Diagnostic Considerations

Also consider the following^[36]:

Drugs: Several classes of drugs induce hyperpigmentation, including minocycline, antimalarials, psychotropic drugs, chemotherapeutic agents, zidovudine, and psoralens. Also see Drug-Induced Pigmentation.
Erythromelanosis follicularis faciei et colli: This is characterized by symmetric reddish-brown pigmentation of the preauricular and maxillary areas, with multiple pinpoint follicular papules superimposed. Keratosis pilaris also may be noted.^[37]
Friction melanosis: Brown or black hyperpigmentation unaccompanied by dermatitis or pruritus characterizes friction melanosis. It is seen primarily over the long bones, knees, elbows, and scapula. It occurs secondary to vigorous rubbing of the skin with nylon towels or brushes when bathing.^[6]
Hori nevus or acquired nevus of Ota: This acquired facial hyperpigmentation is usually seen in women of Asian descent who are aged 20-70 years. It manifests clinically as bilateral blue-gray to gray-brown macules along the zygomatic area and, less often, on the forehead, upper-outer eyelids, and nose. Histologically, spindle-shaped dendritic melanocytes are present in the dermis and are scattered among collagen bundles. Melanophages usually are not present.
Lichen planus pigmentosus and actinic lichen planus: Brown to gray-brown macules evolve into diffuse/reticulated patches in sun-exposed skin and annular red-brown plaques or hyperpigmented patches primarily on sun-exposed skin, respectively.^[3]
Thiazide leukomelanoderma: This is also known as photoleukomelanodermatitis Kobori,^[38]and it is a reticular leukoderma with patchy hyperpigmentation, which can help differentiate it from Riehl melanosis.^[39]

Differential Diagnoses

Addison Disease
Allergic Contact Dermatitis
Ashy dermatosis
Berloque Dermatitis
Erythema Dyschromicum Perstans
Idiopathic eruptive macular pigmentation
Irritant Contact Dermatitis
Lichen planus pigmentosus
Melasma
Ochronosis and Alkaptonuria
Poikiloderma of Civatte

