Erythrose Péribuccale Pigmentaire of Brocq
Erythrose péribuccale pigmentaire of Brocq (pigmented perioral erythema), first described by the French dermatologist Louis-Anne-Jean Brocq in 1923, is a rare chronic disorder of both pigment and blood vessels. It produces symmetric copper-brown, red-brown or gray-brown patches on the chin, around the mouth and along the nasolabial folds, but always spares a narrow 1–2 mm band of normal skin right next to the lip border (vermilion border).
Histologically, the condition combines chronic dilation of superficial small vessels (erythema) with secondary overproduction of melanin in the epidermis and upper dermis (hyperpigmentation). It tends to develop in people with sensitive skin, a background of seborrheic dermatitis or rosacea, or long-term sun exposure, and in those who use fragranced cosmetics or harsh cleansers or overuse topical corticosteroids on the face.
At Haute-Derma, we treat Brocq's perioral pigmentation with a parallel dual approach: first restoring the skin barrier, then clearing the dilated microvessels and excess pigment with BroadBand Light (BBL) combined with low-fluence 1064 nm picosecond laser, to even out the skin around the mouth safely.
Pathogenesis and Cellular Mechanisms
The disease arises from several interlinked layers of blood vessel dysfunction and melanin production:
- Superficial Microvascular Dilation and Chronic Low-Grade Inflammation: External irritants (UV light, heat, cosmetic chemicals, toothpaste containing fluoride, or steroids) cause chronic dilation of the superficial capillaries on the chin and around the mouth. This leads to mild leakage from the vessels and release of inflammatory cytokines (IL-1α, TNF-α).
- Post-Inflammatory Melanogenesis: Ongoing inflammatory cytokines and persistent vasodilation stimulate basal melanocytes to produce more melanin. Melanosomes build up in keratinocytes, and some drop through a damaged basement membrane into the upper dermis, giving the typical copper-brown or gray-brown tone.
- Barrier Dysfunction and Photosensitivity: Damage to the ceramide barrier around the mouth lets irritants and microbes penetrate more easily and makes this skin more sensitive to ultraviolet (UV) radiation, setting up a self-perpetuating chronic cycle.
Differential Diagnosis of Perioral Pigmentation and Redness
| Feature | Erythrose Péribuccale of Brocq | Perioral Dermatitis (POD) |
|---|---|---|
| Appearance | Smooth copper-brown / red-brown erythematous patches | Small pustules and red papules on a red background |
| Lip border (vermilion margin) | Always spares a 1–2 mm rim of normal skin around the lips | Spares a narrow rim of normal skin around the lips |
| Presenting symptoms | Mild stinging, burning in the sun | Marked itching, burning and tightness |
| Vascular component | Obvious microvascular dilation on dermoscopy | Superficial vasodilation with inflammatory papules |
| Response to laser / BBL | Responds very well to combined vascular + pigment treatment | Laser is contraindicated in the acute phase |
Examination, Dermoscopy and Medical Screening at Haute-Derma
- Identifying Triggers and Reviewing Medication History
- We ask about any use of topical steroids, including hydrocortisone cream and mixed "whitening" creams.
- We check the toothpaste (possible fluoride/SLS sensitivity), mouthwash, lipstick and any skincare products with high concentrations of AHA, BHA or retinoids.
- Detailed Perioral Dermoscopy: Dermoscopic features of Brocq: a uniform pinkish-brown background, a network of fine dotted or linear telangiectasias, and light brown pigment granules arranged in a pseudo-network around the follicular openings.
- Measuring Transepidermal Water Loss (TEWL) and Melanin Depth: An advanced skin analyzer estimates how much melanin sits in the epidermis versus the dermis and measures how impaired the skin barrier is, so we can plan barrier repair before any laser treatment.
Treatment Protocol at Haute-Derma
Our treatment strategy at Haute-Derma has three stages:
- Barrier Repair and Calming Low-Grade Inflammation
- Stop all steroid-containing products, AHAs/BHAs, retinoids and makeup around the mouth.
- Switch to a toothpaste free of fluoride and sodium lauryl sulfate (SLS).
- Topical prescription: a calcineurin inhibitor (tacrolimus 0.03%) plus a repair cream with ceramides, cholesterol, free fatty acids and 2% niacinamide for 2–3 weeks to rebuild the barrier.
- Dual Therapy: Vascular BBL and Low-Fluence 1064 nm Picosecond Laser
- Step 1 – Clearing dilated vessels with BBL (BroadBand Light): 560–590 nm filters target hemoglobin in the dilated microvessels, shrinking them and reducing the redness.
- Step 2 – Breaking up melanin with 1064 nm picosecond laser: Immediately after BBL, picosecond toning (1064 nm, 7–8 mm spot, 0.7–0.9 J/cm²) shatters melanin in the epidermis and upper dermis without excess heat build-up.
- Course: 4–6 sessions, spaced 3–4 weeks apart.
- Maintenance and Relapse Prevention
- Use a broad-spectrum, mineral-only sunscreen (15–20% zinc oxide) formulated for sensitive skin.
- Continue a gentle pigment inhibitor such as azelaic acid 10–15% or tranexamic acid 3%.
