You have been logged out of VisualDx or your session has expired.

Please reload this page and sign into VisualDx to continue.

..
  VisualDx Mobile   Select Language

Get VisualDx Mobile

There are VisualDx mobile apps available for iOS and Android devices.

You will need a VisualDx account to use the mobile apps.



Already have an account? Sign In or
sign up for a free trial.

Users with VisualDx accounts earn CME credits for using VisualDx.

Already have an account? Sign In or
sign up for a free trial.

Create a Personal Account

E-mail (username)
Password
Verify Password
First Name
Last Name

Personal Account Created

Mobile Access

You can now download VisualDx for your iOS and Android devices. Launch the VisualDx app from your device and sign in using your VisualDx personal account username and password.

CME Certification

Sign in with your personal account to earn and claim CME credits through VisualDx. Credits can be earned by building a differential or looking up a diagnosis.

Version: 7.13.1441   (build df7aed4)
Select Language


Select Region

Send us your feedback

E-mail
Message
This field is required

Oops! There was an issue during submission. Please try again. If the problem persists, email feedback@visualdx.com with your feedback.

Thank You!

We appreciate your feedback and you will be hearing from us soon.

OK

Share This Page

Thank You!

We have sent an e-mail with a link to the current page.

OK

E-mail This Patient Information Sheet

Thank You!

We have sent an e-mail with this patient information.

