eMedicine Specialties > Dermatology > Photo-Related Diseases

Berloque Dermatitis: Treatment & Medication

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

Treatment

Medical Care

The primary aim of the therapeutic regime is discontinuation of the offending substance. If berloque dermatitis is the putative diagnosis, all bergamot oil-containing perfumes should be avoided. Any perfumes that are worn should be worn on covered-up areas, not on areas of sun exposure.

If the patient presents in the acute phase and is in considerable discomfort, wet compresses may be helpful in relieving the discomfort. Simple analgesia may be given if the patient is in pain.

For secondary hyperpigmentation, the natural course of the dermatitis is spontaneous resolution after several months, but some lesions may persist much longer. The most important step is to minimize exposure to the sun. This may be done by avoiding strong sunlight whenever possible, avoiding the use of sunbeds and using a strong sunscreen (SPF 30 or higher) with activity in both the UVA and UVB spectra. Camouflage also may be used on exposed hyperpigmented areas, for cosmetic reasons. Dermablend and Covermark are preparations combining a water-resistant opaque base with a broad-spectrum sunscreen.

If the pigmentation is persistent, hydroquinone constitutes the mainstay of medical therapy. It usually is given twice a day, at a concentration of about 2%, for several months. At higher concentrations, the patient would be at risk of irritation. Hydroquinone sometimes is administered in conjunction with topical tretinoin (Retin-A). Kligman and Willis16 devised a concoction known as Kligman's formula, consisting of hydroquinone, tretinoin, dexamethasone, ethanol, and propylene glycol, which they found effective in treating hyperpigmentation.

A novel therapy for pigmentary disorders is ellagic acid, now commercialized in Japan. Ellagic acid is a naturally existing polyphenol that inhibits tyrosinase activity by chelation of the copper ion(s) at the active center of the enzyme. The efficacy in a placebo-controlled trial for preventing UV-induced pigmentation has been shown to be 86%, and no side effects have been reported.

Medication

Medical therapy is largely unnecessary for the treatment of berloque dermatitis, except in cases with persistent hyperpigmentation. In these cases, skin-bleaching agents (eg, hydroquinone) are the mainstays of therapy.

Depigmenting agents

Skin bleaching agents are indicated for the gradual depigmentation of hyperpigmented skin conditions.


Hydroquinone USP 4% (Claripel cream with sunscreens)

Produces reversible depigmentation of skin by inhibiting enzymatic oxidation of tyrosine to 3-(3,4-dihydroxyphenyl-alanine (dopa)) and suppression of other melanocyte metabolic processes. Exposure to sunlight or ultraviolet light will cause repigmentation, which may be prevented by the broad-spectrum sunscreen agents contained in this product.

Adult

Apply to affected areas bid

Pediatric

<12 years: Not established
>12 years: Administer as in adults

Documented hypersensitivity to drug or related products

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May produce unwanted cosmetic effects if not used as directed; physician should be familiar with contents of prescribing insert before prescribing or dispensing medication; test for skin sensitivity before using product by applying to small area of unbroken skin (minor redness is not a contraindication, but discontinue use if there is itching, vesicle formation, or excessive inflammatory response); avoid contact with eyes; do not use for prevention of sunburn; discontinue use if no lightening effect is noted after two mo of treatment; on rare occasions, a gradual blue-black darkening of the skin may occur (discontinue use if it occurs)


Hydroquinone (Eldopaque-Forte, Solaquin Forte, Lustra)

Indicated for the gradual bleaching of hyperpigmented skin conditions such as chloasma, melasma, freckles, senile lentigines, and other unwanted areas of melanin hyperpigmentation. Also is used to reduce hyperpigmentation caused by photosensitization associated with inflammation or with the use of certain perfumes (berloque dermatitis).
Topical application of hydroquinone produces a reversible depigmentation of the skin by inhibition of the enzymatic oxidation of tyrosine to 3, 4-dihydroxyphenylalanine (dopa) and suppression of other melanocyte metabolic processes. Depigmentation may take 1-4 mo to occur while existing melanin is sloughed off and excretion of new melanin is increased by hydroquinone. Exposure to sunlight or ultraviolet light will cause repigmentation, which may be prevented by broad-spectrum sunscreen agents.
Available topically, in strengths of 2-4%, in the form of a cream, lotion, solution, powder, or gel.

Adult

Apply uniformly to affected areas and rub-in bid; use until desired degree of pigmentation obtained; frequency can be tapered down to a maintenance regime

Pediatric

<12 years: Not established
>12 years: Administer as in adults

Documented hypersensitivity; sunburn

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Animal reproduction studies have not been conducted; not known whether hydroquinone can affect reproductive capacity or cause fetal harm when used topically on a pregnant woman (only use in pregnant women when clearly indicated)
Mild skin irritation and sensitization have occurred following topical application and occur more frequently with higher concentration; dryness and fissuring of paranasal and infraorbital areas have been reported; chronic use (up to 8 y) has been reported to produce ochronosis and colloid milium; some formulations contain sodium metabisulfite, a sulfite that may cause serious allergic type reactions (eg, hives, itching, wheezing, anaphylaxis) in certain susceptible persons (test for skin sensitivity before using any hydroquinone preparation by applying a small amount to a normal patch of skin and checking it after 24 h); minor redness is not a contraindication, but patient should refrain from using if itching, vesiculation, or excessive inflammatory response is observed
Sunscreen use is essential because even minimal sunlight sustains melanocytic activity; do not apply near eyes, to cut, abraded, or sunburned skin, after shaving, or over miliaria rubra (prickly heat)

More on Berloque Dermatitis

Overview: Berloque Dermatitis
Differential Diagnoses & Workup: Berloque Dermatitis
Treatment & Medication: Berloque Dermatitis
Multimedia: Berloque Dermatitis
References
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References

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  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.

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  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.

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  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].

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  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.

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

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  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.

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Further Reading

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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

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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

 
 
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