Riehl Melanosis (Pigmented Contact Dermatitis) Treatment & Management

Updated: May 27, 2021
  • Author: Elizabeth K Satter, MD, MPH; Chief Editor: William D James, MD  more...
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Medical Care

Complete avoidance of the suspected allergen is necessary, and removal of these agents often leads to gradual improvement.

Consider use allergen-free apparel, soaps, and cosmetics

Cosmetic camouflage makeup may be used if the cosmetic disability is distressing to the patient.

Vigilant sun-protection is essential.

Topical treatments are similar to those used to treat melasma and include hydroquinone, retinoids, topical lignin peroxidase cream, [46] and azelaic acid. In addition, light chemical peels such as glycolic acid can also be considered.

Other options include intense pulsed-light therapy, Q-switched Nd:YAG lasers, nonablative 1927-nm fractional thulium fiber laser, 755-nm picosecond alexandrite laser, and other lasers with wavelengths that specifically target the hyperpigmentation. [11, 47, 48, 49, 50, 51, 52]

A small study from 2018 used a combination of oral tranexamic acid and a glycyrrhizin compound for 3 months, followed by another 3 months of oral tranexamic acid alone, with marked improvement of the hyperpigmentation in the majority of patients; however, because this study only consisted of 10 patients, further research is needed. [53, 54]

Another small pilot study used a combination of therapies to include low-fluence, 1064-nm, Q-switched Nd:YAG laser, hydroquinone cream, and oral tranexamic acid, with the majority of patients experiencing significant improvement and a few patients having almost complete clearing. [55]