Riehl's melanosis-like eruption associated with Sjögren's syndrome

A 58-year-old Japanese female complained of facial erythema and Riehl's melanosis-like pigmentation. Histological examination showed liquefaction degeneration of the basal cells and pigment incontinence. Direct immunofluorescence revealed no deposition of immunoglobulins or complements at the basement membrane zone. Patch test and photopatch test using cosmetics and detergents she had been using were negative. She was diagnosed with Sjögren's syndrome based upon dryness of the mouth, dense periductal infiltration of lymphocytes and plasma cells in the labial salivary gland, positive Shirmer's test, hyper-gamma-globulinemia, positive antinuclear antibody, and positive anti-SSA (Ro) antibody. The pigmentation gradually faded away when she protected her face from ultraviolet irradiation while continuing use of the cosmetics and detergents. Riehl's melanosis-like eruption could be a cutaneous manifestation of Sjögren's syndrome closely related with anti-SSA (Ro) antibody.