Tuesday, 2 August 2016

Berloque dermatitis

Berloque (a pendant) dermatitis is skin pigmentation due to phototoxic reaction to perfumes applied to the skin. Berloque dermatitis is considered a special form of phytophotodermatitis.

The reaction occurs commonly on the neck (hence the name berloque) and face. The acute inflammatory dermatitis due to berloque dermatitis might be unnoticed thus the patient presents with the streaky pigmentation. If the inflammatory phase is severe, bullae are formed. The distribution of the lesions is variable (and here it is on the upper limb) but their configuration is usually distinctive. Deepbrown  pigmentation  follows  the  pattern  formed  by  the  trickle  of  the droplets of perfume over the skin from their points of application.

Berloque dermatitis results from the potentiating of UVstimulated melanogenesis by 5methoxypsoralen (bergapten) in perfumes containing bergamot oil. If a fragrance containing this 5-methoxypsoralen (or another furocoumarin) is applied to the skin before exposure to the sun or tanning lights, berloque dermatitis may result. There are guidelines limiting the use of furocoumarins in some places. There is wide variation in susceptibility. This variation depends on the readiness with which the bergapten  is  absorbed,  the  quantity  applied,  and  the  intensity  and  duration  of  exposure  to  UV  light.  Susceptibility is increased by stripping the horny layer. Hot humid conditions favour absorption.  The pigmentation occurs in susceptible subjects who have been exposed to light after the application of perfume. Some regulations restrict the concentration of bergapten so that it is below the threshold required to cause dermatitis/pigmentation.

The reaction fades gradually over weeks to months. Sunscreens protect the skin from further sun exposure. If tinted, they can also disguise the lesions.

The child used to apply her mother’s perfume on the left upper limb. 

This page was last updated in August 2016

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Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology