1. Frictional Dermatoses in Sportspersons
Jogger’s nipple
17
Cracked & painful nipple
Bleeding±
Nipple
Long distance runners
Continuous friction from cotton type T shirts
Pool palm
21
Recurrent painful, bilateral erythematous patches.
Finger pads, palms and soles
Swimmers
Rower’s hand
20,
48
Erythematous patch or blisters
Fingers, back of hand
Rowers
Athlete’s nodule
17,
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 noir
17,
50Black heel, calcaneal bleed/petechiae
Blue black, linear to oval macule
Posterior or posterolateral aspect of heel
Basketball & tennis players, gymnasts
Skater’s toe/ nail
23
Toe tip callus, nail thickening or SUH
Toe tip or toenail
Skaters, Runners, ice hockey players
Skater’s nodule
23,
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 pad
23
Callus like hyperkeratosis. Superficial than skater’s nodule.
Heels
Skaters
Skater’s bite
23,
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 papule
23,
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 dermatitis
6
Appears as discoid eczema.
Inner ankle, lower knee
Baseball players with endogenous eczema
Tyloma
48
Uniform thickening of skin. Pain & bleeding if fissures develop
Pressure bearing areas of foot, palms and fingers.
Athletes
Pump bump
23
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 kendo
24
Asymptomatic hyperkeratotic to eczematous lesion seen a kendo player (a Japanese sport)
Palmoplantar area
Kendo
2. Frictional Dermatoses in Sportspersons
Corns and Calluses
25 [
Figure 4]
Yellow-white hyperkeratotic callosities
Pressure bearing areas
Protective response to constant mechanical stimuli
Friction Blisters
63
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 neck
56
Eythematous, hyperpigmented, lichenified lesion
Angle of the mandible
Friction at the site where the violin contacts the chin
Clarinetists cheilitis
57
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 callosity
28
Skin colored or hyperpigmented hyperkeratotic plaque
Mid portion of the lip
Repetitively irritated because of intense contact with parts of the instrument
Flautist’s Chin
58
Scaly, erythematous plaques
Chin
Friction, pressure and moisture Sweat and saliva at the site of contact ACD to nickel, chromium
b. Trunk
Cellist’s chest
59
Presents with xiphoid discomfort and hyperpigmented erythematous plaques
Lower end of the sternum at the xiphoid process
-
c. Limbs
Drummer’s digits
12
Yellow-white hyperkeratotic callosities
Lateral aspect of the left index finger
-
Guitarist’s fingers/harpists fingers
59,
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 Pad
12,
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 bump
29
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 thumb
29,
61
Well defined, tender calluses
Medial aspect of the thumb
Excess phone gripping, occasionally
Frictional dermatitis due to computer mouse/ mouse fingers
62
Sharply demarcated lesions with erythema and scaling.
Palmar aspect of first and fifth fingertips
Constant rubbing while using a mouse
Mousing callus
30,
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 melanosis
31
Deep dark brown pigmentation
Bony prominences of the face
Aggressive rubbing of the face with hand or handkerchief
b. Trunk
Lifa disease
33
Deep dark brown pigmentation
Clavicles, shins, upper back and lateral aspect of the arms
Repeated rubbing by lifa (brush for washing)
Orphan Rocker Tracks
34
Frictional dermatosis resembling train tracks
Bony prominences of the lumbosacral spine
Children with autistic behaviour, habitual of rocking movements
Frictional dermatoses due to car seat
35
Linear hyperpigmented patches
Bony prominences on the back
Prolonged periods of sitting and driving
c. Limbs
Frictional asymptomatic darkening of extensor surfaces
36,
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 thighs
37
Asymptomatic darkening.
Inner thighs
Frictional stress -rubbing of thighs; obese females
B. Clothing related
a. Generalised
Nylon cloth frictional dermatoses
38
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 socks
7
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 drawstrings
39
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 Nodules
18 [
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 Blisters
41
Frictional blister
One or both knees
Repeated kneeling on pews in church
Davener’s dermatitis
32
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 sign
42
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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