eMedicine Specialties > Dermatology > Photo-Related Diseases

Riehl Melanosis: Differential Diagnoses & Workup

Author: Helena A Longin, MD, Resident Physician, Department of Dermatology, Naval Medical Center San Diego
Coauthor(s): Elizabeth Kline Satter, MD, MPH, Chairman, Department of Dermatology, Naval Medical Center San Diego
Contributor Information and Disclosures

Updated: Mar 18, 2009

Differential Diagnoses

Addison Disease
Contact Dermatitis, Irritant
Amyloidosis, Lichen
Melasma
Amyloidosis, Macular
Ochronosis
Berloque Dermatitis
Poikiloderma of Civatte
Contact Dermatitis, Allergic

Other Problems to Be Considered

  • Drugs: Several classes of drugs induce hyperpigmentation, including minocycline, antimalarials, psychotropic drugs, chemotherapeutic agents, zidovudine, and psoralens. Also see Drug-Induced Pigmentation.
  • Erythromelanosis follicularis faciei et colli: This is characterized by symmetric reddish-brown pigmentation of the preauricular and maxillary areas, with multiple pinpoint follicular papules superimposed. Keratosis pilaris also may be noted.25
  • Friction melanosis: Brown or black hyperpigmentation unaccompanied by dermatitis or pruritus characterizes friction melanosis. It is seen primarily over the long bones, knees, elbows, and scapula. It occurs secondary to vigorous rubbing of the skin with nylon towels or brushes when bathing.3
  • Hori nevus or acquired nevus of Ota: This acquired facial hyperpigmentation is usually seen in women of Asian descent who are aged 20-70 years. It manifests clinically as bilateral blue-gray to gray-brown macules along the zygomatic area and, less often, on the forehead, upper-outer eyelids, and nose. Histologically, spindle-shaped dendritic melanocytes are present in the dermis and are scattered among collagen bundles. Melanophages usually are not present.
  • Lichen planus pigmentosus and actinic lichen planus: Brown to gray-brown macules evolve into diffuse/reticulated patches in sun-exposed skin and annular red-brown plaques or hyperpigmented patches primarily on sun-exposed skin, respectively.
  • Thiazide leukomelanoderma: This is also known as photoleukomelanodermatitis Kobori,26 and it is a reticular leukoderma with patchy hyperpigmentation, which can help differentiate it from Riehl melanosis.

Workup

Laboratory Studies

  • Patch test: Perform closed patch testing with the standard series, cosmetic series, fragrance series, and patient's personal products.
  • Photo-patch test
  • Provocative use test or repeated open application test (ROAT): Perform this testing when closed patch testing results are equivocal or negative. The concentration of the allergen (eg, preservatives, fragrances) may be too low in the cosmetic series to produce a positive reaction on the back.4

Procedures

  • Skin biopsy

Histologic Findings

Most biopsy results have shown interface dermatitis with vacuolar basal layer degeneration. The superficial dermis often contains a mild-to-moderate lymphohistiocytic infiltrate admixed with melanophages. Findings suggestive of spongiosis are lacking. Some biopsy specimens have shown mild atrophy of the dermis, but this is an inconsistent finding. Negative direct immunofluorescence study results help eliminate hyperpigmented lupus erythematosus from the differential diagnosis.

More on Riehl Melanosis

Overview: Riehl Melanosis
Differential Diagnoses & Workup: Riehl Melanosis
Treatment & Medication: Riehl Melanosis
Follow-up: Riehl Melanosis
References
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References

  1. Riehl G. Uber eine eigenartige melanose. Wien Klin Wochensschr. 1917;30:280-1.

  2. Rorsman H. Riehl's melanosis. Int J Dermatol. Mar 1982;21(2):75-8. [Medline].

  3. Nakayama H. Pigmented Contact Dermatitis and Chemical Depigmentation. In: Rycroft R, Menne T, Frosch P, Lepoittevin J, eds. Textbook of Contact Dermatitis. 3rd ed. New York, NY: Springer; 2001:319-333.

  4. Shenoi SD, Rao R. Pigmented contact dermatitis. Indian J Dermatol Venereol Leprol. Sep-Oct 2007;73(5):285-7. [Medline].

  5. Findlay GH. Some observations on the melanosis of Riehl. S Afr Med J. May 3 1952;26(18):373-5. [Medline].

  6. Osmundsen PE. Pigmented contact dermatitis. Br J Dermatol. Aug 1970;83(2):296-301. [Medline].

  7. Nakayama H, Harada R, Toda M. Pigmented cosmetic dermatitis. Int J Dermatol. Nov 1976;15(9):673-5. [Medline].

  8. Nakayama H, Matsuo S, Hayakawa K, Takhashi K, Shigematsu T, Ota S. Pigmented cosmetic dermatitis. Int J Dermatol. Jun 1984;23(5):299-305. [Medline].

