The diagnosis of skin diseases relies on several clinical signs, among which color is of paramount importance. In this review, we consider certain clinical presentations of both eczematous and noneczematous contact dermatitis in which color plays a peculiar role orientating toward the right diagnosis. The conditions that will be discussed include specific clinical-morphologic subtypes of eczematous contact dermatitis, primary melanocytic, and nonmelanocytic contact hyperchromia, black dermographism, contact chemical leukoderma, and others. Based on the physical, chemical, and biologic factors underlying a healthy skin color, the various skin shades drawing a disease picture are thoroughly debated, stressing their etiopathogenic origins and histopathologic aspects.
Get full access to this article
View all access options for this article.
References
1.
FitzpatrickTB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol, 1988; 124: 869–871.
2.
FitzpatrickTB, BernhardJD, CropleyTG. The structure of skin lesions and fundamentals of diagnosis. In: FreedbergIM, EisenAZ, WolffK, et al., eds. Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999: 13–41.
3.
OrtonneJP. La couleur de la peau humaine: de la recherche à l’esthétique. Ann Dermatol Venereol, 2009; 136 (Suppl 6): 5252–5256.
4.
CoxNH, CoulsonIH. Diagnosis of skin disease. In: BurnsT, BreathnachS, CoxN, et al. eds. Rook’s Textbook of Dermatology. 8th ed. Oxford, United Kingdom: Wiley-Blackwell; 2010: 5.1–5.26.
5.
AnsteyAV.Disorders of skin colour. In: BurnsT, BreathnachS, CoxN, et al. eds. Rook’s Textbook of Dermatology. 8th ed. Oxford, United Kingdom: Wiley-Blackwell; 2010: 58.1–58.59.
BruynzeelDP, van den HoogenbandHM, KoedijkF. Purpuric vasculitis-like eruption in a patient sensitive to balsam of Peru. Contact Dermatitis, 1984; 11: 207–209.
24.
BuckleyWR. Lichenoid eruptions following contact dermatitis. AMA Arch Derm, 1958; 78: 454–457.
25.
CanizaresO. Lichen planus-like eruption caused by color developer. AMA Arch Derm, 1959; 80: 81–86.
26.
HymanAB, BergerRA. Lichenoid eruption due to colour developer. Arch Dermatol, 1959; 80: 243–244.
27.
MandelEH. Lichen planus-like eruptions caused by a color-film developer. Arch Dermatol, 1960; 81: 68–71.
LemboG, BalatoN, PatrunoC, et al.Lichenoid contact dermatitis due to aminoglycoside antibiotics. Contact Dermatitis, 1987; 17: 122–123.
36.
BrancaccioRR, CockerellCJ, BelsitoD, et al.Allergic contact dermatitis from color film developers: clinical and histologic features. J Am Acad Dermatol, 1993; 28: 827–830.
37.
SidiE, HinckyM, GervaisA. Allergic sensitization and photosensitization to phenergan cream. J Invest Dermatol, 1955; 24: 345–352.
SatanoveA. Pigmentation due to phenothiazines in high and prolonged dosage. JAMA, 1965; 191: 263–268.
42.
HaddadRI. Blue skin pigmentation and chlorpromazine. J Ky Med Assoc, 1977; 75: 124–126.
43.
ZelicksonAS. Skin pigmentation and chlorpromazine. JAMA, 1965; 194: 670–672.
44.
HashimotoK, WienerW, AlbertJ, et al.An electron microscopic study of chlorpromazine pigmentation. J Invest Dermatol, 1966; 47: 296–306.
45.
MosherDB, FitzpatrickTB, OrtonneJP, et al. Hypomelanoses and hypermelanoses. In: FreedbergIM, EisenAZ, WolffK, et al. eds. Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999: 945–1017.
46.
BonamonteD, AngeliniG. Disordini pigmentari da contatto. Ann Ital Dermatol Allergol, 2001; 55: 1–15.
47.
BonamonteD, FotiC, AngeliniG. Hyperpigmentation and contact dermatitis due to Juglans regia. Contact Dermatitis, 2001; 44: 101–102.
GellinGA, MaibachHI, MisiaszekMH, et al.Detection of environmental depigmenting substances. Contact Dermatitis, 1979; 5: 201–213.
59.