Workup

Woo YR, Jung Y, Kim M, Park HJ. Impact of Riehl's melanosis on quality of life in Korean patients: A cross-sectional comparative study. J Dermatol. 2020 Aug. 47 (8):893-897. [QxMD MEDLINE Link].
Udompanich S, Vachiramon V. Acquired Macular Pigmentation of Unknown Etiology. J Clin Aesthet Dermatol. 2019 Jan. 12 (1):38-46. [QxMD MEDLINE Link].
Kumarasinghe SPW, Pandya A, Chandran V, Rodrigues M, Dlova NC, Kang HY, et al. A global consensus statement on ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, idiopathic eruptive macular pigmentation, and Riehl's melanosis. Int J Dermatol. 2018 Sep 3. [QxMD MEDLINE Link].
Riehl G. Uber eine eigenartige melanose. Wien Klin Wochensschr. 1917. 30:280-1.
Rorsman H. Riehl's melanosis. Int J Dermatol. 1982 Mar. 21(2):75-8. [QxMD MEDLINE Link].
Nakayama H. Pigmented Contact Dermatitis and Chemical Depigmentation. Rycroft R, Menne T, Frosch P, Lepoittevin J, eds. Textbook of Contact Dermatitis. 3rd ed. New York, NY: Springer; 2001. 319-333.
Shenoi SD, Rao R. Pigmented contact dermatitis. Indian J Dermatol Venereol Leprol. 2007 Sep-Oct. 73(5):285-7. [QxMD MEDLINE Link].
Findlay GH. Some observations on the melanosis of Riehl. S Afr Med J. 1952 May 3. 26(18):373-5. [QxMD MEDLINE Link].
Daadaa N, Ben Tanfous A. Riehl Melanosis. StatPearls [Internet]. 2021 Jan. [QxMD MEDLINE Link]. [Full Text].
Osmundsen PE. Pigmented contact dermatitis. Br J Dermatol. 1970 Aug. 83(2):296-301. [QxMD MEDLINE Link].
Smucker JE, Kirby JS. Riehl melanosis treated successfully with Q-switch Nd:YAG laser. J Drugs Dermatol. 2014 Mar. 13 (3):356-8. [QxMD MEDLINE Link].
Seike M, Hirose Y, Ikeda M, Kodama H. Coexistence of Riehl's melanosis and lichen planus. J Dermatol. 2003 Feb. 30 (2):132-4. [QxMD MEDLINE Link].
Nakayama H, Harada R, Toda M. Pigmented cosmetic dermatitis. Int J Dermatol. 1976 Nov. 15(9):673-5. [QxMD MEDLINE Link].
Nakayama H, Matsuo S, Hayakawa K, Takhashi K, Shigematsu T, Ota S. Pigmented cosmetic dermatitis. Int J Dermatol. 1984 Jun. 23(5):299-305. [QxMD MEDLINE Link].
Imokawa G, Kawai M. Differential hypermelanosis induced by allergic contact dermatitis. J Invest Dermatol. 1987 Dec. 89(6):540-6. [QxMD MEDLINE Link].
Woo YR, Park HE, Jeong SW, Park HJ. Melanogenic Properties and Expression Profiles of Melanogenic Paracrine Molecules in Riehl's Melanosis. Int J Mol Sci. 2020 Mar 2. 21 (5):[QxMD MEDLINE Link].
Woo YR, Jung Y, Jeong SW, Park HJ. Paracrine roles of hormone receptors in Riehl's melanosis: A quantitative analysis of oestrogen and progesterone receptor expression patterns. Exp Dermatol. 2021 Mar. 30 (3):396-401. [QxMD MEDLINE Link].
Ebihara T, Nakayama H. Pigmented contact dermatitis. Clin Dermatol. 1997 Jul-Aug. 15(4):593-9. [QxMD MEDLINE Link].
Hayakawa R, Matsunaga K, Arima Y. Airborne pigmented contact dermatitis due to musk ambrette in incense. Contact Dermatitis. 1987 Feb. 16(2):96-8. [QxMD MEDLINE Link].
Pires MC, Manoel Silva dos Reis V, Mitelmann R, Moreira F. Pigmented contact dermatitis due to Plathymenia foliosa dust. Contact Dermatitis. 1999 Jun. 40(6):339. [QxMD MEDLINE Link].
Fujimoto K, Hashimoto S, Kozuka T, Tashiro M, Sano S. Occupational pigmented contact dermatitis from azo-dyes. Contact Dermatitis. 1985 Jan. 12(1):15-7. [QxMD MEDLINE Link].
el Sayed F, Manzur F, Bazex J. Pigmented contact dermatitis from cosmetics. Contact Dermatitis. 1995 Feb. 32(2):111. [QxMD MEDLINE Link].
Kozuka T, Tashiro M, Sano S, et al. Brilliant Lake Red R as a cause of pigmented contact dermatitis. Contact Dermatitis. 1979 Sep. 5(5):297-304. [QxMD MEDLINE Link].
Sugai T, Takahashi Y, Takagi T. Pigmented cosmetic dermatitis and coal tar dyes. Contact Dermatitis. 1977 Oct. 3(5):249-56. [QxMD MEDLINE Link].
