Dermatology: Practical and Conceptual


Dermatology Practical & Conceptual

Image Letter  |  Dermatol Pract Concept. 2021; 11(3): e2021041. 1

The Atomizer Sign: A Diagnostic Clue to Fragrance 
Allergic Contact Dermatitis

Eduardo Rozas-Muñoz1, Jaime Piquero-Casals2, Juan-Francisco Mir-Bonafé3

1 Department of Dermatology, Hospital San Pablo, Coquimbo, Chile

2 Department of Dermatology, Clínica dermatológica multidisciplinar Dermik, Barcelona 

3 Department of Dermatology, Hospital Son Llàtzer, Palma de Mallorca, Spain 

Key words: Allergic contact dermatitis, fragrances, neck

Citation: Rozas-Muñoz E, Piquero-Casals J, Mir-Bonafé JF. The atomizer sign: a diagnostic clue to fragrance allergic contact dermatitis. 
Dermatol Pract Concept. 2021; 11(3): e2021041. DOI: https://doi.org/10.5826/dpc.1103a41

Accepted: November 12, 2020; Published: July 8, 2021

Copyright: ©2021 Rozas-Muñoz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 
License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original 
authors and source are credited

Funding: None

Competing interests: None

Authorship: All authors have contributed significantly to this publication

Corresponding author: Eduardo Rozas-Muñoz, MD. Department of Dermatology, Hospital San Pablo, Avenida Videla S/N, 1780000 
-Coquimbo. Chile. EMail: docrozas@yahoo.com

Case Report

A 63-year-old man presented with pruritic and well-defined 

erythematous and vesicular eczematous plaques involving 

the anterior aspect of the neck and chest, present for the last 

3 months (Figure 1). The rest of the physical examination 

was unremarkable, and there was no past or family history 

of seborrhea or psoriasis. The patient was treated with top-

ical corticosteroids showing some improvements, but with 

frequent relapses. Patch test with Thin-Layer Rapid Use 

(T.R.U.E.) Epicutaneous Patch Test™ revealed a positive 

(+++) reaction to fragrance mix I. The patient was therefore 

instructed to avoid fragrance-containing products showing 

complete improvement of his dermatitis.

Teaching Point

The presence of an eczematous dermatitis on the anterior 

neck in the Adam’s apple region has been referred to as the 

atomizer sign, being a common area of application of aerosol 
Figure 1. Eczematous plaques involving the anterior aspect of the 

neck (Adam’s apple region) and “V” of the anterior chest.



2 Image Letter  |  Dermatol Pract Concept. 2021; 11(3): e2021041.

perfumes or cologne [1]. Patients with this peculiar presen-

tation should be patch tested to rule-out any allergic contact 

dermatitis to fragrances. 

References:

1. Sharon E Jacob, Mari Paz Castanedo-Tardan. A diagnostic pearl 

in allergic contact dermatitis to fragrances: the atomizer sign. 

Cutis. 2008;82(5):317-318. PMID: 19090333.