OK

Image Contributors

Individuals

  • Christine Ahn MD
    Carl Allen DDS, MSD
    Brandon Ayres MD
    Howard P. Baden MD
    Robert Baran MD
    Keira Barr MD
    Gregory J. Basura MD, Ph.D
    Donald Belsito MD
    Jeffrey D. Bernhard MD
    Jesse Berry MD
    Victor Blanco MD
    Benjamin R. Bohaty MD
    William Bonnez MD
    Sarah Brenner MD
    Robert A. Briggaman MD
    Robert Brodell MD
    Roman Bronfenbrener MD
    Walter Brooks MD
    William Buckley MD
    Philip Bulterys MD, PhD (candidate)
    Susan Burgin MD
    Sonya Burton MD
    Sean P. Bush MD, FACEP
    Jeffrey Callen MD
    Scott Camazine MD
    Michael Cardwell
    Shelley D. Cathcart MD
    Robert Chalmers MD, MRCP, FRCP
    Chia-Yu Chu MD, PhD
    Flavio Ciferri MD
    Maria Rosa Cordisco MD
    Noah Craft MD, PhD
    John T. Crissey MD
    Harold E. Cross MD, PhD
    Charles E. Crutchfield III MD
    Adriana Cruz MD
    Donna Culton MD, PhD
    Bart J. Currie MBBS, FRACP, DTM&H
    Chicky Dadlani MD
    Alexander Dane DO
    C. Ralph Daniel III MD
    Thomas Darling MD, PhD
    William Delaney MD
    Damian P. DiCostanzo MD
    Ncoza Dlova MD
    James Earls MD
    Libby Edwards MD
    Melissa K. Egge MD
    Charles N. Ellis MD
    Rachel Ellis MD
    David Elpern MD
    Nancy Esterly MD
    Stephen Estes MD
    E. Dale Everett MD
    Janet Fairley MD
    David Feingold MD
    Jennifer J. Findeis-Hosey MD
    Benjamin Fisher MD
    Henry Foong MBBS, FRCP
    David Foster MD, MPH
    Brian D. Foy PhD
    Michael Franzblau MD
    Vincent Fulginiti MD
    Sunir J. Garg MD, FACS
    Kevin J. Geary MD
    Lowell Goldsmith MD, MPH
    Sethuraman Gomathy MD
    Bernardo Gontijo MD, PhD
    Kenneth Greer MD
    Kenneth G. Gross MD
    Alan Gruber MD
    Nathan D. Gundacker MD
    Akshya Gupta MD
    Vidal Haddad MSC, PhD, MD
    Edward Halperin MD, MA
    Ronald Hansen MD
    John Harvey
    Rizwan Hassan MD
    Michael Hawke MD
    Jason E. Hawkes MD
    Peter W. Heald MD
    David G. Hicks MD
    Sarah Hocker DO
    Ryan J. Hoefen MD, PhD
    Li-Yang Hsu MD
    William Huang MD
    Sanjana Iyengar MD
    Alvin H. Jacobs MD
    Saagar Jadeja MD
    Shahbaz A. Janjua MD
    Joshua J. Jarvis MD
    Kit Johnson
    Zachary John Jones MD
    Robert Kalb MD
    A. Paul Kelly MD
    Henry Kempe MD
    Loren Ketai MD
    Sidney Klaus MD
    Ashwin Kosambia MD
    Jessica A. Kozel MD
    Carl Krucke
    Mario E. Lacouture MD
    Joseph Lam MD
    Alfred T. Lane MD
    Edith Lederman MD
    Nahyoung Grace Lee MD
    Pedro Legua MD, PhD
    Robert Levin MD
    Bethany Lewis MD
    Sue Lewis-Jones FRCP, FRCPCH
    Taisheng Li MD
    Christine Liang MD
    Shari Lipner MD, PhD
    Adam Lipworth MD
    Jason Maguire MD
    Mark Malek MD, MPH
    Jere Mammino DO
    Ricardo Mandojana MD
    Lynne Margesson MD
    Thomas J. Marrie MD
    Maydel Martinez MD
    Ralph Massey MD
    Patrick McCleskey MD
    Karen McKoy MD
    Thomas McMeekin MD
    Josette McMichael MD
    Somchai Meesiri MD
    Joseph F. Merola MD
    Mary Gail Mercurio MD
    Anis Miladi MD
    Larry E. Millikan MD
    Dan Milner Jr. MD
    Zaw Min MD
    Stephanie Montero
    Alastair Moore MD
    Keith Morley MD
    Dean Morrell MD
    Samuel Moschella MD
    Rehan Naseemuddin MD
    Taimor Nawaz MD
    Vic Newcomer MD
    John Nguyen MD
    Matilda Nicholas MD
    Thomas P. Nigra MD
    Steven Oberlender MD, PhD
    Maria Teresa Ochoa MD
    Art Papier MD
    Lawrence Parish MD
    Tanner Parrent MD
    Mukesh Patel MD
    Lauren Patty-Daskivich MD
    David Peng MD, MPH
    Robert Penne MD
    Nitipong Permpalung MD
    Miriam Pomeranz MD
    Doug Powell MD
    Harold S. Rabinovitz MD
    Christopher J. Rapuano MD
    Sireesha Reddy MD
    Angela Restrepo MD, PhD
    Bertrand Richert MD, PhD
    J. Martin Rodriguez, MD, FACP
    Theodore Rosen MD
    Misha Rosenbach MD
    Scott Schiffman MD
    Robert H. Schosser MD
    Glynis A. Scott MD
    Carlos Seas MD, MSc
    Deniz Seçkin MD
    Daniel Sexton MD
    Paul K. Shitabata MD
    Tor Shwayder MD, FAAP, FAAD
    Elaine Siegfried MD
    Gene Sienkiewicz MD
    Christye Sisson
    Philip I. Song MD
    Mary J. Spencer MD, FAAP
    Lawrence B. Stack MD
    Sarah Stein MD
    William Van Stoecker MD
    Frances J. Storrs MD
    Erik J. Stratman MD
    Lindsay C. Strowd MD
    Erika Summers MD
    Belinda Tan MD, PhD
    Robert Tomsick MD
    Hensin Tsao MD, PhD
    Richard P. Usatine MD
    Jenny Valverde MD
    Vishalakshi Viswanath MD
    Susan Voci MD
    Lisa Wallin ANP, FCCWS
    Douglas Walsh MD
    Ryan R. Walsh MD
    George Watt MD
    Clayton E. Wheeler MD
    Sally-Ann Whelan MS, NP, CWOCN
    Jan Willems MD, PhD
    James Henry Willig MD, MPH
    Karen Wiss MD
    Vivian Wong MD, PhD
    Sook-Bin Woo MS, DMD, MMSc
    Jamie Woodcock MD
    Stephen J. Xenias MD
    Nathaniel Yohannes
    Lisa Zaba MD
    Vijay Zawar MD
    Bonnnie Zhang MD
    Carolyn Ziemer MD
    Jeffrey P. Zwerner MD, PhD


Organizations

  • Am. Journal of Trop. Med & Hygiene
  • Armed Forces Pest Management Board
  • Blackwell Publishing
  • Bugwood Network
  • Centers For Disease Control and Prevention
  • Centro Internacional de Entrenamiento e Investigaciones Mèdicas (CIDEIM)
  • Dermatology Online Journal
  • East Carolina University (ECU), Division of Dermatology
  • International Atomic Energy Agency
  • Massachusetts Medical Society
  • Oxford University Press
  • Radiological Society of North America
  • Washington Hospital Center
  • Wikipedia
  • World Health Organization
ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesView all Images (7)
Pigmented contact dermatitis - Skin
Print
Other Resources UpToDate PubMed

Pigmented contact dermatitis - Skin

Print Images (7)
Contributors: Scarlett Boulos MD, Jeffrey D. Bernhard MD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
Other Resources UpToDate PubMed

Synopsis

Riehl's melanosis, also known as pigmented contact dermatitis, pigmented cosmetic dermatitis, and melanosis faciei feminae (female facial melanosis), is a nonpruritic pigmented contact dermatitis of rapid onset characterized by reticulated brownish-gray pigmentation of the face and neck. It particularly affects the forehead, temples, and zygomatic regions.