  9. Imokawa G, Kawai M. Differential hypermelanosis induced by allergic contact dermatitis. J Invest Dermatol. Dec 1987;89(6):540-6. [Medline].

  10. Ebihara T, Nakayama H. Pigmented contact dermatitis. Clin Dermatol. Jul-Aug 1997;15(4):593-9. [Medline].

  11. Hayakawa R, Matsunaga K, Arima Y. Airborne pigmented contact dermatitis due to musk ambrette in incense. Contact Dermatitis. Feb 1987;16(2):96-8. [Medline].

  12. Pires MC, Manoel Silva dos Reis V, Mitelmann R, Moreira F. Pigmented contact dermatitis due to Plathymenia foliosa dust. Contact Dermatitis. Jun 1999;40(6):339. [Medline].

  13. Fujimoto K, Hashimoto S, Kozuka T, Tashiro M, Sano S. Occupational pigmented contact dermatitis from azo-dyes. Contact Dermatitis. Jan 1985;12(1):15-7. [Medline].

  14. el Sayed F, Manzur F, Bazex J. Pigmented contact dermatitis from cosmetics. Contact Dermatitis. Feb 1995;32(2):111. [Medline].

  15. Kozuka T, Tashiro M, Sano S, et al. Brilliant Lake Red R as a cause of pigmented contact dermatitis. Contact Dermatitis. Sep 1979;5(5):297-304. [Medline].

  16. Sugai T, Takahashi Y, Takagi T. Pigmented cosmetic dermatitis and coal tar dyes. Contact Dermatitis. Oct 1977;3(5):249-56. [Medline].

  17. Leow YH, Tan SH, Ng SK. Pigmented contact cheilitis from ricinoleic acid in lipsticks. Contact Dermatitis. Jul 2003;49(1):48-9. [Medline].

  18. Nath AK, Thappa DM. Kumkum-induced dermatitis: an analysis of 46 cases. Clin Exp Dermatol. Jul 2007;32(4):385-7. [Medline].

  19. Parodi G, Guarrera M, Rebora A. Lichenoid photocontact dermatitis to musk ambrette. Contact Dermatitis. Mar 1987;16(3):136-8. [Medline].

  20. Naganuma M, Hirose S, Nakayama Y, Nakajima K, Someya T. A study of the phototoxicity of lemon oil. Arch Dermatol Res. 1985;278(1):31-6. [Medline].

  21. Serrano G, Pujol C, Cuadra J, Gallo S, Aliaga A. Riehl's melanosis: pigmented contact dermatitis caused by fragrances. J Am Acad Dermatol. Nov 1989;21(5 Pt 2):1057-60. [Medline].

  22. Ozkaya-Bayazit E, Buyukbabani N. Non-eczematous pigmented interface dermatitis from para-tertiary-butylphenol-formaldehyde resin in a watchstrap adhesive. Contact Dermatitis. Jan 2001;44(1):45-6. [Medline].

  23. Trattner A, David M. Pigmented contact dermatitis from topical minoxidil 5%. Contact Dermatitis. Apr 2002;46(4):246. [Medline].

  24. Miyoshi K, Kodama H. Riehl's melanosis-like eruption associated with Sjogren's syndrome. J Dermatol. Dec 1997;24(12):784-6. [Medline].

  25. Perez-Bernal A, Munoz-Perez MA, Camacho F. Management of facial hyperpigmentation. Am J Clin Dermatol. Sep-Oct 2000;1(5):261-8. [Medline].

  26. Kobori T, Araki, Toda K. Photoleukomelanodermatitis (Kobori) caused by benzothiazidiazine derivatives. Jap J Dermatol. 1966;76:665.

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Further Reading

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Keywords

Riehl melanosis, Riehl's melanosis, pigmented contact dermatitis, pigmented cosmetic dermatitis, melanosis faciei feminae, erythroderma exfoliativa recidivans faciei, lichen ruber planus cum pigmentatione, melanodermatitis toxica.

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Contributor Information and Disclosures

Author

Helena A Longin, MD, Resident Physician, Department of Dermatology, Naval Medical Center San Diego
Helena A Longin, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth Kline Satter, MD, MPH, Chairman, Department of Dermatology, Naval Medical Center San Diego
Elizabeth Kline Satter, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American Medical Women's Association
Disclosure: Nothing to disclose.

Medical Editor

John D Wilkinson, MD, MBBS, MRCS, FRCP, Chairman, Clinical Director, Department of Dermatology, Amersham Hospital and High Wycombe Hospital, UK
John D Wilkinson, MD, MBBS, MRCS, FRCP is a member of the following medical societies: American Academy of Dermatology and Royal College of Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, 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

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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