Prayer marks.
BACKGROUND
Prayer marks (PMs) are asymptomatic, chronic skin changes that consist mainly of thickening, lichenification, and hyperpigmentation, and develop over a long period of time as a consequence of repeated, extended pressure on bony prominences during prayer.


METHODS
Three hundred and forty-nine Muslims and 24 non-Muslims were examined for the appearance of PMs at different body sites.


RESULTS
The prospective study of 349 Muslims (both males and females) with regular praying habits showed the occurrence of PMs on specific locations, such as the forehead, knees, ankles, and dorsa of the feet, leading to dermatologic changes consisting of lichenification and hyperpigmentation. The incidence of PMs was significantly higher in males than in females. Older subjects (over 50 years of age) demonstrated a significantly higher frequency of lichenification and hyperpigmentation, suggesting that repeated pressure and friction for prolonged periods are the causative factors for the development of PMs. Histologic examination of skin biopsies from the affected sites showed compact orthokeratosis, hypergranulosis, dermal papillary fibrosis, and dermal vascularization. PMs were not associated with any risk of secondary complications, such as erythema, bullous formation, and infections.


CONCLUSIONS
PMs are commonly occurring dermatologic changes in Muslims who pray for prolonged periods.
Abanmi
Abdullah A
AA
Dermatology Department, Research Center, Riyadh Al Kharj Armed Forces Hospital, PO Box 7897, Riyadh 11159, Saudi Arabia. abanamidr@yahoo.com
Al Zouman
Abdulrahman Y
AY
Al Hussaini
Husa
H
Al-Asmari
Abdulrahman
A
D000328:Adult; D005260:Female; D005528:Foot / Q000473:pathology; D005546:Forehead / Q000473:pathology; D006801:Humans; D017495:Hyperpigmentation / Q000208:ethnology* / Q000209:etiology / Q000473:pathology*; D007514:Islam; D007717:Knee / Q000473:pathology; D017512:Lichenoid Eruptions / Q000208:ethnology* / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000208:ethnology* / Q000209:etiology / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors