Berloque Dermatitis 

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

Background

Berloque dermatitis obtains its name from the German word berlock or the French berloque, meaning trinket or charm. Rosenthal[1] coined the term in 1925 to describe pendantlike streaks of pigmentation on the neck, face, arms, or trunk. He suspected they were due to fluid droplets, unaware that Freund[2] in 1916 had described hyperpigmented macules due to sun exposure after the application of eau de cologne. The phototoxic ingredient causing the pigmentation proved to be bergapten, a component of oil of bergamot, derived from the rind of Citrus bergamia, the bergamot lime. Several cases were reported in the 1950s and 1960s following increased use of perfumes containing oil of bergamot and the passion for sunbathing. Since the introduction of artificial oil of bergamot and the reduced use of the natural product in perfumes, berloque dermatitis has become rare. Note the image below.

Hyperpigmented streaks on the dorsa of hands of a Hyperpigmented streaks on the dorsa of hands of a patient with bergapten phototoxicity

Related eMedicine articles include Cosmetics and Cosmeceuticals.

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Pathophysiology

Phototoxicity or photoirritation is a chemically induced nonimmunologic acute skin irritation requiring light (usually within the UVA spectrum, ie, 320-400 nm). The skin response resembles exaggerated sunburn and does not require prior sensitization; it can be caused by a single simultaneous exposure to the chemical and light source. The photoactive chemical may enter the skin via topical administration, or via ingestion, inhalation, or parenteral administration. The reaction can be evoked in all subjects as long as the concentration of the chemical and the dose of light are sufficient.

In the case of berloque dermatitis, the phototoxic reaction is induced by the effect of long-wave ultraviolet (UVA) radiation on bergapten, or 5-methoxypsoralens, a furocoumarin now known to be the only photoactive component of bergamot oil (see the image below). The bergapten-UVA radiation combination induces an intensification of melanogenesis and a corresponding increase in the number of functional melanocytes, which are more dendritic and dopa-positive. The distribution of melanosomes in keratinocyte changes from the aggregate to nonaggregate form.

Molecular structure of 5-methoxypsoralen (bergapteMolecular structure of 5-methoxypsoralen (bergapten)
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Epidemiology

Frequency

United States

The exact incidence of berloque dermatitis is unknown. In the Untied States, berloque dermatitis now is exceedingly rare due to the use of bergapten-free fragrance formulations. The US Hazardous Substances Act issued regulations stating that products containing oil of bergamot must not exceed 62 ppm bergapten, 2% bergamot oil. Following work performed by Marzulli and Maibach[3] and reported in 1970, even lower concentrations than this have been recommended (< 0.3% bergamot oil, equivalent to 0.001% bergapten), and bergapten-free bergamot oil is used almost always now in the Untied States. However, in some countries where bergamot oil continues to be used, berloque dermatitis remains a problem. Even in the Untied States, milder forms still are being observed. Recently, a patient was reported to have severe berloque dermatitis due to using a suntan booth immediately after applying some 40-year-old Shalimar perfume, which contained bergamot oil.

Apart from the bergamot lime, bergapten also is a component in other substances, inducing bergapten phototoxicity without the typical pendantlike appearance of berloque dermatitis. For instance, in Norway, bergapten phototoxicity has been reported due to Heracleum laciniatum and in Denmark due to Heracleum mantegazzianum (giant hogweed).[4, 5]

Mortality/Morbidity

Phototoxic reactions currently are the most frequently recognized form of photosensitivity reactions. Berloque dermatitis, however, is far more uncommon due to the reasons described above.

Race

Precise information about racial predilection is not available.

Sex

Berloque dermatitis usually occurs in females who wear fragrances containing oil of bergamot, but males who wear fragrances or fragrance-containing products, such as aftershave lotion, also may develop berloque dermatitis.

Age

Berloque dermatitis usually occurs in women, although it can occur in persons of any age who apply fragrances containing oil of bergamot.

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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.

References

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Hyperpigmented streaks on the dorsa of hands of a patient with bergapten phototoxicity
Molecular structure of 5-methoxypsoralen (bergapten)
Bergapten-containing plants
 
 
 
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