bubble_chart Overview

Female facial melanosis is also known as Pigmented Cosmetic Dermatitis. This condition was first identified in Japan and named by Japanese scholar Nakayama Hideo as Pigmented Cosmetic Dermatitis. In recent years, as the use of cosmetics among women in China has increased year by year, the incidence of cosmetic dermatitis has also risen. The clinical features include diffuse or patchy light brown, grayish-brown to purplish-brown pigmentation on the cheeks, temples, and forehead of women, with severe cases extending to the entire face, accompanied by cutaneous pruritus.

bubble_chart Etiology

A history of long-term use of crude cosmetics has revealed that certain ingredients such as fragrances, preservatives, and surfactants in cosmetics can cause photosensitive dermatitis, leading to skin pigmentation due to melanin metabolism disorders. Additionally, variations in the manufacturing process of cosmetics are closely related to the occurrence of cosmetic dermatitis. Exposure to ultraviolet rays, wind, and dry or humid air can all serve as contributing factors to the onset of the condition.

bubble_chart Clinical Manifestations

The main areas affected by pigmentation are the facial makeup regions, initially starting at the malar and temporal areas and gradually spreading to the forehead, cheeks, preauricular, and postauricular regions. In very rare cases, it may involve the neck, upper chest, and arms. The central part of the face is less affected, and the perioral, chin, and mucous membranes remain unaffected.

The pigmentation has clear borders, appearing light brown or gray-brown, and in severe cases, reddish-brown or purplish-brown. Early symptoms include cutaneous pruritus, a burning sensation, or a crawling feeling. After some time, dermatitis develops, with the affected skin becoming hot, erythematous, and swollen. Dense small papules may be faintly visible on the erythematous base. However, discontinuing makeup can lead to the resolution of dermatitis without scarring or with bran-like desquamation. In severe cases, erythema, maculopapules, or papules may appear on the face or other makeup-covered areas, with the erythema rapidly expanding to cover the entire makeup region. Small blisters, localized skin erosion, serous exudation, and pain may also occur.

After the aforementioned dermatitis gradually subsides, pigmentation appears. Initially, it forms a reticulated pattern of pigmented spots around the pores, which later merge into patches of uniform light brown, gray-brown, or purplish-brown appearance. Exposure to sunlight worsens the condition, which stabilizes after reaching a certain degree. The face may be covered with fine powdery scales, accompanied by telangiectasia and follicular keratosis. Over several years, some cases may progress to atrophic skin depression consistent with the pigmented areas.

bubble_chart Diagnosis

The history of cosmetics use and clinical manifestations aid in diagnosis. Laboratory tests show low immunoglobulin E levels. Patch testing and facial patch testing are helpful for diagnosis and also serve as important therapeutic measures.

bubble_chart Treatment Measures

The treatment method is simple. First, stop using cosmetics. For cutaneous pruritus-type dermatitis pigmentation, patch tests are conducted to identify the disease cause, pinpointing a specific allergen in the cosmetic materials. For occupational actor-related cosmetic dermatitis, the cause must be identified and replaced with substances that have the same effect but different structures or purity. Patch tests (including on the face and forearm) are repeated until no allergy occurs. Anti-allergy treatment can also be administered, such as high-dose oral vitamin C or intramuscular and intravenous vitamin C injections.

bubble_chart Differentiation

It should be differentiated from the following diseases:

1. **Melasma**: The face exhibits butterfly-shaped, light yellowish-brown patches, often with a spectacle-like outline. Melasma worsens with sun exposure, whereas the pigmentation around the eyes is more pronounced in this disease.
2. **Riehl's melanosis**: The pigmentation is deeper at the peripheral areas of the face, while the central part is lighter or unaffected. In some cases, pigmentation also appears in the armpits, navel, and other areas, with no history of cosmetic use. In contrast, this morbid complexion shows prominent pigmentation around the eyes, nose, cheeks, and forehead, with a history of cosmetic use.
3. **Civatte poikiloderma**: This is a disease of unknown cause, characterized by brown or reddish-brown reticulated pigmentation on the face and neck, interspersed with punctate skin atrophy or small white spots. It is difficult to distinguish from cosmetic dermatitis, but differentiation can be made based on the history of cosmetic use, the characteristics of pigmentation in cosmetic dermatitis, dermatitis, and cutaneous pruritus. More importantly, patch testing with cosmetic materials aids in diagnosis.