Indian Journal of Dermatology
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Year : 2007  |  Volume : 52  |  Issue : 4  |  Page : 192-193
Prevalence of macular amyloidosis in north Iran

Department of Dermatology, Fatemieh Hospital, Semnan University of Medical Sciences, Semnan, Iran

Correspondence Address:
Ramin Taheri
Department of Dermatology, Fatemieh Hospital, Semnan University of Medical Sciences, Semnan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5154.37724

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Macular amyloidosis is a relatively common cutaneous disease in Asia and the Middle East. It is characterized by a reticulated or rippled pattern of pigmentation mostly in the upper back. This study was performed not only to determine the disease, sex and age distribution but also to evaluate its risk factors and the frequency among the patients in the dermatology clinic. In this study, 100 macular amyloidosis patients were evaluated in a period of 4 years.
The sex ratio (female:male) of the patients was 9:1, and the mean age of the female patients was higher than that of the males. We found no evidence of any other associated risk factors.

Keywords: Macular amyloidosis, prevalence

How to cite this article:
Taheri R. Prevalence of macular amyloidosis in north Iran. Indian J Dermatol 2007;52:192-3

How to cite this URL:
Taheri R. Prevalence of macular amyloidosis in north Iran. Indian J Dermatol [serial online] 2007 [cited 2022 Aug 10];52:192-3. Available from:

   Introduction Top

In general, macular amyloidosis first appears around puberty with an equal sex ratio. [1],[2] Female predominance has been stated in some other references. [3],[4]

Its etiology is unknown, but many risk factors have been implicated, such as ultraviolet B (UVB), Epstein-Barr virus (EBV), race, genetic predisposition and atopy. [5] It is also known as frictional amyloidosis and is partially caused by the habit of vigorous rubbing of the skin with a nylon towel or brush. [6],[7],[8] Macular amyloidosis has also been reported in association with progressive systemic sclerosis, primary biliary cirrhosis, systemic lupus erythematosus, pachyonychia, multiple endocrine neoplasic type 2. [1],[2],[3],[4],[5],[6],[7]

Macular amyloidosis usually presents as small 2-3 mm grayish brown or brown pruritic (82%) or nonpruritic (18%) macules, which gradually join to form symmetric patches with a characteristic rippled pattern that most frequently involves the interscapular area and less frequently the upper arms, chest and thighs. [1],[2] Its diagnosis can be based on its clinical characteristic appearance or on the skin biopsy finding. [1],[2]

This study was carried out to evaluate and assess patients with macular amyloidosis with regards to sex ratio, age distribution, its frequency among dermatologic outpatient department patients and the role of probable risk factors.

   Materials and Methods Top

This study was carried out on 100 Iranian patients from the north-east of Iran with macular amyloidosis diagnosed on the basis of clinical findings, no previous history of inflammatory condition of the involved area, its spontaneous occurrence and slow progression, complete history and physical examination to find any associated systemic disorder or risk factors and histopathological examination of skin. Skin biopsy was performed on all patients who had clinical signs of disease. Specimens were then stained with Congo red and all of the histopathologic positive cases came to this study. The data obtained was statistically analyzed by using an independent "t"- test in SPSS software version 9. Values less than 0.05 were considered to be significant.

   Results Top

From the patients of our dermatology clinic outpatient department, who were evaluated during a 4-year period, based on the abovementioned criteria, 100 cases of macular amyloidosis were diagnosed, 85 patients were female and 15 were males. The patients aged between 16 and 76 years, with 75% being in the age range of 21-50 years. The mean age of the patients was 36.25 1.19 years (mean SE) - 36.9 1.22 years and 26.71 3.41 years for the female and male patients, respectively. There was a significant difference between the sex and age distribution of the male and female patients ( P = 0.027).

Back scratching during bathing is a routine practice in some countries. We found the history of occasional use of back scratchers, nylon towels or vigorous rubbing of the skin was positive in 15 patients (15%). We could not find any other positive risk factors or associated systemic diseases.

Ten percent of our patients had a family history of this disease in close relatives.

   Discussion Top

Macular amyloidosis is a chronic disease that may remain without visible changes for many years. This relatively common skin disease is more common among central and south Americans, people from the Middle East and Asians. [1],[2] The patients with macular amyloidosis comprised 0.55% of our dermatology clinic patients. In contrast to some previous reports with an almost equal sex ratio [1],[2],[9] and consistent with some other reports of female predominance, [3],[4] 85% of our patients were female.

Despite the most common age of the disease presentation being between 21 and 50 years, which is consistent with previous reports, there was a significant difference between the sex and age distribution of the patients. [1],[2],[9] Moreover, none of our patients had any history or clinical features of any associated systemic disorders, which is in contrast to the previous reports. [1],[2]

Eighty-five patients were females with complete Islamic dress code, and all our male patients were indoor workers; none of them had any history of sun or UVB exposure in contrast to previous reports, [1],[2] and this was consistent with the study of Eswaramoorthy et al. [5] It seems that there is no association between sun exposure and macular amyloidosis. The use of back scratchers and nylon towels has been mentioned as risk factors for macular amyloidosis. [6],[7],[8] This association also was not found to be true in our study, which again is consistent with the findings of Eswaramoorthy et al . [5]

Macular amyloidosis is comparatively more frequent among female patients of 21-50 years of age with very few associated physical risk factors or associated systemic disorders. In our opinion, further studies should be carried out to see the possible role of female sex hormones.

   References Top

1.Black MM, Gawkrodger DJ, Seymour CA, et al . Metabolic and nutritional disorders. In : Champion RH, Burton JL, Burns DA, et al. , editors. Textbook of Dermatology, 6 th ed. Oxford Scientific Publications: Oxford; 1998. p. 2627-30.  Back to cited text no. 1    
2.Breathnach SM. Amyloidosis of the skin. In : Freedberg IM, Eisen AZ, Wolff K, et al. , editors. Fitzpatrick's Dermatology in General Medicine, 5 th ed. McGraw Hill Inc: New York; 1999. p. 1760-3.  Back to cited text no. 2    
3.Hashimato K. Amyloidosis. In : Arndt KA, Leboit PE, Robinson JK, et al. , editors. Cutaneous Medicine and surgery, 1 st ed. W. B. Saunders Company: Philadelphia; 1996. p. 1822.  Back to cited text no. 3    
4.Braun-Falco O, Plewing G, Wolff HH, et al . Dermatology, 2 nd ed. Springer: Berlin; 2000. p. 1281.  Back to cited text no. 4    
5.Eswaramoorthy V, Kaur I, Das A, Kumar B. Macular amyloidosis: Etiological factors. J Dermatol 1999;26:305-10.  Back to cited text no. 5  [PUBMED]  
6.Hashimoto K, Ito k, Kumakiri M, Headington J. Nylon brush macular amylodosis. Arch Dermatol 1987;123:633-7.  Back to cited text no. 6  [PUBMED]  
7.Onuma L, Vega M, Arenas R, Dominguez L. Friction amyloidosis. Int J Dermatol 1994;33:74.  Back to cited text no. 7  [PUBMED]  
8.Venkataram MN, Bhushnurmath SR, Murihead DE. Frictional amyloidosis: A study of 10 cases. Australas J Dermatol 2001;42:176-9.  Back to cited text no. 8    
9.Finkel LJ, Headington JT. Cutaneous mucinosis and amyloidosis. In : Moschella SL, Hurley HJ, ed. Dermatology, 3 rd ed. W. B Saunders Company: Philadelphia; 1992. p. 1597-602.  Back to cited text no. 9    

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