Woo YR, Kim JS, Lim JH, Choi JY, Kim M, Yu DS, et al. Acquired diffuse slate-grey facial dyspigmentation due to henna: an unrecognized cause of pigment contact dermatitis in Korean patients. Eur J Dermatol. 2018 Oct 1. 28 (5):644-648. [QxMD MEDLINE Link].
Leow YH, Tan SH, Ng SK. Pigmented contact cheilitis from ricinoleic acid in lipsticks. Contact Dermatitis. 2003 Jul. 49(1):48-9. [QxMD MEDLINE Link].
Nath AK, Thappa DM. Kumkum-induced dermatitis: an analysis of 46 cases. Clin Exp Dermatol. 2007 Jul. 32(4):385-7. [QxMD MEDLINE Link].
Parodi G, Guarrera M, Rebora A. Lichenoid photocontact dermatitis to musk ambrette. Contact Dermatitis. 1987 Mar. 16(3):136-8. [QxMD MEDLINE Link].
Admani S, Goldenberg A, Jacob SE. Contact Alopecia: Improvement of Alopecia with Discontinuation of Fluocinolone Oil in Individuals Allergic to Balsam Fragrance. Pediatr Dermatol. 2017 Jan. 34 (1):e57-e60. [QxMD MEDLINE Link].
Liu KX, Zimarowski MJ, Wu PA. Contact Dermatitis Associated with Alopecia and Hyperpigmentation. Pediatr Dermatol. 2017 Sep. 34 (5):624-625. [QxMD MEDLINE Link].
Naganuma M, Hirose S, Nakayama Y, Nakajima K, Someya T. A study of the phototoxicity of lemon oil. Arch Dermatol Res. 1985. 278(1):31-6. [QxMD MEDLINE Link].
Serrano G, Pujol C, Cuadra J, Gallo S, Aliaga A. Riehl's melanosis: pigmented contact dermatitis caused by fragrances. J Am Acad Dermatol. 1989 Nov. 21(5 Pt 2):1057-60. [QxMD MEDLINE Link].
Ozkaya-Bayazit E, Buyukbabani N. Non-eczematous pigmented interface dermatitis from para-tertiary-butylphenol-formaldehyde resin in a watchstrap adhesive. Contact Dermatitis. 2001 Jan. 44(1):45-6. [QxMD MEDLINE Link].
Trattner A, David M. Pigmented contact dermatitis from topical minoxidil 5%. Contact Dermatitis. 2002 Apr. 46(4):246. [QxMD MEDLINE Link].
Miyoshi K, Kodama H. Riehl's melanosis-like eruption associated with Sjogren's syndrome. J Dermatol. 1997 Dec. 24(12):784-6. [QxMD MEDLINE Link].
Dharman BK, Sridhar S. Diffuse facial melanosis – An overview of etiology and dermoscopic findings. J Skin Sex Transm Dis. 2020. 2(2):86-93.
Perez-Bernal A, Munoz-Perez MA, Camacho F. Management of facial hyperpigmentation. Am J Clin Dermatol. 2000 Sep-Oct. 1(5):261-8. [QxMD MEDLINE Link].
Kobori T, Araki, Toda K. Photoleukomelanodermatitis (Kobori) caused by benzothiazidiazine derivatives. Jap J Dermatol. 1966. 76:665.
Nirmal B, Santhikiran B, Mukhopadhyay S. Multispectral Dermatoscopic Features of Chemical Leucoderma with Pigmented Contact Dermatitis. Indian Dermatol Online J. 2018 Mar-Apr. 9 (2):107-109. [QxMD MEDLINE Link].
Kim SM, Lee ES, Sohn S, Kim YC. Histopathological Features of Riehl Melanosis. Am J Dermatopathol. 2020 Feb. 42 (2):117-121. [QxMD MEDLINE Link].
Wang L, Xu AE. Four views of Riehl's melanosis: clinical appearance, dermoscopy, confocal microscopy and histopathology. J Eur Acad Dermatol Venereol. 2014 Sep. 28 (9):1199-206. [QxMD MEDLINE Link].
Vinay K, Bishnoi A, Parsad D, Saikia UN, Sendhil Kumaran M. Dermatoscopic evaluation and histopathological correlation of acquired dermal macular hyperpigmentation. Int J Dermatol. 2017 Dec. 56 (12):1395-1399. [QxMD MEDLINE Link].
Sitohang IBS, Prayogo RL, Rihatmadja R, Sirait SP. The diagnostic conundrum of Riehl melanosis and other facial pigmentary disorders: a case report with overlapping clinical, dermoscopic, and histopathological features. Acta Dermatovenerol Alp Pannonica Adriat. 2020 Jun. 29 (2):81-83. [QxMD MEDLINE Link].
Yim JH, Kang IH, Shin MK, Lee MH. Differences among Dermoscopic Findings in Riehl's Melanosis of the Cheek and Neck. Ann Dermatol. 2019 Aug. 31 (4):460-463. [QxMD MEDLINE Link].
