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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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Things worth knowing about "Berloque Dermatitis"

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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