Current understanding of frictional dermatoses: A review

1. Frictional Dermatoses in Sportspersons Jogger’s nipple17 Cracked & painful nipple
Bleeding± Nipple Long distance runners
Continuous friction from cotton type T shirts Pool palm21 Recurrent painful, bilateral erythematous patches. Finger pads, palms and soles Swimmers Rower’s hand20,48 Erythematous patch or blisters Fingers, back of hand Rowers Athlete’s nodule17,49
(Skater’s nodules, collagenomas, ‘Nike nodule’ in runners, ‘knuckle pad’ in boxers) Soft skin coloured painful/ painless keratinised nodule. Lateral malleoli, lateral sides of feet, overlying the Achilles tendon Skaters, runners, boxers Talon noir17,50
Black heel, calcaneal bleed/petechiae Blue black, linear to oval macule Posterior or posterolateral aspect of heel Basketball & tennis players, gymnasts Skater’s toe/ nail23 Toe tip callus, nail thickening or SUH Toe tip or toenail Skaters, Runners, ice hockey players Skater’s nodule23,49
(Double ankle bones) Collagenoma which presents with hyperkeratotic, smooth surface nodules Lateral malleoli, lateral sides of feet or skin overlying Achilles tendon Skaters Skater's pad23 Callus like hyperkeratosis. Superficial than skater’s nodule. Heels Skaters Skater’s bite23,51,52 Pain and swelling, radiating pain from lower leg towards toe Dorsum of foot or near the tongue of the skate Skaters, ice hockey players Malleolar bursitis 23,53 Intermittent painful S/C mass. Superimposed infection may occur Tip of malleolus. Medial malleolus most common. Skaters Piezogenic pedal papule23,54,55
[Figure 3] Asymptomatic papule may be painful Medial or lateral aspect of heels (visualised better in standing position) Common in skaters, runners & weightlifters with underlying connective tissue disease, rheumatic heart diseases Baseball pitcher’s friction dermatitis6 Appears as discoid eczema. Inner ankle, lower knee Baseball players with endogenous eczema Tyloma48 Uniform thickening of skin. Pain & bleeding if fissures develop Pressure bearing areas of foot, palms and fingers. Athletes Pump bump23 Painful and inflamed bumps insertion of Achilles tendon Skaters with:
High arched foot
Tight Achilles tendons or
Walking on outer aspects of heels Hyperkeratosis and frictional dermatitis due to practicing kendo24 Asymptomatic hyperkeratotic to eczematous lesion seen a kendo player (a Japanese sport) Palmoplantar area Kendo 2. Frictional Dermatoses in Sportspersons Corns and Calluses25 [Figure 4] Yellow-white hyperkeratotic callosities Pressure bearing areas Protective response to constant mechanical stimuli Friction Blisters63 Blisters Palms and soles Constant stamping action of the feet; shearing force between skin and external surface; separation of epidermis at the level of the stratum corneum. 3. Frictional Dermatoses in Musicians a. Head and Neck Fiddler’s neck56 Eythematous, hyperpigmented, lichenified lesion Angle of the mandible Friction at the site where the violin contacts the chin Clarinetists cheilitis57 Presents with erythema, scaling and lichenification Fissuring, atrophy and depigmentation may also be seen. Median part of the vermilion border of the lower lip, chin Due to the continuous friction, pressure and saliva which collects under lower lip. It is an irritant dermatitis in the area where the wooden reed comes in contact with the skin Lip callosity28 Skin colored or hyperpigmented hyperkeratotic plaque Mid portion of the lip Repetitively irritated because of intense contact with parts of the instrument Flautist’s Chin58 Scaly, erythematous plaques Chin Friction, pressure and moisture Sweat and saliva at the site of contact ACD to nickel, chromium b. Trunk Cellist’s chest59 Presents with xiphoid discomfort and hyperpigmented erythematous plaques Lower end of the sternum at the xiphoid process - c. Limbs Drummer’s digits12 Yellow-white hyperkeratotic callosities Lateral aspect of the left index finger - Guitarist’s fingers/harpists fingers59,60 [Figure 5] Paronychia, blisters, calluses Onycholysis, SUH Sides and tips of the fingers Harpist who is just starting is most prone to injury as calluses have not yet developed Garrod’s fingers/Violinist’s Pad12,59 Thickening of the skin and underlying tissues Backs of IP joints of the index, middle fingers of left hand Force is applied to the strings while playing, calluses protective mechanism Frictional Dermatoses in Writers and Computer users Writer’s bump29 Well circumscribed yellow-white plaque. Slight tenderness on pressure Lateral aspect of DIP of the middle finger of dominant hand Constant pressure of tightly gripped pencils and pens while writing Cell thumb/ Playstation thumb29,61 Well defined, tender calluses Medial aspect of the thumb Excess phone gripping, occasionally Frictional dermatitis due to computer mouse/ mouse fingers62 Sharply demarcated lesions with erythema and scaling. Palmar aspect of first and fifth fingertips Constant rubbing while using a mouse Mousing callus30,63 Painless, yellowish, thickened callus Palmar aspect of the wrist Friction and pressure, on the one hand, prolonged use of computer mouse A. Frictional Melanosis a. Face Facial frictional melanosis31 Deep dark brown pigmentation Bony prominences of the face Aggressive rubbing of the face with hand or handkerchief b. Trunk Lifa disease33 Deep dark brown pigmentation Clavicles, shins, upper back and lateral aspect of the arms Repeated rubbing by lifa (brush for washing) Orphan Rocker Tracks34 Frictional dermatosis resembling train tracks Bony prominences of the lumbosacral spine Children with autistic behaviour, habitual of rocking movements Frictional dermatoses due to car seat35 Linear hyperpigmented patches Bony prominences on the back Prolonged periods of sitting and driving c. Limbs Frictional asymptomatic darkening of extensor surfaces36,64 Asymptomatic darkening overlying sites of friction, ‘sign of dirty knees and elbows.’ Extensor surfaces of elbows and knees Increased frictional rubbing Frictional melanosis of inner thighs37 Asymptomatic darkening. Inner thighs Frictional stress -rubbing of thighs; obese females B. Clothing related a. Generalised Nylon cloth frictional dermatoses38 Dark brown pigmentation Bony prominences: clavicle, back, shoulders, ribs, spinous processes, extensors (limbs) Reported in Japan -practice of rubbing body with wet or dry nylon cloth or scrub brushes b. Limbs Frictional dermatoses due to socks7 Dark brown pigmentation Just below the knees or above the ankles up to mid-calf. Repeated wearing of tight socks/knee length boots c. Trunk Dermatoses due to sari, petticoat, salwar drawstrings39 Post inflammatory hyperpigmentation or hypopigmentation Waist Sari, petticoat/salwar tied to the waist via a drawstring, pressure and friction and formation of an artificial groove C. Religious Practices/ Praying related a. Face and Limbs Prayer Nodules18 [Figure 6] Nodules or calluses Forehead, Knees, ankles and dorsa of feet. Squatting position -knees and ankles held against the floor, weight on the lower legs during prayers; touching forehead on the ground during prayer by Muslims. Pew Blisters41 Frictional blister One or both knees Repeated kneeling on pews in church Davener’s dermatitis32 Hyperpigmented ill-defined areas Lower spinous processes Exclusively in Jewish Israeli Yeshiva students, constant rocking of the upper body sitting on a firm wooden or metal chair with a rigid backrest during praying Yoga sign42 Hyperkeratotic, circumscribed, hyperpigmented plaques Patients suffering of neuropathy may ulceration of the callosities Outer ankles and fifth toes The characteristic Yoga sitting position on plain and hard floor exerts mechanical stress, that is, repeated and prolonged pressure and sheer forces
Yoga sign is also seen in people who sit ‘cross legged’

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