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Year : 1995  |  Volume : 61  |  Issue : 3  |  Page : 145-147

Nylon friction dermatitis: A distinct subset of macular amyloidosis

Correspondence Address:
V K Somani

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Source of Support: None, Conflict of Interest: None

PMID: 20952929

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43 patients were taken up for the study, all of whom were asymptomatic and presented with bluish black pigmentation. 23 patients presented with pigmentation which was proximal and distal to the bony prominences, all of whom gave a history of using nylon scrubbers during bathing. 20 patients gave no history of friction and the pigmentation was present on the extensor forearms, shins and upper back. Histopathological examination confirmed amyloid deposits.

Keywords: Macular amyloidosis, Nylon friction

How to cite this article:
Somani V K, Shailaja H, Sita V, Razvi F. Nylon friction dermatitis: A distinct subset of macular amyloidosis. Indian J Dermatol Venereol Leprol 1995;61:145-7

How to cite this URL:
Somani V K, Shailaja H, Sita V, Razvi F. Nylon friction dermatitis: A distinct subset of macular amyloidosis. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2020 Jan 27];61:145-7. Available from: http://www.ijdvl.com/text.asp?1995/61/3/145/4182

  Introduction Top

Primary cutaneous amyloidosis consists of deposition of amyloid in previously normal skin, with no evidence of deposits occurring in internal organs. Various clinical types are recognised. Macular and papular forms are the commoner presentations. Macular amyloidosis presents as clusters of small pigmented macules 2-3 mm in diameter, which may coalesce to produce macular hyperpigmented areas. The lesions are seen over the extensor aspect of the extremities and back. A reticulate or rippled pattern is a characteristic diagnostic feature. The cases usually present in early adult life with female preponderance.

There have been recent reports of macular amyloidosis which has been reported to follow prolonged chronic friction such as the use of nylon brush.[1][2][3]

  Materials and Methods Top

43 patients presenting with asymptomatic hyperpigmented macules and patches and clinically diagnosed as macular amyloidosis were taken up for the study. A detailed history was taken regarding the use of cosmetics, bathing habits and occupation. The patients were divided into two groups, depending upon the absence or presence of friction from nylon scrubbers used during bathing.

Punch biopsies were taken from the hyperpigmented areas in all the 43 cases and histopathological examination was done using H & E and special stains for amyloid.

  Results Top

Of the 43 patients included in the study, 23 gave a history of using nylon scrubbers during bathing. These patients were in 17-22 years age group. 20 patients gave no history of friction and were in 25-30 years age group. There was a female preponderance in both the groups [Table - 1].

The sites of involvement varied in both the groups. The bluish hyperpigmented macules and patches in cases with a history of friction were seen on the sternal end of the clavicles, vertebral processes, proximal and distal to the ulnar styloid process, besides the extensor forearms and lateral legs. In the nonfriction group the lesions were seen on the extensor forearms, exposed upper back and shins. There was complete absence of itching in all the cases. The mean duration of the presence of these lesions was 1 year [Table - 2].

Histopathological examination revealed deposits in the papillary dermis by H & E stains, which proved to be amyloid deposits after special stains besides pigmentary incontinence.

  Discussion Top

Nylon brush dermatosis or nylon towel dermatosis was first reported from Japan.[1] Later as the aetiology and clinical features became more defined reports came in from different parts of the world. Sumitra and Yesudian[1] published a study which probed the role of friction in causing amyloidosis cutis which to the best of our knowledge is the first report from India.

Our study, taken up over two years, was designed to understand the cause, symptomatology and morphology of macular amyloidosis in the local population, where the practice of using nylon scrubbers during bathing, is prevalent especially among females. In the process, two clear groups emerged those who used nylon scrubbers during bathing and those who did not. Both groups reported complete absence of itching. Females accounted for almost all our case population, which is again at variance with earlier reports.[1],[5]

The bluish black pigmentation, the most striking feature in the friction group was seen over the medial ends of the clavicles and proximal and distal to the ulnar styloid process. The patches which are suggestive of Friction Macular Amyloidosis are seen typically near the bony prominence, but not on it, as the elastic skin moves at the time of scrubbing and the maximum impact of the frictional damage is borne by the skin proximal and distal to the prominence during the to and fro motion of scrubbing.

In the non-friction group there was not a single case showing involvement of the bony prominences. There were two instances where sisters had similar involvement, showing a familial tendency. In addition, the limitation of the lesions on the upper back and extensor aspect of the forearms which are exposed to the sunlight could point to sunlight as one of the contributory factors in the non-friction amyloidosis besides racial and familial factors. Cosmetics and soaps could not be implicated despite a detailed history.

We feel that the picture presented in frictional macular amyloidosis is distinct enough to merit a sub-classification in macular amyloidosis.

A partial response was obtained by using a combination of potent steroids, salicylic acid and bleaching agents. Prevention and patient education remain the only options available to minimise frictional macular amyloidosis.

  References Top

1.Sumitra S, Yesudian P. Friction amyloidosis: A variant or an etiologic factor in amyloidosis cutis. Int J Dermatol 1993;32:422-3.  Back to cited text no. 1    
2.Iwasaki K, Mihara M, Nishiura S, Shimaos. Biphasic amyloidosis arising from friction melanosis. Dermatol 1991;18:86-91.  Back to cited text no. 2    
3.Wong CK, Lin CS. Friction amyloidosis. Int J Dermatol 1988;27:302-7.  Back to cited text no. 3  [PUBMED]  
4.Hashimoto K, Ito K, Kumakiri M, Headington J. Nylon brush macular amyloidosis. Arch Dermatol 1987;123:633-7.  Back to cited text no. 4  [PUBMED]  
5.MM Black. Amyloid and the amyloidosis of the skin. In: Textbook of Dermatology (Champion RH, Burton JL, Ebling FJG, eds). 5th edn. Oxford: Blackwell Scientic Publications, 1992:2333-44.  Back to cited text no. 5    


[Table - 1], [Table - 2]

This article has been cited by
1 Macular amyloidosis: Etiological factors
Eswaramoorthy, V., Kaur, I., Das, A., Kumar, B.
Journal of Dermatology. 1999; 26(5): 305-310


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