Frictional Melanosis of Rubbing Thighs in Iraqi Patients


Background: Frictional melanosis of rubbing inner thighs is a common problem among Iraqi females causing great psychological and cosmetic impact. It might simulate lifa disease but it is a different entity. It is unfortunately not reported in the medical literatures although commonly encountered in daily clinical practice. Objective: To evaluate the hyperpigmentation of inner aspects of thighs in Iraqi females as an isolated pigmentary problem. Patient and Methods: Sixty patients with frictional melanosis of rubbing thighs were seen in Department of Dermatology, Baghdad Teaching Hospital in this case descriptive, clinical and histopathological study, during the period from April 2011 to March 2012. Any associated skin problems were also noticed like folliculitis and boils at area of friction. Forty individuals were enrolled in the present work as the healthy control group. The pigmentation was assessed by clinical, Wood’s light and histopathological examinations (H&E and Fontana stains). Body mass index was obtained for all patients and obesity was graded according to WHO recommendations. Results: The ages of patients ranged between 19 - 52 (32.86 ± 7.65) years, with 59 (98.3%) females and 1 (1.6%) male. By Wood’s light examination, accentuation in pigmentation was observed in 39 (58%) patients, while 21 (42%) of lesions showed no change. Body mass index was ranged from 23.3 - 43.6 (34.04 ± 4.13), history of vigorous rubbing of pigmented area with washing tool (lifa) was positive in 46 (76.6%) patients. Skin biopsies in 10 patients showed pure dermal melanophages in 3 of biopsies with slight melanosis of basal layer of epidermis, while the other 7 biopsies showed mainly increase in basal melanin. There was a statistically significant association between obesity and the severity of pigmentation of the inner thighs. Forty control individuals (2 males and 38 females) were assessed, their ages ranged from 19 - 50 (31.72 ± 6.40) years. All females were within normal weight while males were overweight and BMI was ranged from 19.7 - 28.2 (22.49 ± 1.84). All control individuals showed no pigmentation of inner aspects of thighs. Conclusion: Frictional melanosis of rubbing thighs is considered a new entity which had been not reported before in the medical literatures. This is a disease of mostly young obese females and the effective therapy is weight reduction and possibly liposuction.

Share and Cite:

Sharquie, K. , Noaimi, A. and Hajji, A. (2014) Frictional Melanosis of Rubbing Thighs in Iraqi Patients. Journal of Cosmetics, Dermatological Sciences and Applications, 4, 203-211. doi: 10.4236/jcdsa.2014.43028.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Ruiz-Maldonado, R. and Orozco-Covarrubias, L. (2008) Metabolic and Systemic Diseases. In: Bolognia, J., Jorizzo, J. and Rapini, R.P., Eds., Dermatology, 2nd Edition, Elsevier, Spain, 672.
[2] Sharquie, K.E. (1993) Frictional Dermal Melanosis (Lifa Disease) over Bony Prominences. Journal of the Faculty Medicine (Baghdad), 35, 83-87.
[3] Al-Aboosi, M., Abalkhail, A., Kasim, O., Al-Khatib, A., Qarqaz, F. and Todd, D. (2004) Frictional Melanosis: A Clinical, Histologic, and Ultrastructural Study in Jordanian Patients. International Society of Dermatology, 43, 261-264.
[4] Sharquie, K.E. and Al-Dorky, M.K. (2001) Frictional Dermal Melanosis (Lifa Disease) over Bony Prominences. Journal of Dermatology, 28, 12-15.
[5] Wong, C.K. (1987) Cutaneous Amyloidosis. International Journal of Dermatology, 26, 273-277.
[6] Looi, L.M. (1991) Primary Localized Cutaneous Amyloidosis in Malaysians. Australasian Journal of Dermatology, 32, 39-44.
[7] Sharquie, K.E. and Hasson, S.M. (1991) Primary Cutaneous Amyloidosis in Iraqi Patients: Epidemiological, Clinical and Histopathological Study. Diploma Dissertation, University of Baghdad, Baghdad.
