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Modern Electronic Devices: An Increasingly Common Cause of Skin Disorders in Consumers
Corazza, Monica MD; Minghetti, Sara MD; Bertoldi, Alberto Maria MD; Martina, Emanuela MD; Virgili, Annarosa MD; Borghi, Alessandro MD
Vol. 27 - Issue 3: p 82–89
From the *Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università di Ferrara; and †Dermatological Clinic, Department of Clinical and Molecular Medicine, Polytechnic University of Marche, Torrette, Ancona, Italy.
Address reprint requests to Monica Corazza, MD, Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università di Ferrara, Via Savonarola 9, 44121 Ferrara, Italy. E-mail: firstname.lastname@example.org.
The authors have no funding or conflicts of interest to declare.
The modern conveniences and enjoyment brought about by electronic devices bring with them some health concerns. In particular, personal electronic devices are responsible for rising cases of several skin disorders, including pressure, friction, contact dermatitis, and other physical dermatitis. The universal use of such devices, either for work or recreational purposes, will probably increase the occurrence of polymorphous skin manifestations over time. It is important for clinicians to consider electronics as potential sources of dermatological ailments, for proper patient management. We performed a literature review on skin disorders associated with the personal use of modern technology, including personal computers and laptops, personal computer accessories, mobile phones, tablets, video games, and consoles.
With increasing use at work, home, and school, modern technology is increasingly involved in several dermatological conditions. These skin manifestations will probably increase over time with the use and pervasive popularity of electronic devices. Early recognition of the offending agent and its removal usually allow effective management.
We performed a literature review on cutaneous manifestations associated with the personal use of modern technology, including personal computers (PCs) and laptops, PC accessories, mobile phones, tablets, video games, and consoles.
A comprehensive search for articles in the PubMed database was conducted. Bibliographies of all included studies were also reviewed to find additional studies not included in previous research.
The key words used were as follows: dermatitis, electronic devices, modern technology, contact dermatitis, cutaneous manifestations, PlayStation, PCs and laptops, PC-accessories (such as mouse and mouse pad, keyboard, and keyboard pad), mobile phones, tablets, video games, and console. We included all types of articles.
Search results were categorized as follows: (1) video games; (2) PC, laptop, and computer accessories; and (3) mobile phones and tablets. For each category, we summarized the dermatological conditions related to the use of the device (Table 1).
Video Games–Related Dermatoses
Intensive video gaming has been associated with the occurrence of various cutaneous conditions arising from repeated trauma to the skin caused by the continuous use of video game controllers or by abnormal positions.5 A recent survey has found that the average time spent playing video games in a sitting position is increasing59; this aspect is linked to conditions that are not really dermatological such as deep vein thrombosis and increased risk of thromboembolism.
Over the last few years, the release of a video game console with a motion sensitive control system (Nintendo Wii) has caused a new spectrum of video games–related pathology, not linked to immobility but to strong physical activity, especially in untrained or unfit people.
PlayStation thumb is a repetitive strain injury, usually observed in children and young people, caused by continuous playing of PlayStation games. Repetitive strain injuries are conditions affecting the arms and hands due to repeated movements that damage tendons, nerves, muscles, and other soft body tissues.60 Several jobs, sport activities, and the playing of musical instruments can lead to this kind of injury as well.
The first case of PlayStation thumb, described in 2004,61 has been followed by other case reports and case series.1,60,62
Typically, PlayStation thumb manifests as pain and blisters located exactly on the site of recurrent pressure and friction with the controller of PlayStation, particularly on the thumbs and on the tips of the thumb, even though the involvement of other fingers, sometimes with nail alterations such as onycholysis, has also been reported.1,2 Other possible associated symptoms include pain, stiffness, swelling, numbness, and tingling of the hands, wrists, elbows, shoulders, back, or neck. Dermoscopy on PlayStation thumb shows typical hyperkeratosis and punctate hemorrhages.62 More recently, a parallel-ridge pattern with “pebbles” on the ridges, observed on dermoscopy, has lead some authors to suggest the probably more appropriate term of “PlayStation fingertip” to describe this condition.2
PlayStation Palmar Hidradenitis
To date, only 1 case of PlayStation palmar hidradenitis has been described in literature in a 12-year-old girl.3 It was an acute, painful hand dermatitis characterized, on physical examination, by erythematous, firm and highly tender nodules on the palmar surfaces of the hands. The lesions appeared after she had started to play with a new video game on the PlayStation for several hours a day. The diagnosis of palmar eccrine hidradenitis was confirmed by histopathological examination showing neutrophilic infiltration of the eccrine sweat glands in the absence of infectious agents.3
Frictional Hyperkeratosis (Callus)
The term knuckle pad refers to a fibrous hyperkeratotic plaque, usually round in shape, due to repetitive trauma. The first and only report of a knuckle pad induced by intensive video gaming was described in 2006 by Rushing et al.4 They reported a single fibrotic lesion localized on the right second distal interphalangeal joint of a 13-year-old adolescent boy previously treated for a wart without improvement. Biopsy revealed hyperkeratosis, acanthosis, and increased vascularity and fibroblasts. This thickening of the skin was provoked both by anchoring the video game controller and by video gaming several hours a day. In children, knuckle pads can be idiopathic, inherited in association with an autosomal dominant disorder, but more frequently lesions can be acquired by repetitive actions that traumatize the skin. While the classical causes of knuckle pad are cracking or picking or chewing fingers,4 playing video games may be an additional modern cause.
Contact dermatitis (CD) caused by the use of video game controllers is uncommon and probably underreported.
A possible case of hand eczema caused by a video game controller (Sony PlayStation One) was described in a 34-year-old female1; for work-related reasons, she spent several hours a day playing with a Sony PlayStation One controller in her hands. Patch testing revealed positive reactions for nickel (+++) and cobalt (++). As the manufacturer did not provide the composition of the controller and chemical analysis of the scratched material from the controller was not performed, the diagnosis of allergic CD caused by a metallic part of the video game controller is not incontestable. However, a prompt resolution of the palmar eczema was observed when she stopped the contact with the electronic device. Certainly, the local environment, such as moist and warm conditions as well as sweating of the hands, may accelerate the occurrence of CD, especially by intensifying the penetration of allergens into the skin.
In patients with a history of atopic dermatitis and intensive video gaming, the development of hand allergic CD should be suspected in the case of worsening of their eczema or loss of responsiveness to therapy. Nickel contained in a central “silver” button of the Xbox controller, positive tested by dimethylgloxime (DMG spot test), was the cause of atopic dermatitis exacerbation due to a superimposed allergic CD in a 9-year-old atopic boy.63
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