Contact sensitization to hair colours in acquired dermal macular hyperpigmentation: results from a patch and photo‐patch test study of 108 patients

Abstract

Background Acquired dermal macular hyperpigmentation (ADMH) is an umbrella term including lichen planus pigmentosus, erythema dyschromicum perstans and pigmented contact/cosmetic dermatitis. Objective To establish contact sensitization to hair colours as an aetiological factor for ADMH. Methods Detailed clinical examination, skin biopsies, and patch and photo‐patch testing with Indian standard series and patient's own cosmetic products were performed. Results Thirty‐nine (36.1%) patients were found to demonstrate a positive patch/photo‐patch test with 35/39 reacting to their own products (all were hair colours) and 16/39 reacting to antigens from commercial series (commonly paraphenylenediamine). Fourteen patients developed delayed hyperpigmentation on positive patch‐test sites at 1 month. Higher mean age, symptomatic pigmentation (pruritus, burning and photosensitivity), hair margins involvement (outer surface, helix and lobule of ear; temples and preauricular area), ill‐defined lesions, epidermal atrophy and epidermal melanization extending >3 layers were significantly common in patch‐test‐positive patients. Well‐defined lesions, perioral involvement and associated lichen planus were clinical pointers towards patch‐test negativity. Conclusion Index study exemplifies that patch‐test results have distinct clinical and histopathological correlates in ADMH. Hair dye contact sensitization appears to be an important aetiological factor in about one‐third patients presenting with ADMH.

Face and neck pigmentary alterations in hair dye users: A cross-sectional study from South India

“…Oral or cutaneous lichen planus was significantly higher in the patients without positive patch test results. [ 6 ] However, associated classical papular cutaneous or oral lichen planus was not seen in any patient in our study. We could patch test only a limited number of patients in our study.…”

“…[ 1 2 ] Hair dyes have been implicated in some reports of facial pigmented contact dermatitis, lichen planus pigmentosus, acquired dermal macular hyperpigmentation, and depigmentation. [ 3 4 5 6 7 ] However, there is a paucity of studies on the pigmentary alterations on the face and neck in hair dye users. Hence our objective was to study the pigmentary alterations on the face and neck in hair dye users and identify possible risk factors associated with the face and neck hyperpigmentation.…”

Exaggerated epidermal pigmentation in acquired dermal macular hyperpigmentation: an important finding

“…demonstrating Fontana–Masson staining of epidermal melanin granules in a patient with lichen planus pigmentosus inversus . As authors of two large series on acquired dermal macular hyperpigmentation (ADMH), in both of which we reported the presence of epidermal melanization extending to epidermal layers beyond the basal layer, we suggest that this finding has important pathogenetic and therapeutic implications . Nakazato and Anan also point out that exaggerated epidermal pigmentation is usually a feature of other hyperpigmentary disorders such as melasma and seborrhoeic keratosis .…”

“…ADMH classically involves patients of darker skin colour, and the increased epidermal pigmentation could represent an exaggerated healing response in darker skin phototypes, akin to postinflammatory pigmentation. In our previous study, patients with ADMH having positive patch‐test results to various allergens had epidermal pigmentation (extending beyond three epidermal layers) and severe dermal inflammation (but not band‐like) significantly more often than those having negative patch tests …”

Acquired Dermal Macular Hyperpigmentation

“…There is a significant degree of clinico-pathological and dermoscopic overlap amongst disorders group under ADMH. [ 1 7 17 ] The group overall represents a lichenoid tissue reaction pattern in response to chronic subclinical injury; and represents a distinctive pattern of diseases, which are expressive of the same pathologic process with a similar histopathologic pattern, but with different, as yet unknown, etiologies. [ 1 7 17 ]…”