eMedicine Specialties > Dermatology > Photo-Related Diseases

Berloque Dermatitis: Differential Diagnoses & Workup

Author: Ali Alikhan, BS, University of California, Davis School of Medicine
Coauthor(s): Ai-Lean Chew, MBChB, Specialist Registrar, Department of Dermatology, St John's Institute of Dermatology, UK; 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
Contributor Information and Disclosures

Updated: Jun 2, 2008

Differential Diagnoses

Acanthosis Nigricans
Contact Dermatitis, Allergic
Contact Dermatitis, Irritant
Melasma
Phytophotodermatitis
Riehl Melanosis

Workup

Laboratory Studies

  • Predictive testing: Phototoxicity testing is not carried out diagnostically, but rather for predictive purposes. It routinely is included in the safety evaluation of raw materials by the Research Institute for Fragrance Materials and several methods for identifying phototoxic compounds have been reported. Both in vitro and in vivo methods are used currently. Generally, for in vivo testing, measured amounts of fragrance material are tested, either in laboratory animals (eg, mouse, rabbit, guinea pig models), or ultimately in humans, with an artificial light source. This identifies potential phototoxic substances before they are marketed.
  • In an attempt to decrease animal use in predictive dermatology, the European Union, in cooperation with the European Centre for the Validation of Alternative Methods (ECVAM) and the Interagency Coordinating Committee for the Validation of Alternative Methods (ICVAM), has supported the development of in vitro alternatives.6,7 Initial trials revealed reasonable sensitivity and specificity8,9,10,11 ; false-positive results and false-negative results have already been documented.12,13,14  Thus far, several cosmetic products have been examined in vitro for phototoxicity.15

Other Tests

  • Clinical diagnosis and the role of photopatch testing: Clinical identification of phototoxicity largely resides in morphology and a high index of clinical suspicion. Photopatch testing may be performed if photoallergy is strongly suspected. This consists of occlusive application of the test chemical(s) to the back, followed by irradiation with an UV light source. The results are evaluated at several time intervals, according to an established score based on the skin reaction pattern. Adequate controls are imperative to differentiate phototoxicity from photoallergy. In phototoxicity, all controls will have a positive response, whereas in photoallergy, controls should be negative.

Histologic Findings

The histopathological findings in berloque dermatitis are identical to other phototoxic reactions, an irritant cutaneous response. The epidermal changes consist of keratinocyte necrosis, intercellular and intracellular edema, and intraepidermal blisters. In severe cases, these blisters may rupture, resulting in subepidermal bullae. Neutrophils enter the epidermis at an early stage. In contrast to the extensive epidermal damage, only a mild perivascular infiltrate is present. Changes associated with berloque pigmentation are an increased number and size of melanosomes, melanocyte hypertrophy with increased arborization of dendrites, increased transfer of melanosomes to keratinocytes, and increased tyrosinase activity within the proliferating melanocytes.

More on Berloque Dermatitis

Overview: Berloque Dermatitis
Differential Diagnoses & Workup: Berloque Dermatitis
Treatment & Medication: Berloque Dermatitis
Multimedia: Berloque Dermatitis
References
[ CLOSE WINDOW ]

References

  1. Rosenthal O. Berloque dermatitis: Berliner Dermatologische Gesellschaft. Dermatologische Zeitschrift. 1925;42:295.

  2. Freund E. Uber bisher noch nicht bershriebene Kunstlicke hauverfarbungen. Dermatol Wochenschr. 1916;63:931-3.

  3. Marzulli FN, Maibach HI. Perfume phototoxicity. J Soc Cosmetic Chem. 1970;21:695-715.

  4. Kavli G, Raa J, Johnson BE, Volden G, Haugsbø S. Furocoumarins of Heracleum laciniatum: isolation, phototoxicity, absorption and action spectra studies. Contact Dermatitis. Jul 1983;9(4):257-62. [Medline].

  5. Camm E, Buck HW, Mitchell JC. Phytophotodermatitis from Heracleum mantegazzianum. Contact Dermatitis. Apr 1976;2(2):68-72. [Medline].

  6. Zhai H, Wilhelm K, Maibach HI. Photoirritation (phototoxicity/phototoxic dermatitis). In: Dermatotoxicology. 7th ed. Washington, DC: Taylor & Francis; 2008:209-14, 537-46.

