Current understanding of frictional dermatoses: A review.

Human skin is continually exposed to internal and external forces, dynamic as well as static. The skin is normally flexible and can resist mechanical trauma due to friction, pressure, vibration, suction and laceration to a considerable degree. However, an excess of these forces can abnormally affect the structure and function of the skin, setting the stage for the development of a skin disorder. Repetitive trauma can cause lichenification, hyperpigmentation, erythema, scaling, fissuring, blisters, ulceration and chronic alterations. Frictional dermatoses is an under-recognised entity with no clear-cut definition and encompasses a variety of terms such as frictional dermatitis, frictional melanosis, frictional pigmentary dermatoses and certain other named entities, many of which are confusing. The authors propose to define frictional dermatoses as 'a group of disorders caused by repetitive trauma to the skin as a result of friction of varied aetiology which can have a wide range of cutaneous manifestations depending on the type of insult.' The exact prevalence of frictional dermatoses as a separate entity is unknown. Authors who conducted this review include a group of dermatologists and post graduate students from various institutions. Literature was reviewed through PubMed, Medscape, Medline, ResearchGate and Google Scholar using the terms 'frictional dermatitis,' 'friction and skin,' 'dermatoses and culture,' 'clothing dermatitis,' 'friction melanosis,' 'PPE induced dermatoses in COVID-19 era,' etc. A total of 122 articles were reviewed and 100 articles among them were shortlisted and included in the study, after removing duplications. The review was followed up with further deliberation which resulted in the formulation of a new definition and classification of frictional dermatoses taking into account the morphology, histopathological characteristics, anatomical region affected and the major predisposing factors. The rising incidence of mechanical dermatoses in the COVID-19 era was also emphasised.

Crusted nipple and areola: A new aetiology of secondary hyperkeratosis of the nipple and areola.

Hyperkeratosis of the nipple and areola is a rare condition first described by Tauber in 1923. Less than 100 cases have been reported in the literature. Hyperkeratosis of the nipple and areola presents as hyperkeratotic, hyperpigmented plaques on the nipple and areola. It is more common in females. An 18-year-old female patient presented with hyperkeratotic, plaque-like, hard crusts on both nipples and areolas. The examining physician could successfully remove this crust using his finger. The crust had accumulated as a result of the patient's reluctance to touch or clean the breast area due to psychological issues. A crusted nipple and areola may occur as a secondary condition due to a patient's reluctance to touch or clean their breasts.

Clinical characteristics of acquired ungual fibrokeratoma.

BACKGROUND: Acquired ungual fibrokeratomas are uncommon fibrous tissue tumors located in the ungual area. Though there are many reports of this entity, only some reports have reviewed the clinical features of the tumor. AIMS: The aim of this study was to clarify the clinical characteristics of acquired ungual fibrokeratomas. METHODS: We reviewed twenty patients who were treated surgically at our clinic from 2003 to 2014 for acquired ungual fibrokeratomas confirmed on histopathological examination. Our study was conducted by retrospective analysis of charts, clinical pictures and patient records. Cases of tuberous sclerosis were not included. RESULTS: Acquired ungual fibrokeratomas occurred on toenails in 16 (80%) patients and on fingernails in 4 (20%) patients. Periungual lesions were noted in 15 (75%) patients followed by intraungual lesions in 4 (20%) patients and subungual lesions in 1 (5%) patient. A longitudinal groove was observed in 80% of patients. Surgical resection was performed in all cases for both medical and cosmetic reasons. After excision, recurrence occurred in three cases. LIMITATIONS: This was a retrospective study of a limited number of patients. CONCLUSIONS: Acquired ungual fibrokeratomas occurred more commonly on toenails than on fingernails and were located in the periungual area in most patients. A longitudinal groove in the nail plate was a frequent finding. Surgical resection led to medical and cosmetic improvement with a recurrence in 3 (15%) patients.