Friction melanosis: a clinical, histologic, and ultrastructural study in Jordanian patients

Int J Dermatol. 2004 Apr;43(4):261-4. doi: 10.1111/j.1365-4632.2004.01606.x.


Background: Friction melanosis (FM) is an acquired pigmentary disorder mainly affecting young people. The primary skin regions affected are located over the osseous prominences, especially the clavicular zone and upper back. Our purpose in this study was to report the clinical spectrum, histologic findings, and ultrastructural features of FM in Jordanian patients.

Methods: Thirteen patients with FM (10 women and three men) were studied. The patients were seen at Princess Basma Teaching Hospital in north Jordan between 1999 and 2001.

Results: Eleven patients presented with asymptomatic, diffuse, brownish patches and two presented with mottled patches on the skin over the trunk bones and limbs. All had a history of rubbing their skin repeatedly with scrub pads (loofah) or bathroom towels. Ten of the 13 cases were studied histologically. Skin biopsies from four patients were examined ultrastructurally. Both histologic and electron microscopic examination of the biopsies from our patients showed a marked increase in melanin and melanin incontinence, with a lack of amyloid in the upper dermis.

Conclusions: FM is infrequently seen in north Jordan. We believe that repeated frictional trauma from clothing or scrub pads against the skin overlying the bony protuberances is fundamental in its pathogenesis. Other factors, such as scrub pads made of rough material (loofah), dark skin type, and individual variability, may also play a role in the pathogenesis. We advise patients not to use rough scrub pads during bathing, to avoid rubbing the skin overlying the bony prominences, to avoid rubbing vigorously, and to use a soft cotton pad instead.

MeSH terms

  • Administration, Topical
  • Adolescent
  • Adult
  • Baths
  • Female
  • Friction
  • Humans
  • Hydroquinones / therapeutic use
  • Jordan
  • Keratolytic Agents / therapeutic use
  • Luffa / adverse effects
  • Male
  • Melanosis / drug therapy
  • Melanosis / etiology*
  • Melanosis / pathology*
  • Microscopy, Electron


  • Hydroquinones
  • Keratolytic Agents