Berloque Dermatitis - Perfume-Induced Skin Reactions

Introduction

Berloque dermatitis is a form of photo-contact dermatitis. Berloque dermatitis occurs due to excessive exposure to sunlight followed by contact with bergamot-containing perfumed products. The hallmark features of berloque dermatitis are hyperpigmentation in the striking liner pattern. The unique pattern usually follows the local application of the aromatic effect. Some other symptoms of berloque dermatitis are erythema and blisters. Avoiding sun exposure and topical corticosteroids administration are done to prevent the complications of berloque dermatitis. Continuation of the scented products may lead to further complications. Chronic hyperpigmentation occurs in severe cases. Sometimes, berloque dermatitis will mimic child abuse and should not be misdiagnosed.

What Is Berloque Dermatitis?

Rosenthal first described berloque dermatitis in 1925. The term ’berloque’ means berlock in German and berloque in French meaning charm or trinket. Berloque dermatitis is a type of phototoxic dermatitis condition characterized as the phototoxic reaction induced by excessive exposure to ultraviolet rays and sunlight on bergapten-containing perfumed products. The bergapten is the 5-methoxy psoralen, a photoactive component of bergamot oil most present in scented products. Bergamot oil obtained from bergamot lime is the chief ingredient in most fragrances and perfumes. The symptoms of berloque dermatitis are hyperpigmentation in pendant-like streaks, mostly observed on the face, neck, trunk, and arms. Various names have been known as berloque dermatitis, and the multiple names of berloque dermatitis are given below:

• Block dermatitis.

• Perfume phototoxicity.

• Bergapten phototoxicity.

• Bergamot phototoxicity.

• Photo Dermatitis pigmentaria.

• Dermite pigmentée en forme de coulée.

What Causes Berloque Dermatitis?

Berloque dermatitis is mainly caused by the excessive application of perfumed products containing bergapten following excessive exposure to sunlight and ultraviolet rays. The bergapten is the 5-methoxy psoralen and the furocoumarin, one of the most proactive components of bergamot oil. The combination of 5-methoxy psoralen and excessive ultraviolet or sun exposure causes increased melanin and hyperpigmentation. The bergapten is the oil component obtained from the bergapten lime, derived from the Citrus bergamia rind. The cause of berloque dermatitis is given below:

• Excessive exposure to sunlight.

• Increased ultraviolet rays or artificial light sources.

• Bergapten, a 5-methoxy psoralen-containing perfumed product.

• Induced melanogenesis.

• Increased hyperpigmentation.

• Phototoxicity.

• Other photosensitive compounds in lemons, parsnips, celery, limes, and carrots in contact with sunlight cause berloque dermatitis.

What Are the Symptoms of Berloque Dermatitis?

The symptoms of berloque dermatitis are primarily observed in the sun-exposed areas of the body, such as the face, neck, arms, shoulders, back, and trunk regions. The key symptoms of berloque dermatitis are melanin hyperpigmentation in the pendant-like streaks. The symptoms of berloque dermatitis appear within a day, and blisters remain for a few days. Berloque dermatitis is photo contact dermatitis, and inflammatory symptoms are present. The various signs and symptoms of berloque dermatitis are mentioned below:

• Pendentlike streaks in the sun-exposed areas.

• Generalized erythema.

• Irritation.

• Redness and swelling.

• Desquamating patch.

• Linear streaks of macular pigmentation.

• Blisters.

• Streaks of hyperpigmentation are mostly seen on the cheeks and neck.

• Edema.

• Inhibition of DNA synthesis.

• Inhibition of cell proliferation.

• Stimulation of melanin production.

• Acute symptoms of photo contact dermatitis, like erythematous patches, plaques, bullae, and vesicles, are present.

What Is the Diagnosis of Berloque Dermatitis?

The diagnosis of berloque dermatitis is mainly based on the history of exposure and physical examinations. The symptoms of berloque dermatitis are primarily present in the sun-exposed areas, and the hyperpigmented is examined in the neck, face, arms, and other regions. Berloque dermatitis is often misdiagnosed with child abuse. Hence, a confirmed diagnosis is made to avoid misdiagnosis. In addition, the perfume with 5-methoxy psoralen is avoided after the confirmed diagnosis of berloque dermatitis—the size of the erythematous patch in berloque dermatitis may range from three to five centimeters. The diagnostic measures for berloque dermatitis are mentioned below:

• History of symptoms.

• Physical examination in sun-exposed areas.

• History of perfume use and other phototoxic substances like aromatherapy oils.

• History of contact with psoralen-containing products followed by prolonged sun exposure.

What Is the Differential Diagnosis of Berloque Dermatitis?

There are various differential diagnoses for berloque dermatitis. Symptoms like dermatitis and inflammatory changes are similar in the differential diagnosis. Therefore, the comparison of symptoms will avoid misdiagnosis. Some of the differential diagnoses of berloque dermatitis are mentioned below:

• Contact dermatitis.

• Riehl melanosis.

• Melasma.

• Postinflammatory hyperpigmentation.

• Acanthosis nigricans.

• Mongolian spots.

• Purpura.

• Dermatitis artifacts.

• Allergic contact dermatitis.

• Non-accidental injury.

What Are the Complications of Berloque Dermatitis?

Berloque dermatitis has some complications. The intricacies of berloque dermatitis are mainly due to the prolonged use of the aromatic product with phototoxic substances and excessive sun exposure. Some of the complications of berloque dermatitis are mentioned below:

• Blisters.

• Ulcers.

• Infections.

• Scarring.

• Postinflammatory hyperpigmentation.

What Is the Treatment for Berloque Dermatitis?

The treatment of berloque dermatitis is mainly done to avoid recurrence. The aromatic and fragrance products containing photonic substances are avoided to prevent berloque dermatitis. Topical corticosteroids are advised to reduce the symptoms. Proper sunscreen protection is done to avoid the complications of sunburn, and aggravation of berloque dermatitis is also prevented. The various treatment measures for treating berloque dermatitis are mentioned below:

• Topical corticosteroids relieve skin irritation and swelling.

• Avoiding causative perfume products.

• Sun exposure must be reduced.

• Sunscreen is applied to avoid sun damage.

• Broad spectrum sunscreen can be used, and it blocks the ultraviolet rays A, UVA, and ultraviolet rays B, UVB.

• An effective agent, Avobenzone, gives ultraviolet A and UV-A protection.

• Other supportive measures like cool compress, analgesics, and topical antiseptics are applied to avoid infections.

Conclusion

Berloque dermatitis is a phototoxic condition and a type of photo-contact dermatitis. Berloque dermatitis is caused by the bergapten-5 methoxy psoralen, a phototoxic substance in excessive sun exposure. The symptoms of berloque dermatitis are hyperpigmentation and inflammatory changes in the sun-exposed areas like cheeks, neck, feet, arms, and back. The diagnosis is made with a history of sun exposure and products containing phototoxic substances like perfumes and fragrances. A proper diagnosis is made, and the treatment is done to avoid complications. Topical corticosteroids are used to relieve the symptoms of berloque dermatitis. Early diagnosis, sun protection measures, and avoiding phototoxic substances will prevent the condition.