While some aspects of the etiology remain unclear, investigations, particularly in Japan, have found that the hyperpigmentation stems from sensitivity to certain chemicals in cosmetics. In these investigations, hundreds of patients were shown to have positive patch tests to cosmetics and their ingredients, and their hyperpigmentation significantly improved after avoiding cosmetics with those allergens. (The term "Riehl's melanosis" is actually a misnomer, because it refers to a pattern of hyperpigmentation identified in patients during World War I that is believed to have been caused by a dietary abnormality, whereas pigmented contact dermatitis is understood to be a form of allergic contact dermatitis.)

In contrast to a typical allergic contact dermatitis reaction, which presents with erythema, edema, and pruritus, pigmented contact dermatitis is mostly distinguished by hyperpigmentation and lacks the histological features of contact dermatitis such as spongiosis, which correlates with pruritus. Continuous daily exposure to low doses of allergens associated with this condition histologically produces liquefaction and degeneration of the basal layer of the epidermis, leading to pigmentary incontinence in the dermis with a lichenoid tissue reaction. Thus the inflammatory components of contact dermatitis are minimal while the pigmentary changes predominate. The pigment is so gradually absorbed that the hyperpigmentation is likened to a persistent "melanin tattoo." Treatment with corticosteroid ointments or even oral corticosteroids is essentially ineffective.

Common chemicals implicated in pigmented contact dermatitis include:
  • Fragrances – hydroxycitronellal, benzyl salicylate, jasmine absolute, ylang-ylang oil, cananga oil, sandalwood oil, eugenol, cinnamic derivatives, and balsam of Peru
  • Pigments – D & C Red 31, Red 225; D & C Yellow, No. 11 & 10; and pigments containing phenyl-azo-e-naphthol (PAN), aniline dyes, and kumkum (a red powder commonly used by Hindu women)
  • Optical whiteners
  • Coal tar derivatives, which increase photosensitivity
  • Bactericidals – carbanilides like trichlorocarbanilide and Irgasan CF3
Pigmented cosmetic contact dermatitis most commonly affects women, especially women of Asian and Hispanic origin. Women with very light skin types (little melanin) and very dark skin types (abundant melanin) do not show the same skin color changes.

Codes

ICD10CM:
L81.4 – Other melanin hyperpigmentation

SNOMEDCT:
24285001 – Riehl's melanosis

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

The differential diagnosis of pigmented contact dermatitis includes various other forms of dermatitis and hyperpigmentation disorders such as:
  • Allergic contact dermatitis – Presents with more prominent signs of erythema, urticaria, vesiculation, and pruritus. Caused by specific allergens; distribution varies and depends on contact.
  • Irritant contact dermatitis – May have erythema, mild edema, and scaling caused by direct contact with chemical agents like corrosive agents, which can burn and produce ulcers; most commonly affects the hands.
  • Berloque dermatitis (see phytophotodermatitis) – Hyperpigmentation in drop or pendant-like configuration in sun-exposed areas where perfume with bergamot oil (UV sensitizer) has been applied.
  • Melasma – Brown-gray hyperpigmentation correlated mostly with sun exposure as well as genetics, pregnancy, hormone replacement therapy, oral contraceptives, and thyroid problems.
  • Ochronosis – Bluish-black discoloration of various tissues like ocular tissue and ear cartilage; associated with exposure to various substances and alkaptonuria.
  • Poikiloderma of Civatte – Common disorder, concerning mainly perimenopausal women; located on the lateral and low neck.
  • Erythromelanosis follicularis of the face and neck – Reddish-brown pigmentation affecting follicles in the periauricular and maxillary areas; pigmented areas blanch with applied pressure, showing more brown pigment and telangiectases. Differing histology on skin biopsy.
  • Addison's disease – Hyperpigmentation is more generalized on the body, with other systemic symptoms like hypotension, myalgias, arthralgias nausea, vomiting or diarrhea, and amenorrhea in women.
  • Lichen amyloidosis – Extremely pruritic eruption of red-brown hyperkeratotic papules, distributed mostly on the shins, thighs, and feet; Congo red stain shows green birefringence with polarizing light.
  • Macular amyloidosis – Symmetric and pruritic eruption of brown or grayish macules located on upper back and arms; same Congo red stain results as for lichen amyloidosis.
  • Hyperpigmented lupus erythematosus – Direct immunofluorescence study on skin biopsy helps differentiate the two conditions.

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Updated: 09/11/2012
Copyright © 2018 VisualDx®. All rights reserved.
Pigmented contact dermatitis - Skin
Print 7 Images
View all Images (7)
(with subscription)
Pigmented contact dermatitis : Brown color, Face, Hyperpigmented patch, Neck, Reticular - netlike, Hyperpigmented macules
Clinical image of Pigmented contact dermatitis
Copyright © 2018 VisualDx®. All rights reserved.