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Case Report Volume 15 Issue 1
Prayer nodules: a case report highlighting the importance of thorough history-taking
Rachel K Holbrook,
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Karan Pandher, Natalie H Matthews
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Department of Dermatology, Henry Ford Health, USA
Correspondence: Rachel K Holbrook, Department of Dermatology, Henry Ford Health, 3031 W Grand Blvd Detroit, MI, USA
Received: March 27, 2025 | Published: April 21, 2025
Citation: Holbrook RK, Pandher K, Matthews NH. Prayer nodules: a case report highlighting the importance of thorough history-taking. MOJ Clin Med Case Rep. 2025;15(1):12-13. DOI: 10.15406/mojcr.2025.15.00477
Abstract
Prayer (or athlete’s) nodules are hyperplastic, flesh-colored dermal masses that arise after repetitive trauma to an area, commonly occurring with prayer rituals or sports-related activities such as boxing. These nodules can appear worrisome and may prompt testing for malignancy if a detailed history is not gathered. We present a case of a prayer’s nodule to demonstrate the importance of thorough social history-taking and adjusting treatment plans to align with the patient's best interest while also addressing their concerns.
Introduction
Prayer (or athlete’s) nodules arise from repetitive trauma to an area of the body, often due to continuous friction from prayer rituals or sports-related activities. We report a case of a prayer nodule arising on the foot resulting from frequent prayer rituals.
Case presentation
A 60-year-old South Asian Muslim male with a past medical history of diabetes mellitus, gastric disorder, and hypercholesterolemia presented to the outpatient dermatology office for evaluation of a chronic, mildly painful, left foot nodule. The nodule slowly increased in size over the past five years and was moderately painful upon palpation. He prays several times a day and prefers to sit on the left proximal lateral dorsal foot while praying.
On physical exam, there was a hyperkeratotic, hyper pigmented, and slightly eroded nodule approximately 1.5 cm in size on the left lateral dorsal foot. High-resolution sonographic imaging of the area demonstrated an anechoic, ovoid mass measuring 1.8 x 0.7 x 1.5 cm with thick walls and without internal hyperemia. The mass directly overlies peroneal tendons. The patient was recommended to have a contrast-enhanced MRI for further evaluation, but he was unable to follow up with MRI testing.
The patient was counseled to use pressure-relieving cushioning and to reposition sitting to distribute pressure more evenly on his foot. He was also recommended to use keratolytics, specifically urea cream 40%, under occlusion. After several months of pressure-relieving measures, the patient noticed mild symptomatic improvement, allowing the patient to continue utilizing his preferred method of prayer, which was his main priority. Since residual pain remained, a punch biopsy was recommended to rule out malignancy, but the patient declined.
Discussion
Prayer or athletes’ nodules (collagenomas) are minimally symptomatic to asymptomatic, hyperplastic, flesh-colored masses. Prayer nodules arise from epidermal thickening resulting from repetitive, frictional trauma due to activities such as yoga or praying.1–3 These nodules often occur on the forehead, hands, feet, and knees.4–6 The incidence is often higher in males and adults over 50 years of age.7 Differential diagnoses include lipoma, simple ganglion cyst, gout, epidermoid cyst, hypertrophic scar, callus, and elastoma.8 Some prayer nodules may bleed if the patient has vascular disease or neuropathy.1
A thorough history can aid in diagnosis, as in our case. If a punch biopsy is obtained, the histopathology will reveal hyperkeratosis, acanthosis, hypergranulosis, and dermal vascularization.2,7 Other than behavioral modification, such as the use of protective socks or prayer rugs, treatment is not necessary unless the nodule is bothersome to the patient.6 Treatment consists of surgical or laser removal, urea cream or salicylic acid, or intralesional steroids.4,6
Conclusion
This case outlines the importance of thorough history-taking in patients who present with suspicious subcutaneous nodules. It also emphasizes the significance of inquiring about patients’ daily activities to help determine the etiology of a nodule. Identifying prayer nodules as a source of collagenoma development can help avoid unnecessary workup and incorrect diagnoses of nodules, leading to improved patient outcomes (Figure 1).
Figure 1 Hyperkeratotic, hyper pigmented, and slightly eroded nodule on the left proximal lateral dorsal foot.
Funding
None.
Conflicts of interest
The authors declare they have no conflicts of interest.
References
- Fosse N, Rast AC, Kammermann A, et al. Pitfall prayer marks: recognition and appropriate treatment: a case report and review of literature. Dermatol Ther. 2020;33(1):e13176.
- Dejonckheere G, Daoud M, White JM. Raised lesions on the ankles. 2023;383:e074383.
- Gupta D, Thappa DM. Dermatoses due to indian cultural practices. Indian J Dermatol. 2015; 60(1):3–12.
- Carr PC, Cropley TG. Sports dermatology: skin disease in athletes. Clinics in Sports Medicine. 2019; 38(4): 597–618.
- Kahana M, Cohen M, Ronnen M, et al. Prayer nodules in Moslem men. 1986;38(4):281–282.
- Habib ur Rehman, Asfour NA. Prayer nodules. Canadian Medical Association Journal. 2010;182(1):E19.
- Abanmi AA, Al Zouman AY, Hussaini HA, et al. Prayer marks. Int J Dermatol. 2002;41(7):411–414.
- Adams BB. Dermatologic disorders of the athlete. Sports Med. 2002;32:309–321.
©2025 Holbrook, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.