Frictional sweat dermatitis

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.

A study of pattern and assessment of life quality index in patients of nonvenereal dermatoses of external genitalia at a tertiary care center

Background

Nonvenereal dermatoses (NVD) are the spectrum of disorders involving the genitalia with varied etiology and having a considerable influence on the health-related quality of life (QOL), but it remains under evaluated.

Objective

To study the prevalence, pattern, and the effect of nonvenereal genital dermatoses on the QOL of patients with the help of dermatological life quality index (DLQI) questionnaire.

Materials and Methods

This was a cross-sectional study conducted for a period of 1 year. A total of 132 patients were included in the study. QOL was assessed by using the DLQI questionnaire.

Results

The prevalence was found to be 10.2/1000 cases in our study. Genital scabies (34.8%) was the common dermatoses followed by vitiligo (18.9%) and lichen simplex chronicus (8.3%). These dermatoses were having moderate effect on the DLQI of majority (52.3%) of the patients and its having very large effect on DLQI in 20.5% of patients. Mean DLQI scores were high among the age group of 41-70 years, male sex and in patients who had <1 month duration of the dermatoses. Regarding individual dermatoses, infestation (scabies) was having higher mean DLQI scores and it was statistically significant.

Conclusion

This study depicts that NVD are having impact on the QOL and its mainly attributed to the site of dermatoses and also due to the symptoms. Proper counseling about the nature of these disorders and prompt treatment were important, thereby improving the QOL of such patients.

'Occupational dermatoses from Personal Protective Equipment during the COVID-19 pandemic in the tropics - A Review'

The COVID-19 pandemic has enveloped the world and there has been a high incidence of occupational dermatoses related to Personal Protective Equipment (PPE) amongst healthcare workers (HCWs) during this period. Prevention and management of these conditions will not only improve staff morale and quality of life, but will also minimize the risk of breaching PPE protocol due to such symptoms. The tropical climate in Singapore predisposes HCWs to more skin damage and pruritus due to intense heat, high humidity and sun exposure. The effects of friction, occlusion, hyperhidrosis and overheating on the skin in the tropics should not be neglected. Preventive measures can be taken based on our recommendations, and the working environment can be made more conducive for frontline HCWs. We review the literature and discuss various preventive and management strategies for these occupational skin diseases for our frontline HCWs, especially those working in less controlled working environments beyond the hospital in Singapore. Shorter shifts and frequent breaks from PPE are recommended. Duration of continuous PPE-usage should not exceed 6 h, with breaks in non-contaminated areas every 2-3 h to hydrate and mitigate the risk of skin reactions. Other strategies, such as teledermatology, should be considered so that consultations can remain accessible, while ensuring the safety and well-being of our clinical staff.

Atypical Presentation of Sweat Dermatitis with Review of Literature

Sweat dermatitis is a peculiar kind of irritant inflammatory dermatoses occurring due to prolonged exposure of retained sweat over the skin. It is commonly seen in hot and dry climates like tropics during summer months due to thermal stress. Typically, parchment paper or cellophane paper like scaling is seen over occluded areas of back, shoulder, and other areas. Here we have reported a varied presentation of sweat dermatitis in the form of its coexistence with miliaria rubra (impending to thermal burn). Further we have also observed co existing pityriasis versicolor and sweat dermatitis where the former has prevented the development of latter. Till date there is very little discussion on this condition, so we have tried to provide a concise review about sweat dermatitis along with its classical to atypical presentation with special emphasis on dermoscopy.

A cross-sectional study of sweat-induced dermatitis during a South Indian summer: a glimpse of sweat gland-mediated cutaneous inflammation

BACKGROUND

The role of sweat gland in inflammation has not received sufficient attention. The thermal stress during the summer months in tropical areas provides an opportunity to study the morphological patterns of inflammation produced primarily by the sweat gland.

AIM

To collect clinical data on sweat-induced dermatitis during the summer months.

METHODS

A hospital-based descriptive cross-sectional study was done during the hot and humid summer months of April to June in a tertiary care institute in Puducherry. Patients clinically diagnosed with sweat-induced dermatitis (dermatitis primarily due to retention or extravasation of sweat) were included in the study. A detailed history was taken, and clinical examination was done.

