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Year : 1997  |  Volume : 63  |  Issue : 2  |  Page : 99-100

Frictional pigmentary dermatoses : a clinical and histopathological study of 27 cases

VG Prabhakara, Suresh Chandra, DS Shankar Krupa 
 

Correspondence Address:
V G Prabhakara


Abstract

Twenty seven patients presenting with the complaint of pigmentary changes following friction were studied. Sixteen patients showed only pigmentary changes and 11 patients showed the presence of amyloid.



How to cite this article:
Prabhakara V G, Chandra S, Krupa DS. Frictional pigmentary dermatoses : a clinical and histopathological study of 27 cases.Indian J Dermatol Venereol Leprol 1997;63:99-100


How to cite this URL:
Prabhakara V G, Chandra S, Krupa DS. Frictional pigmentary dermatoses : a clinical and histopathological study of 27 cases. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2019 Jul 20 ];63:99-100
Available from: http://www.ijdvl.com/text.asp?1997/63/2/99/4528


Full Text

 Introduction



Pigmentary change is a common presenting complaint in daily practice. Some of the patients present with pigmentary changes following friction, commonly over the upper limbs, trunk and the legs. It is usually difficult to make accurate diagnosis clinically. Hence, this study was conducted to elucidate accurate diagnosis and to differentiate between confusing terminologies like frictional melanosis, frictional amyloidosis, idiopathic amyloidosis and macular pigmentation due to other causes.

 Materials and Methods



Twenty seven patients presenting with the complaint of pigmentary changes following friction were studied. No other selection criteria were used. Complete relevant history was taken and all the patients were thoroughly examined. All of them underwent routine blood, urine and stool examinations. Histopathological examination of a haematoxylin and eosin stained section and another section stained with Congo red was carried out on all patients.

 Results



[Table:1]shows characteristics of the patients included in the study. There was no correlation between the development of either pigmentation or amyloid to the material used for applying friction. However, there was direct correlation between the duration of friction and the development of pigmentation/ amyloid. Males were affected more.

All patients had multiple, irregular, ill-defined, pigmented, non-scaly, macular patches over the clavicles, thyroid cartilage, acromion, vertebral spines, scapular and suprascapular areas, elbow and epicondyles, ulnar styloid, and ulnar aspect of the forearms. In a few patients lateral aspect of distal l/3rd of the thigh was involved.

Histopathology showed mild hyperkeratosis, acanthosis and increase in the melanin in the basal and suprabasal cells. Incontinence of the melanin pigment, melanophages and perivascular lymphohistiocytic infiltrate were found commonly in the upper dermis. Special staining for amyloid using Congo red showed the presence of amyloid in 11 patients.

 Discussion



Frictional melanosis and frictional amyloidosis have been observed earlier.[1][3] Hidano et al have claimed that frictional melanosis is unique and should be differentiated from pigmentary disorder and macular amyloidosis.[2] In 1991, Iwasaki et al reported a case of biphasic amyloidosis arising from frictional melanosis.[4]

Our main idea for conducting the study was to avoid confusion while differentiating frictional melanosis, frictional amyloid, idiopathic amyloidosis and other causes of pigmentation. Our appreach towards this goal is given is [Table:2] If a patient with only pigmentary changes and no amyloid at the time of presentation subsequently shows the presence of amyloid, his place in the classification changes accordingly. Our observation is that if the friction is stopped completely, frictional melanosis tends to disappear over a period of 3-5 years, whereas frictional amyloidosis is less likely to do so. We hope our readers will find our approach interesting[Figure 1][Figure 2].

References

1Hata S, Tanigaki T, Misaki K, et al. Incidence of frictional melanosis in young Japanese women induced by using nylon towels and brushes. J Dermatol 1987;14:437-9.
2Hidano A, Mizuguchi M, Higaki Y, et al. Friction melanosis. Ann Dermatol Venereol 1984;111:1063-71.
3Chu-Kwan-Wang, Chrang-Shi Lin. Friction amyloidosis. Int J Dermatol 1988;27:302-7.
4Iwasaki K, Mihara M, Nishiura S, et al. Biphasic amyloidosis arising from friction melanosis. J Dermatol 1991;18:86-91.

 

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