  7. Holtz R. REACH and In Vitro Alternatives: Phototoxicity Testing. Cosmet Toilet. May 2008;123:61-3.

  8. Spielmann H, Balls M, Dupuis J, Pape WJ, Pechovitch G, Desilva O, et al. The international EU/COLIPA in vitro phototoxicity validation study - results of phase II (blind trial) - Part 1 - The 3T3 NRU phototoxicity test. Toxicol In Vitro. 1998;12:305-27.

  9. Spielmann H, Lovell WW, Hoelzle E, Johnson BE, Maurer T, Miranda MA, et al. In vitro phototoxicity testing. The report and recommendations of ECVAM workshop 2. Altern Lab Anim. 1994;22:314-48.

  10. Spielmann H, Muller L, Averbeck D, Balls M, Brendler-Schwaab S, Castell JV, et al. The second ECVAM workshop on Phototoxicity Testing - the report and recommendations of ECVAM Workshop 42. Altern Lab Anim. 2000;28:777-814.

  11. Spielmann H, Balls M, Brand M, Doring B, Holzhutter HG, Kalweit S, et al. EEC COLIPA project on in-vitro phototoxicity testing - first results obtained with BALB/C 3T3 cell phototoxicity assay. Toxicol In Vitro. 1994;8:793-6.

  12. Jones PA, King AV. High throughput screening (HTS) for phototoxicity hazard using the in vitro 3T3 neutral red uptake assay. Toxicol In Vitro. Oct-Dec 2003;17(5-6):703-8. [Medline].

  13. Spielmann H, Liebsch M. Validation successes: chemicals. Altern Lab Anim. Dec 2002;30 Suppl 2:33-40. [Medline].

  14. Kejlová K, Jírová D, Bendová H, Kandárová H, Weidenhoffer Z, Kolárová H, et al. Phototoxicity of bergamot oil assessed by in vitro techniques in combination with human patch tests. Toxicol In Vitro. Oct 2007;21(7):1298-303. [Medline].

  15. Hans RK, Agrawal N, Verma K, Misra RB, Ray RS, Farooq M. Assessment of the phototoxic potential of cosmetic products. Food Chem Toxicol. May 2008;46(5):1653-8. [Medline].

  16. Kligman AM, Willis I. A new formula for depigmenting human skin. Arch Dermatol. Jan 1975;111(1):40-8. [Medline].

  17. American Society of Health-System Pharmacists. Hydroquinone. American Hospital Formulary Service Drug Information. 1998;2971.

  18. Baran R, Maibach HI. Textbook of Cosmetic Dermatology. 3rd ed. London: Taylor and Francis; 2005:65-70.

  19. Castell JV, Gomez-Lechon MJ. In Vitro Methods in Pharmaceutical Research. San Diego, Calif: Academic Press; 1997:290-315.

  20. Harber LC, Bickers D, eds. Photosensitivity Diseases: Principles of Diagnosis & Treatment. Toronto: BC Decker; 1989.

  21. Kamide R, Arase S, Takiwaki, Watanabe S, Watanabe Y, Kageyama S. Clinical evaluation on the effects of XSC-29 preparation on the pigmentation of the skin by exposure to ultraviolet light. Nishinihon J Dermatol. 1995;57:136-42.

  22. Lovell CR. Plants and the Skin. Vol 6. Oxford: Blackwell Scientific Publications; 1993:64-85.

  23. Maibach HI, Marzulli FN. Photoirritation (phototoxicity) from topical agents. Dermatol Clin. Apr 1986;4(2):217-22. [Medline].

  24. Rietschel RL, Fowler JF Jr. Fisher's Contact Dermatitis. Baltimore: Lippincott William & Wilkins; 1995:524-543.

  25. Wilkinson JD, English J. Psoralens. Seminars in Dermatol. June 1983;2(2):85-100.

  26. Zaynoun ST, Aftimos BA, Tenekjian KK, Kurban AK. Berloque dermatitis - a continuing cosmetic problem. Contact Dermatitis. Mar 1981;7(2):111-6. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

berlock dermatitis, perfume phototoxicity, perfume photoirritation, bergapten phototoxicity, bergapten photoirritation, bergamot phototoxicity, bergamot photoirritation, photodermatitis pigmentaria, dermite pigmentée en forme de coulée, 5-Methoxypsoralens photoirritation

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ali Alikhan, BS, University of California, Davis School of Medicine
Ali Alikhan, BS 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, Specialist Registrar, Department of Dermatology, St John's Institute of Dermatology, UK
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.

Medical Editor

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.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White 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: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

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.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.