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Black dermographism
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Black dermographism

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Contributors: Connie R. Shi, Susan Burgin MD
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Synopsis

Black dermographism is a darkly pigmented or black skin discoloration due to surface deposition of metallic particles on the skin. It occurs underneath rings, bracelets, other jewelry, and other metal objects directly in points of contact with the skin.

Gold is most commonly associated with black dermographism, but objects containing silver, platinum, copper, nickel, and iron are also frequently associated. Abrasions between these metals and makeup powders, sunscreens, and toothpastes applied to the skin – especially those containing zinc oxide or titanium oxide – can result in physical deposition of pigmented metallic particles.

Unlike true dermographism, black dermographism is not an urticarial-type reaction. Therefore, black dermographism does not appear as localized wheals and should be neither pruritic nor erythematous.

Most cases are asymptomatic, and the discoloration is not permanent.

Codes

ICD10CM:
L81.9 – Disorder of pigmentation, unspecified

SNOMEDCT:
373591006 – Disorders of skin caused by physical agents

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Metallic tarnishing causing temporary skin discoloration – Workplace exposures such as industrial smog and corrosive chemicals, as well as perspiration, can react with metals and cause tarnishing. An occupational exposure history will be helpful to exclude metallic corrosion as a contributing factor.
  • Allergic contact dermatitis – Consider if pruritus, erythema, rash, and irritative symptoms are present.
  • Dermatographism – Presents as erythematous raised wheals where skin is stroked.

Best Tests

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Therapy

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References

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Last Updated: 09/21/2016
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Black dermographism
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Black dermographism : Jewelry contact
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