Riehl melanosis L81.4

Inflammatory spotty pigmentation on the face, which is seen as a variant of melanodermatitis toxica.

Unexplained, probably photosensitization of previously damaged skin. Noxae to be considered: asphalt, tars and fats (in inferior cosmetics), foodstuffs, medicines. The increased incidence of melanosis in times of war with malnutrition has also given the disease the nickname "war melanosis".

It is possible that chronic malnutrition causes a deficit of skin active substances and vitamins which can lead to pigmentation and endocrine disorders.

Symmetrically localized, blurred, initially itchy red spots. Transformation into asymptomatic, slate grey to deep brown, laminar, also reticular pigmentation.

Development of follicular or perifollicular keratoses and possibly lichenoid papules.

• According to the authors, cosmetic cover (e.g. Dermacolor) and textile sun protection as well as physical/chemical sun protection (e.g. Anthelios) are the most sensible therapy approach (all year round, even during winter holidays).
• Although the changes show a good response to the application of local bleaching agents like combined application of hydroquinone with glucocorticoids or retinoids (effect after 4 weeks at the earliest, peak after 4 months; e.g. Pigmanorm, R118 ), spotty changes of the skin as well as irreversible hypopigmentations have to be expected with this treatment. If necessary, prior testing on a small area of skin.

  Notice! Be careful when using depigmenting external agents on the face! Permanent pigment shifts may occur!

• Therapy attempts with azelaic acid (e.g. Skinoren) 1-2 times/day, over 3-12 months have also shown success. If necessary, treatment attempts with chemical peeling or high-energy flash or short-arc lamp technology (IPL = Intense Pulsed Light).

1. Civatte A (1923) Poïkilodermie réticulée pigmentaire du visage et du cou. Ann Derm Syph Paris 4: 605-620
2. Katoulis AC et al (2002) Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte. Br J Dermatol 147: 493-497
3. Perez-Bernal A et al (2000) Management of facial hyperpigmentation. At J Clin Dermatol 1: 261-268
4. Raulin C et al (2003) IPL technology: a review. Lasers Surg Med 32: 78-87
5. Riehl G (1917) About a strange melanosis. Vienna clin Wschr 30: 780-781
6. Serrano G, Pujol C, Cuadra J et al (1989) Riehl's melanosis: Pigmented contact dermatitis caused by fragrances. J Am Acad Dermatol 21: 1057-1060