Address
Jaipur
Email
editor@e-ijcd.in
Indian Journal Of Clinical Dermatology

ORIGINAL ARTICLE

Year: 2018 I Volume: 1 I Issue: 1 I Page: 16-18

Female Facial Melanosis in India : Role of contact sensitivity

Srivastava P.K 1 , Bajaj A.K 2

1Consultant Dermatologist Mansi Skin & Allergy Clinic, Allahabad,

2Bajaj Skin Clinic, Allahabad

Corresponding Author:
Dr. P. K. Srivastava
Consultant Dermatologist,
244/60 M.G.Marg, George Town,
Allahabad 211002 UP, India
Email: dr_pks123@rediffmail.com

How to cite this article:
Srivastava P.K, Bajaj A.K. Female Facial Melanosis in India : Role of contact sensitivity. JDA Indian Journal of Clinical Dermatology 2018;1:16-18.

 

Key Words-Cosmetics, Pigmented cosmetic dermatitis, Isoeugenol, Females Facial Melanosis, Ylang Ylang oil, Cananga odorata oil.

Introduction:

The wish to get lighter skin in Asian women, in particular, is very high as it is believed to be an indication of superiority and higher socioeconomic status. Recently the spread of visual media even to the smaller towns of India as well as on the counter availability of large number of fairness creams have resulted in their increasing usage with very little information regarding the safety profile and side effects. Paradoxically there is sudden increase in the number of female patients seeking consultation for facial melanosis. We hereby report a series of such patients with an attempt to delineate the probable role of contact sensitivity .

Materials and Methods:

Thirty three female patients, aged between 18 – 57yrs, with predominantly diffuse pigmentation of the face and neck(Fig. 1 a,b) were included in the study, carried out from May 2015 to September 2016.. In some patients the volar aspect of the forearms (Fig.1c) or upper back of the trunk were also involved (Table 1).Case series is small, reason being only patients who agreed for patch testing were included . A small number of patients (n =7) had previously also suffered from mild dermatitis. The duration of hyperpigmentation varied from 6 month to 3 years.

All patients were patch tested with the Indian baseline series, the fragrance series (Chemotechnique Diagnostics, Vellinge, Sweden) and some also with their own products used.

The closed patches were applied on the back and occluded for 2 days, and the readings were taken on D 2 and 4 according to the ICDRG guidelines. In 6 patients, biopsy specimens were obtained from a pigmented area for histopathological examination. Photo Patch test could not be done because of non availability of Photo Patch test facility

Fig 1 (a, b, c): Patient with predominantly diffuse pigmentation of the face and neck

Click here to view

Results:

21 out of 33 patch-tested patients showed positive reactions to various allergens, the results of which are given in Tables 1 and 2.

Most patients presented with contact sensitivity to isoeugenol (n=14) followed by Hydroquinone and Fragrance mix 1 (n=5), and Cananga odorata or Ylang YlangOil (n=4). Among the fifteen patients tested with their personal products seven had a positive reaction,of which three were considered irritant. The biopsy specimens showed mild hyperkeratosis, occasional basal layer liquefaction degeneration along with accumulation of melanin pigment, and a mononuclear cell infiltrate in the upper dermis. However a band like infiltrate with lymphocytes and histiocytes, hypergranulosis, saw toothed appearance and acanthosis of epidermis, or Hyaline bodies were absent.

Fig-2: Histopathology showing liquefaction degeneration and accumulation of melanin pigment in the basal layer, and a sparse mononuclear infiltrate of the upper dermis (H&E staining).

Click here to view

15 out of the 21 patients having reacted positively on patch testing were followed up during a two year period to assess any improvement after elimination of the allergens identified, Table 3.

Discussion:

Widespread or localized hyperpigmentation may be associated with a large number of conditions (1). In our study, patients were having diffuse hyperpigmentation of the face and neck with history of application of various cosmetic creams, aromatic oils, or fragrances. In some patients mild dermatitis preceded the onset of hyperpigmentation.

The majority of our patients (21/33) showed positive patch-test reactions to various components of cosmetics, particularly the fragrance ingredients isoeugenol followed by Cananga odorata or Ylang Ylang Oil, and Fragrance Mix1, components which have been implicated to cause Pigmented Cosmetic Dermatitis (2). Five patients reacted to a popular brand of herbal fairness cream, found to contain geraniol, citronellol, Santalum Album or sandalwood oil, and eugenol, also known to produce hyperpigmentation (3, 4). The positive reactions to nickel and potassium dichromate in 5 and 2 patients respectively, were not considered relevant to the present condition.