[8] Hidano, A., Mizuguchi, M. and Higaki, Y. (1984) Friction Melanosis. Annales de Dermatologie et de Venereologie, 111, 1063-1071.
[9] Sumitra, S. and Yesudian, P. (1993) Friction Amyloidosis: A Variant or an Etiological Factor in Amyloidosis Cutis. International Journal of Dermatology, 32, 422-423.
[10] Hashimato, K., Ito, K., Kumakiri, M. and Headington, J. (1987) Nylon Brush Macular Amyloidosis. Archives of Dermatology, 123, 633-637.
[11] Tan, T. (1990) Epidemiology of Primary Cutaneous Amyloidosis in Southeast Asia. Clinics in Dermatology, 22, 1082-1087.
[12] Black, M.M. and Jones, E.W. (1971) Macular Amyloidosis: A Study of 21 Cases with Special Reference to the Role of the Epidermis in Its Histogenesis. British Journal of Dermatology, 84, 199-209.
[13] Wong, C.K. and Lin, C.S. (1988) Friction Amyloidosis. International Journal of Dermatology, 27, 302-307.
[14] Anekohji, K., Maeda, K. and Shigemoto, K. (1983) A Peculiar Pigmentation of the Skin over Bony Regions. Rinsho Dermatol (Japanese Journal of Clinical Dermatology), 25, 1259-1262.
[15] Asai, Y., Hamada, T., Suzuki, N., Nakano, K., Tanii, T. and Izutani, K. (1983) Acquired Hyperpigmentation Distributed on the Skin over Bones. Japanese Journal of Dermatology, 93, 405-414.
[16] Tanigaki, T., Hata, S., Kitano, Y., Nomura, M., Sano, S. and Endo, H. (1985) Unusual Pigmentation on the Skin over Trunk Bones and Extremities. Dermatologica, 170, 235-239.
[17] Tanigaki, T., Hata, S., Kitano, Y., Sano, S., Nomura, M. and Satoh, K. (1985) Epidemiological Survey of Nylon Clothes Friction Dermatosis. Nihon Hifuka Gakkai Zasshi, 95, 1159-1164.
[18] Iwasaki, K., Mihara, M., Nishiura, S. and Shimao, S. (1991) Biphasic Amyloidosis Arising from Friction Melanosis. The Journal of Dermatology, 18, 86-91.
[19] Hata, S., Tanigaki, T. and Misaki, K. (1987) Incidence of Frictional Melanosis in Young Japanese Women Induced by Using Nylon Towels and Brushes. The Journal of Dermatology, 14, 437-439.
[20] Somani, V.K., Shailaja, H., Sita, V. and Fatima, R. (1995) Nylon Friction Dermatitis: A Distinct Subset of Macular Amyloidosis. Indian Journal of Dermatology, Venereology and Leprology, 61, 145-147.
[21] Probhakara, V.G., Chandra, S. and Krupa, D.S. (1997) Frictional Pigmentary Dermatoses: A Clinical and Histopathological Study of 27 Cases. Indian Journal of Dermatology, Venereology and Leprology, 63, 99-100.
[22] Siragusa, M., Cavallari, V. and Schepis, C. (2000) Macular Amyloidosis Due to Friction by a Horsehair Glove. Dermatology, 200, 82-83.
[23] Siragusa, M., Ferri, R., Cavallari, V. and Schepis, C. (2001) Friction Melanosis, Friction Amyloidosis, Macular Amyloidosis, Towel Melanosis: Many Names for the Same Clinical Entity. European Journal of Dermatology, 11, 545-548.
[24] Venkataram, M.N., Bhushnurmath, S.R., Muirhead, D.E. and Al-Suwaid, A.R. (2001) Frictional Amyloidosis: A Study of 10 Cases. Australasian Journal of Dermatology, 42, 176-179.