FisherAA. Differential diagnosis of contact leukoderma and idiopathic vitiligo. Part I. Cutis, 1994; 53: 158.
60.
FisherAA. Differential diagnosis of contact leukoderma and idiopathic vitiligo. Part III: occupational leukoderma. Cutis, 1994; 53: 278–280.
61.
MaltenKE, SeutterE, HaraI, et al.Occupational vitiligo due to paratertiary butylphenol and homologues. Trans St Johns Hosp Dermatol Soc, 1971; 57: 115–134.
62.
TaylorJS, MaibachHI, FisherA, et al.Contact leukoderma associated with the use of hair colors. Cutis, 1993; 52: 273–280.
63.
KwokC, WilkinsonM, SommerS. A rare case of acquired leukoderma following patch testing with an acrylate series. Contact Dermatitis, 2011; 64: 292–294.
64.
CrépyMN, Bensefa-ColasL, KriefP, et al.Facial leucoderma following eczema: a new case induced by spectacle frames. Contact Dermatitis, 2011; 65: 243–245.
65.
GhoshS, MukhopadhyayS. Chemical leucoderma: a clinico-aetiological study of 864 cases in the perspective of a developing country. Br J Dermatol, 2009; 160: 40–47.
66.
BoissyRE, MangaP. On the etiology of contact/occupational vitiligo. Pigment Cell Res, 2004; 17: 208–214.
67.
YangF, BoissyRE. Effects of 4-tertiary butylphenol on the tyrosinase activity in human melanocytes. Pigment Cell Res, 1999; 12: 237–245.
68.
YangF, SarangarajanR, Le PooleIC, et al.The cytotoxicity and apoptosis induced by 4-tertiary butylphenol in human melanocytes are independent of tyrosinase activity. J Invest Dermatol, 2000; 114: 157–164.
69.
PicardoM, PassiS, Nazzaro-PorroM, et al.Mechanism of antitumoral activity of catechols in culture. Biochem Pharmacol, 1987; 36: 417–425.
70.
MangaP, SarangarajanR, RamnathE, et al.4-(tert)butylphenol cytotoxicity is mediated by tyrosinase related protein-1. Mol Biol Cell, 2002; 13S: 306a.
71.
Le PooleIC, YangF, BrownTL, et al.Altered gene expression in melanocytes exposed to 4-tertiary butyl phenol (4-TBP): upregulation of the A2b adenosine receptor 1. J Invest Dermatol, 1999; 113: 725–731.
72.
CummingsMP, NordlundJJ. Chemical leukoderma: fact or fancy. Am J Contact Dermatitis, 1996; 6: 126–127.
73.
GellinGA. Chemical leucoderma. Am J Contact Dermatitis, 1996; 6: 126–127.
74.
MeneghiniCL, AngeliniG. Hypopigmentation following acute contact dermatitis from a match-box. Contact Dermatitis, 1975; 1: 55.
75.
UrbachE, PillsburyDM. The phenomenon of black dermographism. JAMA, 1943; 121: 485.
76.
HurleyHJ. Black dermographism. Arch Dermatol, 1960; 81: 329–332.
77.
FisherAA. What causes gold smudge?. Jewelers Circular-Keystone, 1971; 141: 64.
78.
FisherAA. Black dermographism. A physical phenomenon. Cutis, 1974; 13: 187–189.
79.
RapsonWS. Skin contact with gold and gold alloys. Contact Dermatitis, 1985; 15: 56–65.
80.
MallorySB, MillerOF, TylerWB. Toxicodendron radicans dermatitis with black lacquer deposit on the skin. J Am Acad Dermatol, 1982; 6: 363–368.
BurgeKM, WinkelmannRK. Mercury pigmentation. An electron microscopic study. Arch Dermatol, 1970; 102: 51–61.
86.
KennedyC, MollandEA, HendersonWJ, et al.Mercury pigmentation from industrial exposure. An ultrastructural and analytical electron microscopic study. Br J Dermatol, 1977; 96: 367–374.
87.
VierkötterA, SchikowskiT, RanftU, et al.Airborne particle exposure and extrinsic skin aging. J Invest Dermatol, 2010; 130: 2719–2726.
88.
BuckleyWR, WestW. Persistent dye staining of the skin. Arch Dermatol, 1970; 102: 71–77.
