Authors’ reply

We would like to thank you our readers¹ for taking an interest in our article² and providing your suggestions. As previously outlined, no single definition exists for frictional dermatosis and therefore currently there is no accepted classification encompassing the wide range of conditions that can be categorized under this entity.

We have reviewed the literature on skin disorders that “primarily” arise due to frictional abuse and have devised a classification to club them together to enable a simple clinical approach for a therapeutic solution.

A detailed literature review was made via PubMed, Medscape, Medline, ResearchGate and Google Scholar using the terms “frictional dermatitis,” “friction and skin,” “dermatoses and culture,” “clothing dermatitis,” “friction melanosis,” “PPE induced dermatoses in COVID-19 era,” etc. A total of 122 articles were reviewed and 100 articles among them were shortlisted and included in the study.

Though the definition of frictional dermatoses may overlap, we have included the dermatoses caused by frictional forces in daily activities, habits, rituals and cultural practices as such.

The category “secondary frictional dermatosis” includes entities where friction plays a contributory role in the pathogenesis; however, its presence alone is not sufficient for the development of the lesion. Infection, sweat or other inciting agents and/or a pre-existing dermatosis are prerequisites for the development of these conditions.

Psychodermatoses would be another perspective or could be included as a separate classification. The article references are very old and have largely been re-classified into impulse control disorders or dermatitis artefacta (chewing pads). Trichoteiromania and russell pads of bulimia are other entities which may be included in this spectrum.

As elucidated clearly by the authors themselves, the self-inflicted conditions that they have mentioned are related to obsessive compulsive disorder as a primary cause representing the impossibility to release emotional tension by other means and appearing in situations of stress, anxiety, insecurity or nervousness. These compulsive acts are performed to release feelings of anxiety which become alleviated with those frictional actions; however, friction itself is not the inciting factor as is the case with “primary” frictional dermatosis.