According to Osmundsun (5) pigmented contact dermatitis (PCD) is an idiosyncratic reaction. Although the exact mechanism by which the allergic reaction induces epidermal and dermal hyperpigmentation is still not known. It has been hypothesized that allergens responsible for PCD may have special affinity for melanin, inciting an inflammatory reaction around the melanocytes and around the cells incorporating melanin granules (6). Nakayama et al. (7) hypothesized that the concentration of allergens in commercial preparations were too low to produce spongiotic dermatitis but may give rise to a cytolytic type IV allergy at the basal layer of the epid ermis, resulting in PCD. Similar histopathological features were observed in our cases as well.

In a recent Thai study( 8) patients having hyperpigmentation due to Ashy dermatosis(AD), Lichen planus pigmentosus( LPP) and suspected pigmented contact dermatitis ( PCD) were patch tested and almost half of them ( 21 of 43 ; 48.83 %) showed relevantly positive reactions. The positive reactions were seen in 40% cases of Ashy dermatosis, 36.36 % cases of LPP and 80% cases of PCD. Our study has almost similar results and follow up of our cases over 2 years with avoidance of putative allergens resulted in improvement of pigmentation in significant number of patients.It is suggested that patch testing in patients with hyperpigmentation will go a long way in proper management of these cases

Conclusion:

Whereas cosmetics are intended to improve the appearance of the skin or enhance the attractiveness of the users, paradoxically skin lightening creams have led to an epidemic of diffuse hyperpigmentation. Therefore, stringent regulations are needed, since such preparations should not be made available over the counter; moreover, mandatory labeling of the constituents should be required.

Patch testing, also with the personal products used, is a useful tool in identifying the etiology of female Facial Melanosis, since, at least in significant number of cases, elimination of the allergens identified resulted in clinical improvement.

Table 1: The sites affected and positive patch-test results

Click here to view

PPDA: Para-phenylenediamine; HICC: hydroxyisohexylcyclohexene carboxaldehyde; HQ: Hydroquinone; YYO: Ylang Ylang oil; POM: Patient own material; FMI: Fragrance Mix1; FM II: Fragrance Mix 2

Table 2: Number (Nr.) of positive patch-test reactions to the different series and the patients’ own cosmetics

Click here to view
Table 3: Number of patients with positive patch tests and of results of clinical follow-up after withdrawal of the allergens identified

Click here to view

References:

1. Trattner A, Hodak E, David M. Screening patch tests for pigmented contact dermatitis in Israel. Contact Dermatitis 1999;40: 155-7

2. Nakayama H. Pigmented contact dermatitis, Chapter 18, in Contact Dermatitis 4th edition. Eds. FroschPJ, Menné T, Lepoittevin JP.

3. Prakash P and Gupta N. Indian J Physiol Pharmacol 2005; 49: 125–131

4. Stewart, D. (2005). The Chemistry Of Essential Oils Made Simple: God’s Love Manifest In Molecules. Care.

5. Osmundsen PE. Pigmented contact dermatitis. Br J Dermatol 1970; 83: 296-301

6.Nagao S, Iijima S. Light and electron microscopic study of Riehl’s melanosis. Possible mode of its pigmentary incontinence. J Cutan Pathol 1974; 1: 165-75.

7. Nakayama H, Matsuo S, Hayakawa K, Takashi K, Shigematsu T, Ota S. Pigmented cosmetic dermatitis. Int J Dermatol 1984; 23: 299-305.

8. TienthavornT Tresukosol, Sudtikoonaseth P. Patch testing and histopathology in Thai patients with hyperpigmentation due to Erythema dyschromicum perstans, Lichen planus pigmentosus and Pigmented contact dermatitis. Asian Pac J Allergy Immunol 2014;32:185-92

149 comments on “Female Facial Melanosis in India : Role of contact sensitivity”

  1. Pingback: canadianpharmaceuticalsonline.home.blog
  12. Pingback: 2sluggish

  61. Your article gave me a lot of inspiration, I hope you can explain your point of view in more detail, because I have some doubts, thank you.

