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Butterfly-shaped area of hypopigmentation on the back
    Differential Diagnosis[Top] [Nav]
pruritus and scratching in all other skin areas
    Discussion -- not available online[Top] [Nav]
    Update Comments[Top] [Nav]
  • This paper describes hyperpigmentation over the spine, ribs, and other protruding bones, but not in the center of the back. It is thought that mechanical trauma from nylon towels and scrub brushes, which became popular in Japan in the 1980s, are responsible for the pigmentation. Users of these products initially experienced a tingling pain, but eventually became accustomed to it in their quest "to make the skin lustrous, smooth, and to appear healthy," as advertisements proclaimed. [102]
  • Mentions, in passing, notalgia paraesthetica, which is a persistent itching in the center of the back. [103]
  • "Factitious lesions do not appear between the scapulae." [104]
    Footnotes in Print Edition[Top] [Nav]
    (1) The "butterfly" sign in patients with chronic jaundice and pruritus.
  Reynolds TB.   Ann Intern Med 1973 Apr;78(4):545-6.  Pubmed  Similars
    (2) The 'butterfly' sign. A clue to generalized pruritus in a patient with chronic obstructive hepatobiliary disease.
  Goldman RD, Rea TH, et al.   Arch Dermatol 1983 Feb;119(2):183-4.  Pubmed  Similars
    New References[Top] [Nav]
    101.The "butterfly" sign in patients with primary biliary cirrhosis [letter].
  Venencie PY, Cuny M, et al.   J Am Acad Dermatol 1988 Sep;19(3):571-2.  Pubmed  Similars
    102.Unusual pigmentation on the skin over trunk bones and extremities.
  Tanigaki T, Hata S, et al.   Dermatologica 1985;170(5):235-9.  Pubmed+Abstract  Similars
    103.Pathophysiology of itching [see comments].
  Greaves MW, Wall PD.   Lancet 1996 Oct 5;348(9032):938-40.  Pubmed+Abstract  Similars
    104.A Little Book of Doctors' Rules.
  Meador CK. Philadelphia: Hanley & Belfus, 1992: 215.   Amazon.com
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    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:33 PDT on July 4, 2000.[Top]

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