Berloque Dermatitis Clinical Presentation

  • Author: Ali Alikhan, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 14, 2010
 

History

The clinical presentation of berloque dermatitis may be classically divided into 2 phases. The initial acute inflammatory phase consists of erythema, edema, pain, pruritus, and increase in skin temperature around the area of contact with the phototoxic agent. The second stage is hyperpigmentation of the lesion. Patients usually present with small areas of redness or pigmentation of the skin, usually on sun-exposed areas, such as the neck. Pain and, sometimes, pruritus may be felt during the acute erythematous phase before the lesions become hyperpigmented. However, hyperpigmentation is the chief complaint; sometimes patients may not even recall the inflammatory phase. A careful history may reveal use of a perfume or fragrance-containing product on the skin prior to a period of sun exposure, such as sunbathing or a picnic. If untreated, the natural history of the disease also is biphasic; the inflammatory lesions resolve in days to weeks, but the pigmentation may last months or even years.

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Physical

Erythema, edema, vesiculation, hyperpigmentation, and desquamation are typical phototoxic skin effects. In classic berloque dermatitis, brown hyperpigmentation with or without preceding erythema is seen in a droplike or pendantlike configuration. It usually is distributed over the sides of the neck in adult females, although it may be seen in any part of the body where perfume was applied followed by sun-exposure.

Some less typical presentations of berloque dermatitis are, for example, symmetrical facial pigmentation on a man, caused by aftershave lotion containing bergapten, and an infant who developed pigmentation on her body and arms where her mother applied eau de toilette prior to taking her to the beach.

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Causes

Bergapten, or 5-methoxypsoralen, is the photoactive component of bergamot oil from the bergamot lime (C bergamia), which is a popular ingredient in perfumes and fragrances. Apart from their obvious existence in cosmetics and toiletries (such as toilet water, aftershave lotions, colognes, sunscreen lotions, moisturizers), perfumes also are found in soap, household cleaners, detergents, air fresheners, and a myriad of other everyday items.

Besides the bergamot lime, bergapten is a naturally occurring component of various other fruits and plants (see the image below). Examples of these are figs (Ficus carica), celery (Apium graveolens), lemon oil, Tromso palm (H laciniatum), Queen Anne's lace (Ammi majus), and giant Russian hogweed (H mantegazzianum). All these are capable of inducing bergapten phototoxicity, although they are not perfume-related and, therefore, classified as phytophotodermatitis rather than berloque dermatitis.

Bergapten-containing plants Bergapten-containing plants
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Contributor Information and Disclosures
Author

Ali Alikhan, MD  Resident Physician, University of Chicago, MacNeal Hospital

Ali Alikhan, MD is a member of the following medical societies: American Medical Student Association/Foundation, Islamic Medical Association of North America, and Student National Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ai-Lean Chew, MBChB, MRCP  Honorary Consultant, St John's Institute of Dermatology, Guy's and St Thomas' Hospital NHS Trust, UK and Locum Consultant, South London Healthcare NHS Trust, UK

Ai-Lean Chew, MBChB, MRCP, is a member of the following medical societies: British Association of Dermatologists, British Medical Association, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Howard I Maibach, MD  Professor and Vice Chairperson, Department of Dermatology, University of California School of Medicine at San Francisco; Consulting Staff, University of California Hospitals

Howard I Maibach, MD is a member of the following medical societies: American Academy of Dermatology, American College of Forensic Examiners, American College of Physicians, American Contact Dermatitis Society, American Dermatological Association, American Federation for Clinical Research, American Medical Association, California Medical Association, Pacific Dermatologic Association, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Marjan Garmyn, MD, PhD  Professor, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium; Chair and Adjunct Head, Department of Dermatology, University of Leuven, Belgium

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Molecular structure of 5-methoxypsoralen (bergapten)
Bergapten-containing plants
 
 
 
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