Black Palmar Macules

Black heel, talon noir or calcaneal petechiae?

“…Similarly, black palms have been described as hyperpigmented macules or punctate haemorrhages on the thenar aspect of the palms in sportsmen who apply pressure to their hands, such as gymnasts, golfers, weightlifters, racket sports players, and mountain climbers. Another two cases have been reported after a self‐inflicted hammer blow, 2 and following excessive manual activity 6 . More recently, the so‐called ‘playstation thumb’ has been reported in video game players, in whom excessive playing action induced pain, blisters and haemorrhages on the thumbs 7 …”

“…A well‐known condition produced by trauma and characterized by hyperpigmented macular lesions over the lateral keratotic border(s) of the heel(s), which sometimes have a linear arrangement, has been accurately called calcaneal petechiae, black heel, or talon noir, 1 terms that have become generally accepted because of their descriptive accuracy and clear meaning. However, reports 2–7 of similar lesions that sometimes did not coincide with this location or pattern have led to a multiplicity of names for the same process (Table 1), due to the presence of haemoglobin within a thickened stratum corneum 1 . Some of these names denote the traumatic origin of the lesion, or the causal sport, others include in the definition its haemorrhagic nature, still others differentiate it when occurring on the hands.…”

PlayStation® purpura

“…Subcorneal haematoma is produced by extreme shearing forces leading to rupture of the papillary dermal capillaries, with subsequent erythrocyte extravasation into the papillary dermis and stratum corneum 6 . On histopathology, extravasated erythrocytes and amorphous eosinophilic material are particularly obvious around the sweat duct openings 12 . This observation helps to correlate the dermoscopic findings of both ‘pebbles on the ridges’ and the parallel ridge pattern in these lesions.…”