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Case Reports
. 2025 May 31;17(5):e85161.
doi: 10.7759/cureus.85161. eCollection 2025 May.

A Unique Acquired Athletic Dermatologic Condition in a Half Marathon Participant: An Autobiographical Case Report of Sports-Associated Clothing Related Axillary Tangled Clumped Hairs (SCRATCH)

Philip R Cohen  1   2   3
Affiliations
Case Reports

A Unique Acquired Athletic Dermatologic Condition in a Half Marathon Participant: An Autobiographical Case Report of Sports-Associated Clothing Related Axillary Tangled Clumped Hairs (SCRATCH)

Philip R Cohen. Cureus. .

Abstract

Runners are susceptible to developing sports-related disorders. A 66-year-old man developed a unique cutaneous condition affecting his armpits while participating in a 13.1-mile race. Friction from the shirt he was wearing resulted in the development of sports-associated clothing related axillary tangled clumped hairs (SCRATCH). Removal of the hairs that had become tangled and clumped resulted in temporary localized patches of alopecia. The incidence of SCRATCH remains to be established. The condition results from the seams of the shirt rubbing against the axillary hairs and creating a mass of tangled and clumped hairs that are painful when the runner moves their arms. Removal of the hair masses can result in focal areas of alopecia in the affected axillae; subsequently, the tractional alopecia created by the hair removal resolves. SCRATCH does not occur in individuals who regularly shave their axillary hairs. The condition can be prevented by shaving or cutting the axillary hairs prior to running, possibly by applying a salve to the axillary hairs so that they do not adhere to the shirt, or by wearing shirts that do not rub against the axillae. A comprehensive summary of sports-associated dermatologic conditions in runners is presented. In conclusion, individuals who participate in ambulatory activities are susceptible to many dermatologic conditions related to their sport and SCRATCH can be added to the list of potential cutaneous disorders that can occur in runners.

Keywords: acquired; axilla; clothes; clumped; hair; running; scratch; sports; tangled; walking.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Sports-associated clothing related axillary tangled clumped hairs (SCRATCH)
Distant (A) and closer (B and C) views of the left axilla of a 66-year-old man who completed a 13.1-mile race wearing a long-sleeved shirt. Some of the axillary hairs (black arrows) are either tangled in a linear morphology or clumped in a matted presentation.
Figure 2
Figure 2. Tangled and clumped axillary hairs after removal
Distant (A) and closer (B and C) views of the sports-associated clothing related axillary tangled clumped hairs (SCRATCH) following removal of the altered hairs. The clothing rubbed against the axillary hairs; however, threads from the shirt are not observed in either the linearly tangled hairs ranging from six to 12 millimeters in length (black arrows) or the clumped matted hairs ranging from two to five millimeters in diameter (orange arrows).
Figure 3
Figure 3. The long-sleeved shirt that the man was wearing during the race
The external view (A) and the internal view (B) of the blue, 100 percent cotton, shirt that the man was wearing during the half marathon; the white ovals surround the portions of the shirt that rubbed against the axillae. On the internal view (B) of the shirt, frayed strands of material extending from the seams (within the white ovals), can be seen in the axillary regions.
Figure 4
Figure 4. Focal patches of traction alopecia that resulted from the removal of the sports-associated clothing related axillary tangled clumped hairs (SCRATCH)
Distant (A) and closer (B and C) views of the left axilla after removal of SCRATCH. There are focal patches of alopecia (areas within the black circles), where the altered hairs had been located, after the brisk removal of the tangled and clumped axillary hairs by pulling them from the skin.
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