  62. Pingback: What kills bacteria fast what is stromectol?
  63. Pingback: What are the effects of chronic alcoholism on erectile function in young men generic for levitra?
  64. Pingback: What not to do on antibiotics ivermectin for rabbits?
  65. Pingback: Can excessive pornography consumption contribute to erectile dysfunction how does levitra work?
  66. Pingback: Why do I still love my ex generic levitra from india?
  67. Pingback: What causes relationship to end vardenafil uses?
  68. Pingback: Exploring the Intersection of Traditional and Modern Medicines vidalista 40 reviews?
  69. Pingback: Medications and Emotional Wellness - Managing Stress, Finding Inner Peace stromectol for sale?
  70. Pingback: Medications and Dental Health - Beyond Toothpaste and Floss stromectol 3 mg online?
  71. Pingback: Medications and Asthma Control - Breathing Freely, Living Fully ventolin hfa 90 mcg inhaler?
  72. Pingback: Medications and Foot Fungus Treatment - Restoring Healthy Feet levitra for erectile dysfunction?
  73. Pingback: How quickly do men fall in love Cenforce over the counter medication?
  74. Pingback: How do you make a girl love you fast Cenforce 50mg cheap?
  75. Pingback: What animal can get pregnant while pregnant Cenforce 100mg uk?
  76. Pingback: How do I love a man order generic Cenforce 100mg?
  77. Pingback: Medications and Sleep Disorders in Children - Restoring Restful Nights buy ivermectin for humans?
  78. Pingback: Medications and Allergy Relief - Reclaiming Comfort, Enjoying the Outdoors Zithromax medication?
  79. Pingback: vidalista?
  80. Pingback: Medications and High Cholesterol - Managing Cardiovascular Health buy furosemide without prescription?
  81. Pingback: where can i buy dapoxetine in us?
  82. Pingback: scabies ivermectin?
  83. Pingback: Artificial Pancreas Technology for Diabetes Management z-pack 500 mg?
  84. Pingback: Medications and Chemotherapy - Minimizing Side Effects, Maximizing Results buy Cenforce 100mg pill?
  85. Pingback: Medications and Anxiety Management - Finding Calm in Chaos viagra low price online buy?
  87. Pingback: The Power of Medications in Promoting Longevity and Healthy Aging buy priligy on the internet without a prescription?
  88. Pingback: Medications for Healthy Aging - Promoting Longevity buy dapoxetine online?
  89. Pingback: Can antibiotics be used for parotitis ivermectin pills for humans?
  90. Pingback: How do I make him feel jealous 100 mg viagra generic?
  91. Pingback: Can antibiotics be used to treat infections in patients with rheumatoid arthritis ivermectin generic?
  92. Pingback: What is the safest asthma inhaler albuterol 90 mcg
  93. Pingback: What is the role of the FDA in addressing concerns about the safety of medication compounding in healthcare settings priligy where to buy new york
  94. Pingback: Can patients request a medication review to assess potential drug interactions dapoxetine hcl tablets 60 mg
  95. Pingback: Are there red flags to watch for when buying medicines online generic priligy
  96. Pingback: cenforce 100 obat apa
  97. Pingback: what dose dapoxetine work for
  98. Pingback: How many rounds can a woman go??
  99. Pingback: When did a girl first give birth??
  100. Pingback: priligy where to buy new york - What do guys like to get as gifts?
  101. Pingback: albuterol 90 mcg inhaler
  102. Pingback: albuterol sulfate nebulizer solution
  103. Pingback: generic priligy
  104. Pingback: vardenafil vilitra 60 mg
  105. Pingback: lasix 40mg price
  107. Pingback: metronidazole price walgreens
  108. Pingback: nolvadex cost
  109. Pingback: testosterone gel for women
  110. Pingback: albuterol inhaler
  111. Pingback: can you get furosemide over the counter
  112. Pingback: buying kamagra online
  113. Pingback: proair digihaler 90 mcg inhaler
  114. Pingback: strattera uk
  115. Pingback: tadalista
  116. Pingback: cheap viagra
  117. Pingback: buy vidalista
  118. Pingback: vilitra 40 mg reviews
  119. Pingback: keflex generic
  120. Pingback: amoxicillin clavulanate potassium
  121. Pingback: 1 androgel
  122. Pingback: amoxil tablet uses
  123. Pingback: androgel price
  124. Pingback: buy revatio online
  125. Pingback: Can antibiotics prevent infection in daycare attendees hcq 200 mg tablet?
  126. Pingback: priligy cost
  127. Pingback: Cenforce 100 dosage
  128. Pingback: stromectol 12mg online
  129. Pingback: Cenforce medication
  130. Pingback: fildena professional
  131. Pingback: Cenforce 100 sildenafil citrate
  132. Pingback: Where to Buy Generic clomid
  133. Pingback: fildena 100 purple for sale
  134. Pingback: hydroxy-clomiphene
  135. Pingback: ventolin inhaler blue
  136. Pingback: vidalista
  137. Pingback: Cenforce 100 sildenafil citrate
  138. Pingback: fildena
  139. Pingback: priligy 30 mg
  140. Pingback: centurion laboratories vidalista 40
  141. Pingback: fildena 200mg reviews
  142. Pingback: Buy clomid over the counter
  143. Pingback: hydroxychloroquine 200 mg tablet
  144. Pingback: clomid and low testosterone
  145. Pingback: Where Can i get Generic clomid
  146. Pingback: Generic clomid without dr prescription
  147. Pingback: dapoxetine 60mg
  148. Pingback: kamagra oral jelly
  149. Pingback: buy kamagra oral jelly

Leave a Reply

Your email address will not be published. Required fields are marked *