[25] Naimer, S.A., Trattner, A., Biton, A., Avinoach, I. and Vardy, D. (2000) Davener’s Dermatosis: A Variant of Friction Hypermelanosis. Journal of the American Academy of Dermatology, 42, 442-445.
[26] Macsween, R.M. and Salhan, E.M. (1997) Nylon Cloth Macular Amyloidosis. Clinical and Experimental Dermatology, 22, 28-31.
[27] Higgins, S.P., Freemark, M. and Prose, N.S. (2008) Acanthosis Nigricans: A Practical Approach to Evaluation and Management. Dermatology Online Journal, 14, 2.
[28] Sharquie, K.E., Al-Bayatti, A.A., Al-Zaidi, Q.M. and Al-Bahar, A.J. (2004) Acanthosis Nigricans as Skin Manifestation of Polycystic Ovarian Syndrome in Primary Infertile Female. Middle East Fertility Society Journal, 9, 136-139.
[29] Sharquie, K.E., Noaimi, A.A. and Muhammad Ali, A.H. (2008) Acanthosis Nigricans in Iraqi Patients Clinical, Histopathological and Theraputic Study. Thesis for Fellowship of Iraqi Board for Medical Specializations in Dermatology and Venereology.
[30] Garcia-Hidalgo, L., Orozco-Topete, R., Gonzalez-Barranco, J., Villa, A.R., Dalman, J.J. and Ortiz-Pedroza, G. (1999) Dermatoses in 165 Obese Adults. Obesity Research, 7, 299-302.
[31] Chang, M.W. (2008) Disorders of Hyperpigmentation. In: Bolognia, J., Jorizzo, J. and Rapini, R.P., Eds., Dermatology, 2nd Edition, Elsevier, Spain, 946-948.
[32] Bunker, C.B. and Neill, S.M. (2010) The Genital, Perianal and Umbilical Regions. In: Burns, T., Breathnach, S., Cox, N. and Griffiths, C., Eds., Chap. 71. Rook’s Text Book of Dermatology, 8th Edition, Blackwell Scientific Publication, Singapore City, 4-6.
[33] Costin, G.-E. and Hearing, V.J. (2007) Human Skin Pigmentation: Melanocytes Modulate Skin Color in Response to Stress. The FASEB Journal, 21, 976-994.
[34] Ortonne, J.P. and Nordlund, J.J. (2006) Mechanisms That Cause Abnormal Skin Color. In: Nordlund, J.J., Boissy, R.E., Hearing, V.J., King, R.A., Oetting, W.S. and Ortonne, J.P., Eds., Chap. 28. The Pigmentary System: Physiology and Pathophysiology, 2nd Edition, Blackwell Scientific Publication, New York, 521-535.
[35] Sharquie, K.E., Al-Rawi, J.R. and Al-Tamimi, F.F. (2005) The Frequency of Skin Disease in Obese Children and Adult Iraqi Population. Saudi Medical Journal, 26, 1835-1836.
[36] Cho, S.H., Park, J.M. and Kwon, O.Y. (2004) Gender Differences in Three Dimensional Gait Analysis Data from 98 Healthy Korean Adults. Clinical Biomechanics, 19, 145-152.
[37] Sharquie, K.E., Bayatti, A.A., Ajeel, A.I., Bahar, A.J. and Noaimi, A.A. (2007) Free Testosterone, Luteinizing Hormone/Follicle Stimulating Hormone Ratio and Pelvic Sonography in Relation to Skin Manifestations in Patients with Poly Cystic Ovary Syndrome. Saudi Medical Journal, 28, 1039-1043.
[38] Sharquie, K.E., Al-Dhalimi, M.A., Noaimi, A.A. and Al-Sultany, H.A. (2012) Lactic Acid as a New Therapeutic Peeling Agent in the Treatment of Lifa Disease (Frictional Dermal Melanosis). Indian Journal of Dermatology, 57, 444-448.

Copyright © 2023 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.