Talon Noir - Submitted on: Tuesday September, 10, 2002

Contributed by:Aaron Caplan, MD, N/A

Talon Noir, originally called “Calcaneal petechiae”, was first described in 1961 as a “highly characteristic traumatic petechial eruption of the heels” peculiar to basketball players (1). Since this initial description, talon noir has enjoyed many names including the aforementioned calcaneal petechiae, black heel (3), post-traumatic punctate hemorrhage of the skin (2), plantar pseudochromhidrosis (2), keratosis hemorrhagica (3), and basketball heels (6).

Definition: Talon noir is an asymptomatic, trauma-related petechial lesion found primarily on acral sites that histologically is characterized by blood within the stratum corneum (4).

Clinical Features: The lesions may consist of multiple punctate petechiae or a coalescence of petechiae forming what may appear to be a darkly pigmented macule. They are often bilateral (1), and although characteristically found on the heel, may be found on any acral surface (2). The lesions are traumatic in origin, and likely are due to tangential force applied to the skin as may be encountered during a game of basketball, with the hard running, quick stops, and pivoting. These lesions have reportedly been identified following other types of sports including football and tennis (4), and following pedestrian mishaps like striking one’s finger with a hammer (2).

Histology: Figures (Click on an image for a larger view) Figure 1: Figure 2 The histologic features of talon noir are characteristically limited to the stratum corneum where homogeneous rounded masses of red-brown material is sequestered (3,4). The material does not stain positively with iron stains such as Prussian blue. However, the material, which consists of lysed red blood cells, does stain positively with Benzidine, a stain specific for hemoglobin (3). Occasionally, extravasated red blood cells can be found in the dermal papillae, where the transepidermal elimination of the blood begins.

Treatment: These harmless lesions disappear spontaneously. No treatment is required

Bibliography: 1 Crissey JT, Peachey JC: Calcaneal petechiae. Arch Derm 83: 501, 1961. 2 Levit F, Blankenship ML : Posttraumatic punctate hemorrhage of the skin: a better name than black heel. Arch Derm 105:759, 1972. 3 Hafner J, Haenseler E, et al: Benzidine stain for the histochemical detection of hemoglobin in splinter hemorrhage (subungual hematoma) and black heel. Am J Dermatopathol 17:362-7, 1995. 4 Elder D, Elensitas R, Jaworsky C, et al., in: Lever’s Histopathology of the Skin, 8th Edition. Philadelphia, Lippincott-Raven, 1997, p315. 5 Crowson AN, Magro CM, Mihm MC, in: The Melanocytic Proliferations: A Comprehensive Textbook of Pigmented Lesions. New York, Wiley-Liss, 2001, p307. 6 Fromer JL (eds): Talon noir. Arch Derm 104: 452, 1971.

 

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