RESULTS

One hundred and fifty patients were included in the study. Various typical and atypical manifestations of sweat-induced dermatitis were seen. "Sweat dermatitis" presenting with dry, hyperpigmented, fissured "parchment"-like skin, shiny "crinkled cellophane paper"-like skin, or asymptomatic hyperpigmented macules was seen. Other atypical presentations included miliaria pustulosa with "hypopyon sign" and "linear and parallel ridge pattern" of dermatitis in patients with miliaria rubra affecting the lower neck and upper chest.

CONCLUSION

A wide spectrum of sweat-induced dermatitis was seen during the summer months in a tropical region. It reflects the role of the sweat gland in cutaneous inflammation. An increased awareness of atypical manifestations is needed.

A study of pattern of nonvenereal genital dermatoses of male attending skin OPD at a tertiary care center

BACKGROUND

Nonvenereal dermatoses tend to create confusion from venereal dermatoses. This may be responsible for considerable concern to the patient as well as may cause diagnostic dilemma to the physicians. Nonvenereal dermatoses may not be restricted to genitalia alone; it may affect skin and mucous membrane also. Most of the patients with genital lesions had apprehension of suffering from some venereal disorders.

AIM

The aim was to determine clinical and epidemiological pattern of nonvenereal dermatoses of male external genitalia.

MATERIALS AND METHODS

This was a descriptive study of 100 consecutive adult male patients with nonvenereal genital dermatoses attending skin and STD OPD at J A Group of Hospitals, Gwalior. Cases having any venereal dermatoses were excluded from this study.

RESULTS

The study included 100 male patients with nonvenereal genital lesions. A total of sixteen nonvenereal genital dermatoses were noted. The most common nonvenereal genital dermatoses were vitiligo (18%), pearly penile papule (16%), fixed drug eruptions (12%), scabies (10%), scrotal dermatitis (9%) and lichen planus (9%). Other dermatoses included sebaceous cyst, psoriasis, lichen sclerosus, plasma cell balanitis or Zoon's balanitis, granuloma annulare, lichen nitidus, lymphangioma circumscriptum, papulo-necrotic tuberculid, squamous cell carcinoma and tinea infections. The age ranged from 18 years to 65 years with majority in the age group of 21-30 years (40%).

CONCLUSION

This study highlights the importance of diagnosing common nonvenereal genital dermatoses. It also helps in avoiding the general misconception that all genital lesions are sexually transmitted.

Physical friction is under-recognized as an irritant that can cause or contribute to contact dermatitis

BACKGROUND

The role of physical friction as an irritant in the causation of contact dermatitis is under-recognized. Frictional dermatitis is defined as an eczematous process in which physical frictional trauma contributes to the induction of a dermatitis process.

OBJECTIVES

To examine the clinical background of patients in whom friction was contributing to dermatitis.

METHODS

Over a 30-month period during which 2700 new patients were seen, frictional irritancy was identified as playing a role in the dermatosis in 31 cases: in 27 of these, case notes were evaluated for a range of parameters.

RESULTS

Physical friction was identified as causing or contributing to the dermatitis in 18 men and nine women, mean age at onset 42 years. The hands, usually the fingers of the dominant hand, were affected in all but two cases. Occupational frictional activities were found in 25 cases: commonly handling small metal components, paper, cardboard or fabric, and driving. Potential frictional activities in hobbies were noted in 12 cases. Wet work irritancy contributed in four cases (15%). Patch testing showed relevant contact allergies as cofactors in seven of 25 subjects tested (26%). Psoriasis was a cofactor in four (15%), and atopic dermatitis in 11. The study was selective, being based in a teaching hospital clinic with a special interest in contact dermatitis. Frictional irritancy is often one of several factors contributing to dermatitis.

CONCLUSIONS

The contribution of friction to contact dermatitis is under-recognized probably because dermatologists do not think about the potential for physical forces to induce eczematous changes in the skin.