Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Brief Report
Case Report
Images/Instrument in Dermatology/Dermatosurgery
Letter to the Editor
Living Legends
Looking back in history
Original Article
Resident Forum
Residents Forum
Review Article
Spot the Diagnosis
Tropical Dermatology
Visual Treats in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor

Mangalasutra dermatitis-A cultural dermatosis in India

Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry-605006, India
Corresponding author: Arunachalam Narayanan Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry-605006, India
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Sivakumar A, Narayanan A, Spandana DK, Thappa DM. Mangalasutra dermatitis-A cultural dermatosis in India. Cosmoderma 2021;1:8.

Dear Sir,

Cultural dermatoses often occur in specific patterns. It gives a diagnostic clue to the possible site of contact of the allergen. Dermatologists must educate themselves about “cultural dermatology” and ask direct questions to the patients about the same.[1] We describe a patient with contact dermatitis due to mangalasutra and added components.

A 60-year-old female homemaker presented to us with pruritic pigmented skin lesions over the neck and chest for the past one year. The patient was wearing a plastic thread necklace with all the components of mangalasutra around the neck. The metallic ornaments and beads in the mangalasutra thread were extending up to the mid-chest. She stopped wearing them two months back due to pruritic skin lesions over the same area after consultation. She also gave a history of turmeric application over the thread and had stopped applying it recently because of pruritic skin lesions over the place. No other family member had similar complaints. On physical examination, multiple shiny lichenoid papules coalescing to form plaques with scaling and pigmentation were noted along the neck and the central chest (Figures 13). In the epigastric area, the lesions had become lichenified with the surrounding lichenoid papular eruption. The lesions were distributed along the area of contact of the chain. No other skin lesions were observed.

Figure 1:: Multiple lichenoid papules coalescing to form plaques present over the left neck linearly distributed in a well-defined manner along the thali thread.
Figure 2:: Multiple lichenoid papules coalescing to form plaques present over the left chest and left para-median intermammary area lying in close contact with knots of the thali thread.
Figure 3:: Well-defined lichenified plaque surrounded by multiple lichenoid papules present over the upper abdomen over areas in contact with the thali thread and metal ornaments.

We considered a clinical diagnosis of contact dermatitis to thali thread, turmeric, or metal. The patient underwent patch testing with Indian standard series patch testing with a set of allergens and the patient’s own materials (thread and turmeric). A piece of the thread was soaked in normal saline for 20 minutes and then patch tested using a Finn chamber. The readings were taken after 48 and 96 hours. The patient was found to be positive (1+) to thread. Indian Standard Series (ISS) allergens and turmeric didn’t show any reaction.

Thread has an important place in the various socio-religious practices in India. It is worn in the form of mangalasutra (thali thread) around the neck, the sacred janeu thread over the chest, drawstrings worn around the waist to secure the clothes, and araijan kayiru (worn by children around the waist). These cultural practices lead to various dermatoses due to contact sensitization, frictional forces, or occlusion. They can also aggravate pre-existing dermatoses such as dermatophyte infection, pressure leukoderma, frictional lichenoid dermatitis around waist (drawstring dermatitis), or lichen planus (due to koebnerisation).[2]

In India, the holy thread, referred to as the mangalasutra, is tied as a symbol of marriage around the bride’s neck during the wedding. Turmeric is applied over these threads during the wedding ritual. The thread can also have metallic ornaments. The thread, turmeric, or metallic ornament can contribute to the development of contact dermatitis.

These threads are usually made of natural fibers and are colored with azo dyes. However, the composition of these ceremonial threads can change with different cultures and places. In recent times, these threads are been synthesized using synthetic plastic materials, as seen in our patient. Azo and anthroquinone dyes and formaldehyde resins are some of the important causes of such thread dermatitis.[3] One of the challenges while dealing with such materials is that the manufacturers don’t label the dyes. In such cases, patch testing needs to be done using fabric, extracts, or textile series.[4]

Turmeric (Curcuma longa) is a yellow spice used in South India for its flavor and medicinal properties.[5] Curcumin is the main ingredient in turmeric. It is also present in other products such as kumkum, disinfectants, food coloring, milled spices, and cosmetic creams. Indian women smear turmeric over the mangalasutra regularly. Pigmented contact dermatitis can occur due to incomplete washing off of the turmeric from the thali thread.

As seen in our case, clinical suspicion of contact dermatitis to the thread should always be followed by a patch test. The unilateral distribution of the lesions noticed in our patient might be due to behavioral traits or clothing style (saree pallu). The dermatologist must be aware of thread dermatitis, its causative allergen, and issue appropriate allergen checklist for the same. The panel should include thread material per se, materials such as turmeric, which are smeared on it, and metal ornaments that are worn alongside the mangalasutra. More studies are needed on the chromatographic analysis of the thread for finding out novel allergens where the patch test series fails in identifying the appropriate substance.

Declaration of patient consent

Patient’s consent not required as patients identity is not disclosed or compromised.

Financial support and sponsorship


Conflicts of interest

Dr. Devinder Mohan Thappa is the Editor-In-Chief of this journal.


  1. , . Dermatoses due to Indian cultural practices. Indian J Dermatol. 2015;60:3-12.
    [CrossRef] [Google Scholar]
  2. , . Importance of cultural dermatology in India. Int J Dermatol. 2015;54:e237-39.
    [CrossRef] [Google Scholar]
  3. , , . Traditional threads tied on children in India trigger dermatitis and may contain carcinogens. Pediatr Dermatol. 2020;3:1068-72.
    [CrossRef] [Google Scholar]
  4. , , . Allergic contact dermatitis induced by textile necklace. Case Rep Dermatol. 2013;5:336-9.
    [CrossRef] [Google Scholar]
  5. , . Turmeric: A condiment, cosmetic and cure. Indian J Dermatol Venereol Leprol. 2018;84:16-21.
    [CrossRef] [Google Scholar]

Fulltext Views

PDF downloads
View/Download PDF
Download Citations
Show Sections