By Gary M. White, MD
Hispanic woman in her 60's with a slowly progressive pigmentation of the neck and chest over 4 years. She had been using the same perfume, sprayed on the neck, chest and behind the ears for 5 years.
Pigmented contact dermatitis is a non-eczematous form of allergic contact dermatitis, aka Riehl's melanosis. Some have theorized the concentration of the allergen is too low to elicit an eczematous reaction but strong enough to stimulate the melanocytes.
Spotty hyperpigmented macules and patches are seen behind the ears and on the sides of the neck extending to the chest. It is thought to represent a phototoxic dermatits to cosmetics--most commonly to fragrances and fragrance fixatives, such as benzyl salicylate in cosmetics. Rheil's melanosis a variant. In 1917, during the First World War, Riehl in Vienna observed several patients with striking dark brown to grayish-brown pigmentation on the forehead, temporal and zygomatic region of the face.
Hyperpigmentation on the forehead, temporal and zygomatic regions, especially in darker skin individuals.
Patch testing may be done. This condition should be distinguished from lichen planus pigmentosus which can also present with pigmented lesions on the neck.
The Q-switched Nd:YAG laser has been reported effective [J Drugs Dermatol. 2014 Mar;13(3):356-8].
Same patient as above.
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