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