis of the clinical presentation of progressive macular hypomelanosis and outcome of its therapeutic intervention with narrow- band ultraviolet b phototherapy. IOSR J Dent Med Sci 2017;16:14-19.  Back to cited text no. 8
    
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Santos JB, Almeida OL, Silva LM, Barreto ER. 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 2011;86:50-4.  Back to cited text no. 9
    
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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.  Back to cited text no. 10
    
11.
Chung YL, Goo B, Chung WS, Lee GS, Hann SK. A case of progressive macular hypomelanosis treated with narrow-band UVB. J Eur Acad Dermatol Venereol 2007;21:1007-9.  Back to cited text no. 11
    
12.
Hassan AM, El-Badawi M, Abd-Rabbou F, Gamei M, Moustafa K, Almokadem A. Progressive macular hypomelanosis pathogenesis and treatment: A randomized clinical trial. J Microsc Ultrastruct 2014;2:205-16.  Back to cited text no. 12
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13.
Hwang SW, Hong SK, Kim SH, Park JH, Seo JK, Sung HS, et al. Progressive macular hypomelanosis in korean patients: A clinicopathologic study. Ann Dermatol 2009;21:261-7.  Back to cited text no. 13
    
14.
Duarte I, Nina B, Gordiano MC, Buense R, Lazzarini R. Progressive macular hypopigmentation: An epidemiological study and therapeutic response to phototherapy. An Brasil Dermatol 2010;85:621-4.  Back to cited text no. 14
    
15.
Thng ST, Long VS, Chuah SY, Tan VW. Efficacy and relapse rates of different treatment modalities for progressive macular hypomelanosis. Indian J Dermatol Venereol Leprol 2016;82:673-6.  Back to cited text no. 15
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