Berloque Dermatitis: Causes, Symptoms and Treatment
Berloque dermatitis is a phototoxic skin reaction caused by contact with furancoumarin-containing substances followed by UV light exposure. It typically presents as brown pigmentation marks on the skin.
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Berloque dermatitis is a phototoxic skin reaction caused by contact with furancoumarin-containing substances followed by UV light exposure. It typically presents as brown pigmentation marks on the skin.
What is Berloque Dermatitis?
Berloque dermatitis (also spelled berlock dermatitis) is a phototoxic skin reaction triggered by the combination of certain chemical substances and ultraviolet (UV) light. The name derives from the French word berloque, meaning a pendant or charm, because the resulting pigmented spots often appear in droplet or pendant-like shapes on the skin. Unlike an allergic reaction, berloque dermatitis is based on a purely chemical-physical mechanism and can, in principle, affect any person exposed to the relevant substances in sufficient concentration.
Causes
The primary cause of berloque dermatitis is skin contact with furanocoumarins (also known as psoralens), followed by exposure to UV radiation, particularly UV-A. Furanocoumarins are naturally occurring compounds found in certain plants and plant-derived extracts.
- Perfumes and eau de cologne: Many classic perfumes contain bergamot oil, which is rich in bergapten (a furanocoumarin). Reactions frequently occur on the neck, chest, or wrists where perfume is applied.
- Cosmetics: Certain skincare products, sunscreens, or hair products containing plant extracts may include furanocoumarins.
- Plant contact: Direct contact with plants such as parsley, celery, figs, rue, or giant hogweed, followed by sun exposure, can trigger similar reactions.
Symptoms
Berloque dermatitis typically progresses in two distinct phases:
Acute Phase
- Redness, mild swelling, and a burning sensation in the affected skin areas
- Occasional blister or vesicle formation in severe reactions
- Symptoms usually appear within a few hours after UV exposure
Chronic Phase / Post-reaction
- Hyperpigmentation: The characteristic brown to dark-brown spots, often in a droplet or streaky pattern, develop and may persist for weeks to months
- Spots are frequently located on the neck, chest, wrists, and forearms
- No pain or itching during the chronic phase
Diagnosis
The diagnosis of berloque dermatitis is typically made clinically, based on the characteristic appearance and the patient history. The following aspects are relevant:
- Medical history: Inquiry about perfumes, cosmetics, plant contact, and sun exposure
- Clinical presentation: Characteristic distribution patterns and shape of the pigmented lesions
- Photopatch test: To rule out photoallergic contact dermatitis, a photopatch test may be performed, where suspected substances are applied to the skin and subsequently irradiated with UV-A light
- Differential diagnosis: Distinction from melasma, post-inflammatory hyperpigmentation, and photoallergic contact dermatitis
Treatment
Specific treatment of berloque dermatitis is often not necessary, as the changes frequently resolve spontaneously. However, the following measures are recommended:
Acute Measures
- Immediate washing of the affected skin areas to remove the triggering substance
- Consistent sun protection (SPF 50+) throughout the entire reaction phase
- Skin cooling and, if necessary, topical corticosteroids for severe acute inflammation
Treatment of Hyperpigmentation
- Lightening creams containing active ingredients such as hydroquinone, kojic acid, azelaic acid, or vitamin C can help fade the pigmented spots
- Chemical peels or laser treatments may be used for persistent pigmentation
- Consistent UV protection is essential to prevent worsening
Prevention
Berloque dermatitis can be effectively prevented once the triggering substances are identified:
- Avoid applying perfume and furanocoumarin-containing cosmetics to skin areas exposed to direct sunlight
- Apply perfume preferably to clothing or covered areas of the body
- Wash skin after contact with risk plants and avoid sun exposure
- Choose modern, bergapten-free perfumes when possible
References
- Merk, H.F., Bickers, D.R.: Dermatopharmakologie und Dermatotherapie. Blackwell Wissenschafts-Verlag, Berlin, 1992.
- Bruynzeel, D.P. et al.: Photopatch testing: the 5-year follow-up of the European multicenter photopatch test study. Journal of the European Academy of Dermatology and Venereology, 2004.
- World Health Organization (WHO): Ultraviolet radiation and the INTERSUN Programme. WHO, Geneva. Available at: https://www.who.int/uv/en/
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