Prayer nodules

The faithful male Shi'ite muslim sometimes develops nodules on his forehead as a result of repeated pressure where he touches his prayer stone. Age and actinic damage may also be factors in the development of the lesions. The histology of the nodules showed hyperkeratosis and thinning of the epidermis with multiple comedones and epidermoid cysts, some of which connected with the overlying epidermis.     

Prayer nodules

Prayer nodules have been reported to occur on the foreheads of elderly male and female Muslims (Vollum & Azadeh, 1979; Monk, 1982), but have not been reported to occur elsewhere. We would like to report the occurrence of a prayer nodule on the dorsal aspect of a foot, which from our experience is another common site.     

Prayer nodules in Moslem men

Seven cases of Israeli Moslem men with hyperkeratotic nodular callosities of the legs and forehead are reported. These patients were randomly encountered over a two-year period in our dermatology clinic. The nodules were attributed to repeated trauma to the legs and forehead sustained during Moslem prayer. This article familiarizes the clinician with the morphologic characteristics of these lesions, which may occur in some Moslem men.     

Laser therapy of stretch marks

Striae distensae, better known as stretch marks, are a common disfiguring skin disorder of significant cosmetic concern. Many sources have reported the use of lasers to diminish the appearance of striae. Controlled clinical studies of the various treatment modalities available for striae are relatively uncommon, and much of the clinical data are anecdotal. The use of lasers alone or in combination with other therapeutic modalities can provide a safe and effective reduction in the appearance of both red and white striae distensae. Many of these therapies require special measures for darker skin phototypes. This article reviews the historical use of laser therapy for this disorder and discusses current therapeutic options.     

Some observations on the direction of scratch marks

This study consists of two parts. In the first we recorded 1696 scratch marks seen on 69 pruritic patients. The scratch marks followed a consistent pattern on the skin, which was independent of the cause of the itching. The most striking feature was a longitudinal alignment on the limbs. Next we tried to relate our findings to experimental work that suggests that itching is extinguished most effectively by counterstimuli applied within the same dermatomal segment. If this is the case, sufferers from itchy skin diseases might be expected to scratch itchy points on their skin using strokes directed along dermatomal lines, thereby gaining maximal relief. We used the data obtained during the first part of our study to test this possibility. Fifty-one percent of the scratch marks analyzed ran at an angle of less than 20 degrees to the nearest interdermatomal line (significantly higher than the 22.5% expected by chance). However the tendency for scratch marks to run along dermatomal lines was confined to the limbs. In addition, the preferred scratch directions of a group of nonitchy subjects, not driven by the need to alleviate actual itching, coincided closely with the pattern of scratch marks seen on the itchy patients. The direction of scratch marks may therefore be determined as much by mechanical factors affecting the ease of scratching as by the distribution of dermatomes.     

Stretch marks during pregnancy: a review of topical prevention

Striae gravidarum (SG), or stretch marks developing during pregnancy, affect up to 90% of women. While not medically dangerous, SG can be disfiguring, causing emotional and psychological distress. However, studies specifically addressing the prevention of SG, especially during pregnancy, are sparse. Furthermore, the molecular pathogenesis of SG is unclear and may differ from that of striae from other causes. Considering these factors, we review topical modalities that have been used specifically for preventing SG during pregnancy. We identify two major strategies (end points) addressed by these modalities, namely (i) preventing the de novo development of SG and (ii) reducing the severity of SG that have recently developed. We also identify risk factors for the development of SG and suggest that pregnant women with these risk factors are an appropriate target population for prevention. In reviewing the literature, we find that there is limited evidence that centella, and possibly massage with bitter almond oil, may prevent SG and/or reduce their severity. There is weak evidence that hyaluronic acid prevents SG. Tretinoin holds promise for reducing the severity of new‐onset SG, but its use is limited by its pregnancy category. Finally, cocoa butter and olive oil are not effective for preventing SG or reducing the severity of lesions. We conclude that reliable methods for preventing SG are scarce. Furthermore, available topical modalities generally lack strong evidence from rigorous, well‐designed, randomized controlled trials with ample numbers of subjects. Thus, further research is necessary to elucidate SG pathogenesis, which may lead to effective prevention modalities.