Lifa Disease: Frictional Dermal Melanosis over Bony Prominences (Clinicopathological Study)


Background: Lifa disease (Frictional dermal melanosis over bony prominences) has been described in Iraq for the first time in 1993, as a new distinctive pigmentary skin condition that followed chronic friction with a body washing agent (lifa) during bathing. Objective: To assess this increasingly common problem where still many doctors unaware about its presence especially in other Middle East countries. Patients and Methods: A case series descriptive study done in Departments of Dermatology-Najaf and Baghdad Teaching Hospitals, between March 2007- Oct.2008. Full history and clinical examination were done for all patients including Wood's light examination. Biopsies were taken from 21 patients and sent for hematoxylin-eosin and Congo red stains. Results: Fifty two (49 female and 3 male) patients with typical clinical features of lifa disease were studied. The mean age of presentation was 27.92 ± 7.58 years. All patients were slim with prominent bones and low body mass index, used lifa vigorously during bathing.Pigmentation was distributed bilaterally and symmetrically over bony prominences. The most common affected sites were: clavicular areas (67.3%) and upper back (42%). Wood's light and histopathological examinations revealed dermal melanosis. No amyloid deposit was detected by using Congo red stain in any patient. Conclusions: Lifa disease is a common distinctive pigmentary disfiguring problem especially among females. The histopathology showed dermal melanosis, and might be confused with other pigmentary problems like macular amyloidosis.

Share and Cite:

K. Sharquie, M. Al-Dhalimi, A. Noaimi and H. Al-Sultany, "Lifa Disease: Frictional Dermal Melanosis over Bony Prominences (Clinicopathological Study)," Journal of Cosmetics, Dermatological Sciences and Applications, Vol. 2 No. 3, 2012, pp. 196-200. doi: 10.4236/jcdsa.2012.23036.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] M. Kurita, H. Kato and K. Yoshimura, “A Therapeutic Strategy Based on Histological Assessment of Hyperpigmented Skin Lesions in Asians,” Journal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 62, No. 7, 2009, pp. 955-963.
[2] T. B. Fitzpatrick and J. P. Ortonne, “Normal Skin Color and General Considerations of Pigmentary Disorders,” In: I. M. Freedberg, A. Z. Eisen, K. Wolf, K. F. Austin, L. A. Goldsmith and S. Katz, Eds., Fitzpatrick’s Dermatology in General Medicine, 6th Edition, McGrow-Hill, New York, 2003, pp. 819-825.
[3] J. P. Ortonne and J. J. Nordlund, “Mechanisms That Cause Abnormal Skin Color,” In: J. J. Nordlund, R. E. Boissy, V. J. Hearing, R. A. King, W. S. Oetting and J. P. Ortonne, Eds., The Pigmentary System: Physiology and Pathophysiology, 2nd Edition, Blackwell Scientific Publication, New York, 2006, pp. 521-535.
[4] K. E. Sharquie, “Frictional Dermal Melanosis (Lifa Disease) over Bony Prominences,” Journal of the Faculty of Medicine, Baghdad, Vol. 35, 1993, pp. 83-87.
[5] K. E. Sharquie and M. K. Al-Dorky, “Frictional Dermal Melanosis (Lifa Disease) over Bony Prominences,” The Journal of Dermatology, Vol. 28, No. 1, 2001, pp. 12-15.
[6] M. Al-Aboosi, A. Abalkhail, O. Kasim, A. Al-Khatib, F. Qarqaz, D. Todd, et al., “Frictional Melanosis: A Clinical, Histologic, and Ultrastructural Study in Jordanian Patients,” International Journal of Dermatology, Vol. 43, No. 4, 2004, pp. 261-264. doi:10.1111/j.1365-4632.2004.01606.x
[7] M. MaGana-Garcia, G. Carrasco, R. Herreva-Goepfert and S. Pueblitz-Peredo, “Hyperpigmentation of the Clavicular Zone: A Variant of Friction Melanosis,” International Journal of Dermatology, Vol. 28, No. 2, 1989, pp. 119-122.
[8] A. Hidano, M. Mizuguchi and Y. Higaki, “Friction Melanosis,” Ann Dermatol Venereol, Vol. 111, No. 12, 1984, pp. 1063-1071.
[9] H. E. Kang, S. H. Rhee, Y. C. Kim and E. S. Lee, “Friction Melanosis and Striae Distensa Caused by Stretch Training on a Bench Press,” The Journal of Dermatology, Vol. 32, No. 9, 2005, pp. 765-766.
[10] V. G. Probhakara, S. Chandra and D. S. Krupa, “Frictional Pigmentary Dermatoses: A Clinical and Histopathological Study of 27 Cases,” Indian Journal of Dermatology, Venereology and Leprology, Vol. 63, No. 2, 1997, pp. 99-100.
[11] S. M. Hasson, “Primary Cutaneous Amyloidosis in Iraqi Patients: Epidemiological, Clinical and Histopathological Study,” Diploma Dissertation, University of Baghdad, Baghdad, 1991.
[12] T. Tan, “Epidemiology of Primary Cutaneous Amyloidosis in Southeast Asia,” Clinics in Dermatology, Vol. 8, No. 2, 1990, pp. 20-24.
[13] R. P. Sarkany, S. M. Breathnach, C. A. Setmour, K. Weismann and D. A. Burns, “Metabolic and nutritional Disorders,” In: T. Burns, S. Breathnach, N. Cox and C. Griffiths, Eds., Rook’s Text Book of Dermatology, 7th Edition, Blackwell Scientific Publication, Blackwell Scientific, Italy, 2004, pp. 57.36-57.50.
[14] M. M. Black and E. W. Jones, “Macular Amyloidosis: A Study of 21 Cases with Special Reference to the Role of the Epidermis in Its Histogenesis,” British Journal of Dermatology, Vol. 84, No. 3, 1971, pp. 199-209. doi:10.1111/j.1365-2133.1971.tb14208.x
[15] C. K. Wong and C. S. Lin, “Friction Amyloidosis,” International Journal of Dermatology, Vol. 27, No. 5, 1988, pp. 302-307. doi:10.1111/j.1365-4362.1988.tb02357.x

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.