Knuckle pads from boxing

European Journal of Dermatology. Volume 8, Number 5, 359-61, July - August 1998, Cas cliniques

Author(s) : Lasse KANERVA, Section of Dermatology, Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FIN 00250 Hel-sinki, Finland..

Summary : A 21-year-old man developed painful hyperkeratotic, fissured, callosities on his knuckles (“knuckle pads”) after having boxed for five evenings a week for six months. Boxer’s knuckle pads are one type of traumatic skin injury regularly found in athletes, such as “jogger’s toe”, “athelete’s nodule”, “jog-ger’s nipple”, “runner’s rump”, “runner’s bump”, “rower’s rump”, “tennis toe”, “skier ’s shin”, “surfer’s nodule” “black heel”, “black palm”, “jazz ballet bottom” and “stria distensae”. These types of traumatic skin injuries are briefly reviewed here.

Keywords : knuckle pads, boxing, occupational marks, hand dermatitis, friction, mechanical trauma, callosities.)

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ARTICLE

Callosities may develop on any area of skin which is subjected to repetitive trauma, pressure or friction [1], and may be distinctive, occupational marks of various professions, trades or hobbies [2-3]. Professional and hobby sports may result in a great number of traumatic skin injuries (Table I), including fibromatous nodules overlying the finger joints (knuckle pads).

Case report

A 21-year old man underwent skin prick testings in order to be evaluated for possible atopy and to identify the cause of his rhinitis. During reading of the prick test reactions, it was noticed that the patient had on both hands hyperkeratotic, fissured callosities on most of his proximal and interphalangeal joints as well as on some of his metacarpophalangeal joints (Fig. 1, "knuckle pads"). He informed us that they had developed after six months of boxing, which was his hobby. During training he used boxing gloves. He was not involved in top-level competitive boxing but practised boxing for five evenings a week. His main problem was that the knuckle pads fissured from continuous mechanical trauma. Accordingly, they were also painful.

Discussion

Our patient's knuckle pads can be considered "occupational marks", which represent the effects of a particular occupation on a worker's skin [2, 3]. These are usually calluses or corns that develop in locations subjected to repeated friction, pressure, or other trauma, and include discolorations, telangiectases, tattoos, odors, deformities, and other changes. In some occupations, the marks may be quite variable, e.g., in musicians [4]. Similarly, many types of marks have been reported from sports activities (Table I) [3, 5-11]. In earlier times, such marks were common among workers and served to identify many occupations [2]. Knuckle callosities have been reported in many occupations, such as laundry bag carriers, paper hangers, gardeners, polishers, leather buffers and stackers, school teachers, card players, sheep shearers, carpet layers, tailors, plasterers, egg packers, bakers, cleaners, marble players and live-chicken hangers [2, 3, 12]. Today, with increasing automation, less frequent manual operation of tools, better protective clothing, and a shorter working week, occupational marks have become less frequent. They have almost disappeared from many industries, but can probably still be found in less industrialized countries. Occupational marks must be distinguished from so-called, pseudo-occupational marks, such as familial knuckle pads [13], knuckle biting, nail biting, cuticle pulling, and trichotillomania. Our patient had no special predisposing diseases. Boxer's "knuckle pads" although probably very common are seldom reported in the literature, although they are mentioned in Fitzpatrick and coworkers'textbook [8].

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