Lu Q, Yang C, Wu J, Wei Z, Xu S, Wang C, et al. Confocal laser scanning microscopy, a diagnostic alternative for five pigmented lesions on the face: An observational study. Skin Res Technol. 2019 Nov. 25 (6):871-876. [QxMD MEDLINE Link].
Chan KTM, Ma MMW. A Case of an Elderly Women Presented with Severe Pigmented Contact Dermatitis (Riehl's melanosis) Effectively Treated with Topical Lignin Peroxidase Cream. Med Rep Case Stud ISSN: 2572-5130. 2019. 4:174.
On HR, Hong WJ, Roh MR. Low-pulse energy Q-switched Nd:YAG laser treatment for hair-dye-induced Riehl's melanosis. J Cosmet Laser Ther. 2015 Jun. 17 (3):135-8. [QxMD MEDLINE Link].
Chung BY, Kim JE, Ko JY, Chang SE. A pilot study of a novel dual--pulsed 1064 nm Q-switched Nd: YAG laser to treat Riehl's melanosis. J Cosmet Laser Ther. 2014 Dec. 16 (6):290-2. [QxMD MEDLINE Link].
Choi CW, Jo G, Lee DH, Jo SJ, Lee C, Mun JH. Analysis of Clinical Features and Treatment Outcomes Using 1,064-nm Nd-YAG Laser with Topical Hydroquinone in Patients with Riehl's Melanosis: A Retrospective Study in 10 Patients. Ann Dermatol. 2019 Apr. 31 (2):127-132. [QxMD MEDLINE Link].
Kim SM, Hwang S, Almurayshid A, Park MY, Oh SH. Non-Ablative 1927 nm Fractional Thulium Fiber Laser: New, Promising Treatment Modality for Riehl's Melanosis. Lasers Surg Med. 2020 Dec 1. [QxMD MEDLINE Link].
Iwayama T, Oka M, Fukumoto T. Treatment of henna-induced Riehl's melanosis with a 755-nm picosecond alexandrite laser. Lasers Med Sci. 2020 Sep. 35 (7):1659-1661. [QxMD MEDLINE Link].
Cho MY, Roh MR. Successful Treatment of Riehl's Melanosis With Mid-Fluence Q-Switched Nd:YAG 1064-nm Laser. Lasers Surg Med. 2020 Oct. 52 (8):753-760. [QxMD MEDLINE Link].
Xu Z, Xing X, Zhang C, Chen L, Flora Xiang L. A pilot study of oral tranexamic acid and Glycyrrhizin compound in the treatment of recalcitrant Riehl's melanosis. J Cosmet Dermatol. 2018 Oct 19. [QxMD MEDLINE Link].
Wang L, Wen X, Hao D, Li Y, Du D, Jiang X. Combination therapy with salicylic acid chemical peels, glycyrrhizin compound, and vitamin C for Riehl's melanosis. J Cosmet Dermatol. 2020 Jun. 19 (6):1377-1380. [QxMD MEDLINE Link].
Kwon HH, Ohn J, Suh DH, Park HY, Choi SC, Jung JY, et al. A pilot study for triple combination therapy with a low-fluence 1064 nm Q-switched Nd:YAG laser, hydroquinone cream and oral tranexamic acid for recalcitrant Riehl's Melanosis. J Dermatolog Treat. 2017 Mar. 28 (2):155-159. [QxMD MEDLINE Link].

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Author

Elizabeth K Satter, MD, MPH Dermatologist and Dermatopathologist

Elizabeth K Satter, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Medical Women's Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

John D Wilkinson, MD, MBBS, MRCS, FRCP Chairman, Clinical Director, Department of Dermatology, Amersham Hospital and High Wycombe Hospital, UK

John D Wilkinson, MD, MBBS, MRCS, FRCP is a member of the following medical societies: American Academy of Dermatology, Royal College of Physicians

Disclosure: Nothing to disclose.

Helena A Longin, MD Resident Physician, Department of Dermatology, Naval Medical Center San Diego

Helena A Longin, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference acknowledge the contributions of previous author, Mohsin Ali, MBBS, FRCP, MRCP, to the development and writing of this article.

Sections Riehl Melanosis (Pigmented Contact Dermatitis)
Overview
Presentation
DDx
Workup
Treatment
Medication
Questions & Answers
References

Riehl Melanosis (Pigmented Contact Dermatitis) Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

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