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The Best of the Best
Nov 2012

Top Accessed Article: Propionibacterium Acnes and the Pathogenesis of Progressive Macular Hypomelanosis

Arch Dermatol. 2012;148(11):1256. doi:10.1001/archdermatol.2012.2177

Westerhof W, Relyveld GN, Kingswijk MM, de Man P, Menke HE. Propionibacterium acnes and the pathogenesis of progressive macular hypomelanosis. Arch Dermatol. 2004;140(2):210-214.

Progressive macular hypomelanosis is a common entity and is often mistaken for tinea versicolor and pityriasis alba; however, it is unresponsive to medications for these conditions. The authors of this interesting article had previously noted a red fluorescence of the follicles of affected skin in affected patients. Using biopsy specimens of lesional and healthy follicular skin as well as lesional and healthy interfollicular skin in 8 patients, they demonstrated gram-positive rods in the affected follicles but not in the unaffected follicles or the interfollicular skin. Culture of the affected follicles yielded Propionibacterium acnes in 7 of the 8 patients, while the unaffected follicles and the nonfollicular skin did not yield this organism. No spores or hyphae were visible in any biopsy specimens (stained with periodic acid–Schiff).

Westerhof and colleagues' astute observational skills and subsequent study of affected and control skin led to the discovery of P acnes as the etiologic agent. Also, they provided a useful method to make the diagnosis using a simple Wood lamp. Subsequently, articles have been published from all over the world confirming their findings and reporting good results using topical and systemic antimicrobial agents as well as phototherapy. This article is a good example of how a thorough examination and curiosity can stimulate research, leading to improvement of the lives of patients.

From October 2010 to August 2011, this article was viewed 1651 times on the Archives of Dermatology website.

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Contact Dr Pandya at the Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 (amit.pandya@utsouthwestern.edu).

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