Extending Prayer Marks as a Sign of Worsening Chronic Disease

Abstract

A 60-year old Muslim man was admitted to the Dhaka Hospital of ICDDR,B with an exacerbation of his chronic obstructive pulmonary disease. Incidental hyperpigmented skin lesions were noticed overlying the dorsum of his ankles, knees, and elbows. Such asymptomatic areas of thickened, lichenified and hyperpigmented skin are called ‘prayer marks’ and are well-imprinted on the knees, ankles, and forehead. These are secondary to prolonged periods of pressure over bony prominences during prayer. The patient's wife stated that the appearance of the elbow marks had coincided with an increase in his breathlessness and subsequent use of his elbows to rise from daily prayers. Prayer marks extending to the elbows could be a sign of worsening chronic disease.

Prayer-marks Heralding Acute Coronary Syndrome

“…We read, with interest, the case report on extension of prayer-marks by Cangiano et al and its association with worsening of the underlying chronic disease (1). We report a case where the occurrence of a similar skin lesion preceded an episode of acute coronary syndrome.…”

Pitfall prayer marks: Recognition and appropriate treatment: A case report and review of literature

“…In Muslims, the location of prayer marks varies depending on the four praying postures «Waquf» (standing), «Ruku» (bowing), «Sajda» (prostration), and «Julus» (sitting; Figure 1a,b). These marks can be located on the head (zebibah zabība, «raisin», «Prayer's bump»), the knees, or dorsa of the feet (talar callosity, «Prayer foot» as in our case)-especially the left foot attributed to a typical praying position (Abanmi et (Cangiano, Chisti, Pietroni, & Smith, 2011;Çarlı, Cömerto glu, & Turgut, 2016;Monk & Lowenstein, 2014;Papadakis et al, 2016;Sharma, Sharma, & Aggarwal, 2011). As shown in our case whose prayer marks have been mistaken for "drug eruptions" they may not be recognized by physicians unaware of the origin of this kind of skin changes.…”

“…For example, shortness of breath due to chronic obstructive airway disease may result in an altered praying position with prominent prayer marks on the elbows (Cangiano et al, 2011). Conversely, the fading of a callus may indicate an underlying disease that disrupts praying habits (Mishriki, 1999).…”

“…These marks can be located on the head (zebibah zabība, «raisin», «Prayer's bump»), the knees, or dorsa of the feet (talar callosity, «Prayer foot» as in our case)-especially the left foot attributed to a typical praying position (Abanmi et al, 2002;Monk & Lowenstein, 2014;Orenay & Sarifakioglu, 2015;Saif & Woywodt, 2009). Usually, prayer marks are insignificant and painless callosities, however, they have been reported to indicate the worsening of an underlying chronic disease such as diabetes mellitus, chronic obstructive pulmonary disease or myositis ossificans (Cangiano, Chisti, Pietroni, & Smith, 2011;Çarlı, Cömerto glu, & Turgut, 2016;Monk & Lowenstein, 2014;Papadakis et al, 2016;Sharma, Sharma, & Aggarwal, 2011). As shown in our case whose prayer marks have been mistaken for "drug eruptions" they may not be recognized by physicians unaware of the origin of this kind of skin changes.…”

Prayer Mark on the Forehead: Hyperpigmentation

“…The resulting prayer marks are mainly distributed on the forehead, elbows, knees, and ankles ( Fig. 1A ) 3 . In one reported case, the mark was on the nasal bridge 4 .…”