Occupational marks

A 36-year-male coconut tree climber presented with asymptomatic hyperpigmentation and thickening over the bilateral dorsum of the foot. There is no history of itching or oozing. These lesions have been present for the past 15 years, resulting from using a belt over the ankle for climbing coconut trees. On examination, skin over the dorsum of both feet was hyperpigmented and lichenified [Figure 1]. Bilateral palms and soles showed diffuse thickening of the palms with focal yellowish callosities and loss of dermatoglyphic markings [Figure 2]. Based on the history and clinical examination, a diagnosis of occupational marks secondary to friction was made, and the patient was counseled about this.

Close

Figure 1:

Hyperpigmented and lichenified plaques over the dorsum of both feet.

Export to PPT

Close

Figure 2:

Palms showing diffuse thickening with focal callosities and loss of dermatoglyphics.

Export to PPT

Occupational marks are due to the effect of a particular occupation on the worker’s skin. Coconut tree climbing is common in southern Indian states such as Tamil Nadu, Kerala, and Karnataka. Gripping the tree with the belt over the ankle and shoulder and then pushing up the body to climb higher results in intermittent pressure over the ankle and palms. In response to friction, there is a steady rate of increase in epidermal turnover and laying down of thickened, vertically oriented collagen bundles in the papillary dermis, resulting in lichenification.^[1] Occupational marks such as lichenification and hyperpigmentation over the forearms, legs, and dorsum of the foot, thickening of palms and soles, callosities, and nail damage can be seen in coconut tree climbers. Our case highlights the severe degree to which the skin can adapt in response to frictional forces in this unique occupation.